Mitral Stenosis
Description
The mitral valve separates the upper and lower chambers on the left side of the heart (left atrium and left ventricle). The valve opens allowing blood to flow from the left atrium to the left ventricle and then closes preventing blood from flowing backward. In mitral stenosis the opening becomes narrowed restricting the blood flow. The main cause of mitral stenosis is rheumatic fever as a child. Other causes include congenital heart defects and rarely a tumor can obstruct the blood flow. Severe stenosis can cause: heart failure, enlargement of the heart and atrial fibrillation.
Symptoms
Symptoms may develop gradually and include: chest pain, cough, difficulty breathing, fatigue, frequent respiratory infections such as bronchitis, heart racing, palpitations, swelling of the feet, breathing problems laying flat (orthopnea).
Tests
A history and physical exam will be done. The provider can sometimes hear an abnormal heart sound called a murmur. Diagnosis is confirmed with an echocardiogram, transesophageal echocardiogram (TEE), MRI and/or coronary angiography.
- Cardiac catheterization
- Echocardiogram
- EKG
- Transesophageal echocardiogram
Treatment
Therapy depends on the symptoms being experienced and damage being done to the heart and lungs. Those with mild symptoms may be observed. Treatment includes: medications to help improve the heart function, catheter repair of the heart valve (percutaneous mitral balloon valvuloplasty), and surgical replacement of the valve. Artificial heart valves are made from tissue or metal. Metal valves last longer but require life long blood thinners such as warfarin/Coumadin. Tissue valves are made from pig, bovine or human cadaver tissue and do not require blood thinner medications but do not last as long and many times have to be replaced. Medications that may be used include diuretics, vasodilators and antiarrythmics if there is an abnormal heart rhythm such as atrial fibrillation. Antibiotics may be prescribed to prevent infection of the valve before dental work, gastrointestinal procedures, and urinary tract procedures.
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