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Mitral Stenosis

What is mitral stenosis?

Mitral stenosis is a condition where the mitral valve in your heart is narrow. The mitral valve is between the left ventricle and left atrium of your heart. The lower left ventricle pumps blood into your upper left atrium. The valve opens and closes to direct blood flow through your heart. When the mitral valve is narrowed, blood flow through your heart may decrease. Your tissues and other organs will not have enough oxygen and nutrients to function properly.

What causes mitral stenosis?

  • Rheumatic fever: This is fever and inflammation of your joints. It can develop after you have a strep throat infection. Rheumatic fever can cause inflammation and damage to your mitral valve. The walls of your mitral valve may narrow, and may even join together.

  • Congenital heart defect: Some people are born with a damaged mitral valve that leads to narrowing and blockage.

  • Calcium buildup: As you age, calcium can build up on the mitral valve walls. The calcium stiffens and thickens the valve.

  • Medical conditions: Tumors, an infection, or an autoimmune disease may cause mitral stenosis. An autoimmune disease is when your body attacks itself instead of an illness or disease.

What are the signs and symptoms of mitral stenosis?

  • Severe tiredness

  • Shortness of breath during activity or when you lie down

  • Swollen feet or ankles

  • Fast, jumpy, or fluttery heartbeat

  • Coughing up bloody mucus

  • Trouble swallowing and a hoarse voice

How is mitral stenosis diagnosed?

Your healthcare provider will ask about your signs and symptoms and listen to your heart. He will ask if you have ever had strep throat or rheumatic fever. You may need any of the following tests:

  • EKG: This test records the electrical activity of your heart. It is used to check for an abnormal heart rhythm caused by mitral stenosis.

  • Chest x-ray: This is used to check the size of your heart and to look for fluid around your heart and lungs.

  • An echocardiogram is a type of ultrasound. Sound waves are used to show the structure and function of your heart.

  • Transesophageal echocardiogram: This test is also called a TEE. It may be done if your heart cannot be seen well during a regular echo. A TEE will show blood clots or a heart infection. You will be given medicine to relax you during a TEE. Healthcare providers will put a tube in your mouth that is moved down into your esophagus. The tube has a small ultrasound sensor on the end. Since your esophagus is right next to your heart, your healthcare provider can see your heart clearly.

  • Cardiac catheterization: This procedure is done to find and treat heart blockages. A thin, bendable tube is inserted into your arm, neck, or groin and moved into your heart. An x-ray may be used to guide the tube to the right place. Dye may be put into your vein so the pictures show up better on a monitor. Tell the healthcare provider if you have ever had an allergic reaction to contrast dye.

How is mitral stenosis treated?

  • Medicines: You may need the following medicines to improve your symptoms or prevent problems caused by mitral stenosis:

    • Antibiotics: This medicine will help fight or prevent an infection. You may need it if you had rheumatic fever in the past so you do not get it again. You may need to take the medicine every day, or once a month.

    • Heart medicine: This medicine is given to slow your heart rate and help your heart fill with blood. This will help your heart pump blood to your body more efficiently.

    • Diuretics: This medicine is given to remove extra fluid that has collected in your heart, lungs, or legs. They are often called water pills. You may urinate more often when you take this medicine.

    • Blood thinners: This medicine helps prevent clots from forming in the blood. Clots can cause strokes, heart attacks, and death. Blood thinners make it more likely for you to bleed or bruise. Use an electric razor and soft toothbrush to help prevent bleeding.

  • Procedures:

    • Valvotomy: This helps widen your mitral valve and allow blood to flow through easier. A catheter (long thin tube) with a balloon on the tip is inserted through a small skin incision in your arm or groin. The catheter is guided through a blood vessel, and into your left atrium near your mitral valve. When the balloon is inflated, it stretches the valve opening.

    • Valvuloplasty: Healthcare providers make an incision in your chest to repair and widen your mitral valve. The valve walls are separated or calcium buildup is removed. This helps improve the blood flow through your heart.

    • Replacement: Healthcare providers make an incision in your chest to replace your damaged mitral valve. Part or all of your mitral valve is removed and a new valve is secured in place. You may get a new valve from a donor (another person or animal), or you may get an artificial valve. When you have an artificial valve, you may need to take antibiotic medicine when you have medical procedures. This includes before and after dental work or surgery. The antibiotic medicine will help prevent germs from causing an infection in your heart.

What are the risks of mitral stenosis?

  • Your mitral valve may narrow again, even after treatment. Tissues, other heart valves, and nearby areas may get damaged during surgery. You may bleed more than expected. After surgery, you may get an infection. The sac that surrounds your heart and its large blood vessels may swell. The swelling may cause fluid to collect around your heart, making it hard for your heart to beat. The valves may stop working well and blood may flow back into the upper chamber of your heart.

  • You may get a blood clot in your leg or arm. This can cause pain and swelling, and it can stop blood from flowing where it needs to go in your body. The blood clot may break loose and travel to your lungs or brain. A blood clot in your lungs can cause chest pain and trouble breathing. A blood clot in your brain can cause a stroke. These problems can be life-threatening.

  • Without treatment, your symptoms, such as shortness of breath and fatigue may get worse. Blood and fluid may build up in your lungs, and your heart or lungs may begin to fail. You may get an infection in your heart. Mitral stenosis may cause abnormal heartbeats, which increase the risk of blood clots forming in your heart. You may have a stroke. If you are pregnant, mitral stenosis may cause health problems for you and your unborn baby. Your symptoms may get worse. These problems can be life-threatening.

How can I manage my symptoms?

  • Eat a variety of healthy foods: Healthy foods include fruits, vegetables, whole-grain breads, low-fat dairy products, beans, lean meats, and fish. Decrease the amount of salt and caffeine you eat or drink. Ask if you need to be on a special diet.

  • Exercise: This will improve your heart health. Ask your healthcare provider about the best exercise plan for you. Start slowly and increase activity as you get stronger. Stop if you feel short of breath.

  • Maintain a healthy weight: Ask your healthcare provider how much you should weigh. Ask him to help you create a weight loss plan if you are overweight.

When should I contact my healthcare provider?

  • You are bleeding from your nose or gums.

  • The veins in your neck look swollen or are bulging.

  • You have a fever.

  • You have blood in your urine or bowel movements.

  • You have questions or concerns about your condition or care.

When should I seek immediate care or call 911?

  • Your arm or leg feels warm, tender, and painful. It may look swollen and red.

  • Your heart is beating faster than normal for you, and you feel fluttering in your chest.

  • You suddenly feel lightheaded and short of breath.

  • You have chest pain that feels like squeezing, pressure, or fullness.

  • You have chest pain that lasts for more than a few minutes or returns.

  • You are nauseated and have trouble breathing.

  • You have a severe headache, a cold sweat, and feel lightheaded or dizzy.

  • You have weakness or numbness in one arm or leg, or on one side of your face.

  • You are confused and cannot speak clearly.

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment. The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

© 2014 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

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