Mitral Stenosis

What is mitral stenosis?

• Mitral stenosis is a disease that leads to narrowing of the mitral valve in your heart. Your heart has four chambers (spaces), including two upper atria and two lower ventricles. There are valves (doors) with leaflets (flaps) between the chambers. The valves open and close to direct blood flow through your heart. The mitral valve is found between the left atrium and left ventricle. The left atrium receives blood with oxygen from your lungs. The blood passes through the mitral valve into your left ventricle, and is pumped out to your body.
  
  
• Mitral stenosis happens when the leaflets of your mitral valve get thicker and stiffer. This makes the valve opening smaller making it harder for blood to move into the left ventricle. The narrowing of your mitral valve may worsen over time. Blood flow through your heart may decrease, and your heart may not pump enough blood to your body. Tissues and other organs will not have enough oxygen and nutrients to function properly. You may feel tired or short of breath when doing your normal activities. Having your mitral stenosis treated may improve your ability to be active without tiring so easily. Your symptoms, such as shortness of breath may go away.

What causes mitral stenosis?

Mitral stenosis may be caused by the following:

• Rheumatic fever: Rheumatic fever is a condition that can occur after a strep throat infection. Rheumatic fever can cause inflammation (swelling) and damage to your heart muscle and valves. The leaflets of your mitral valve may thicken, and may even join together.
  
  
• Calcium buildup: As you age, calcium can build up on the mitral valve leaflets. The calcium stiffens and thickens the valve leaflets.
  
  
• Congenital heart defect: Some people are born with a damaged mitral valve that leads to stenosis.
  
  
• Medical conditions: Tumors (growths), an infection, or an autoimmune disease may cause mitral stenosis. Your immune system is your body's defense against illness and disease. When you have an autoimmune disease, your body attacks itself instead.

What are the signs and symptoms of mitral stenosis?

You may not have any signs and symptoms of mitral stenosis. Symptoms may only appear when the stenosis becomes severe (very bad). You may have any of the following:

• Coughing up bloody sputum (mucus).
  
  
• Feeling like you heart is beating faster than normal for you. You may also feel like your heart is jumping or fluttering in your chest.
  
  
• Fatigue (feeling more tired than usual).
  
  
• Shortness of breath during activity.
  
  
• Trouble swallowing and a hoarse (rough) voice.

How is mitral stenosis diagnosed?

Your caregiver will ask about your signs and symptoms and listen to your heart. You may need any of the following tests:

• Heart monitor: This test is also called an EKG or ECG. Sticky pads are placed on your skin to record your heart's electrical activity. An EKG gives information about how your heart is working. Lie as still as possible during the test.
  
  
• Chest x-ray: A chest x-ray is a picture of your heart and lungs. Caregivers use the x-ray to check the size of your heart. A chest x-ray is also done to look for fluid around your heart and lungs.
  
  
• Computed tomography scan: A computed tomography (CT) scan is an x-ray that uses a computer to take pictures of your heart. The pictures are taken to check for problems in your heart. The pictures may show if you have calcium build-up on your mitral valve. Before taking the pictures, you may be given dye through an IV. An IV is a thin tube put in your vein to give medicines and liquids. The dye helps your heart show up better in the pictures. People who are allergic to shellfish (lobster, crab, or shrimp) may be allergic to this dye. Tell your caregiver if you are allergic to shellfish, or if you have any other allergies.
  
  
• Echocardiogram: This test is a type of ultrasound. Sound waves are used to show the structure, movement, and blood vessels of your heart.
  
  
• Transesophageal echocardiogram: A transesophageal echo (TEE) may be done if your heart cannot be seen well during a regular echo. You may need a TEE to check for blood clots or a heart infection. You will be given medicine to relax you during a TEE. Caregivers will put a tube in your mouth that is moved down into your esophagus (food pipe). The tube has a small ultrasound sensor on the end. Since your esophagus is right next to your heart, your caregiver can see your heart clearly.
  
  
• Cardiac catheterization: A cardiac catheterization is done to check how well your heart is working, and to look for blockages. A tube is guided into your heart through a blood vessel in your leg or arm. Dye may be given before pictures are taken of your heart.

How is mitral stenosis treated?

You may not need treatment for your mitral stenosis if you do not have any symptoms. If caregivers feel treatment is needed, you may have any of the following:

• Medicines: You may have the following medicines to improve your symptoms or prevent problems caused by mitral stenosis:
  
  
  • Antibiotic medicine: This medicine helps prevent, or fight, an infection caused by germs called bacteria. You may need antibiotic medicine if you had rheumatic fever in the past to prevent getting it again. You may need to take the medicine every day, or once a month. Ask your caregiver if, and when you need to take antibiotic medicine.
    
    
  • Aspirin: This medicine may be given to help thin the blood to keep blood clots from forming. This medicine makes it more likely for you to bleed or bruise.
    
    
  • 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.
    
    
  • Diuretics: This medicine is given to decrease edema (excess fluid) that collects in a part of your body, such as your legs. Diuretics can also remove excess fluid from around your heart or lungs and decrease your blood pressure. It is often called water pills. You may urinate more often when you take this medicine.
    
    
  • Heart medicine: This medicine is given to strengthen or regulate your heartbeat. It also may help your heart in other ways. Talk with your caregiver to find out what your heart medicine is and why you are taking it.
    
    
  • Steroids: Steroid medicine may help to open your air passages so you can breathe easier.
  
  
• Surgery: Ask your caregiver for more information about the following:
  
  
  • Mitral balloon valvotomy: This is surgery to help 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 (cut). The catheter is guided through a blood vessel, and into your left atrium near your mitral valve. When the balloon is inflated (made larger), it forces the valve to open.
    
    
  • Mitral valve commissurotomy: This is surgery to repair and widen the mitral valve in your heart. During surgery, the valve leaflets are separated and calcium build-up may be removed. Surgery helps to improve blood flow to the left ventricle. Caregivers may be able to do this surgery through a small cut in your chest.
    
    
  • Mitral valve replacement: This is surgery to replace your damaged mitral valve. During surgery, part, or all of your mitral valve is removed and a new valve is secured in place. The new valve may be from a donor (another person or animal), or may be a man-made valve. When you have a man-made valve, you may need to take antibiotic medicine when having medical procedures. This includes before and after having dental work or surgery. The antibiotic medicine will help prevent germs from causing an infection in your heart.

How can I help manage my mitral stenosis?

• Activity: You may need to decrease or stop doing some activities if they worsen your symptoms. Your caregiver may also suggest a light exercise program to help improve your heart health. It is best to start slowly and do more as you get stronger. Rest when you need to. Do not start an exercise program without talking to your caregiver. Together you can plan the best exercise program for you.
  
  
• Diet: You may need to limit the amount of salt you eat. Special cookbooks can make it easier to plan low salt meals. Ask your caregiver if you should be on a special diet.

What are the risks of mitral stenosis?

• During surgery, the tissues, other heart valves, and nearby areas may get damaged. 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. Even after treatment, your mitral valve may narrow again.
  
  
• 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 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, and you may die. If you are a pregnant woman, mitral stenosis may cause health problems for you and your unborn baby. Your symptoms may get worse, and you and your unborn baby may die. Talk with your caregiver if you have questions or concerns about your condition or treatment.

Where can I find more information?

Contact the following:

• American Heart Association National Center
  7272 Greenville Avenue
  Dallas , TX 75231-4596
  Phone: 1- 800 - 242-8721
  Web Address: http://www.americanheart.org
  

• National Heart, Lung and Blood Institute
  Health Information Center
  P.O. Box 30105
  Bethesda , MD 20824-0105
  Phone: 1- 301 - 592-8573
  Web Address: http://www.nhlbi.nih.gov/health/infoctr/index.htm
  

When should I call my caregiver?

Call your caregiver if:

• You are bleeding from your nose and it will not stop.
  
  
• You are feeling more tired than usual.
  
  
• You have a fever.
  
  
• You have blood in your urine or bowel movements.
  
  
• You have trouble breathing with activity.
  
  
• You have chest pain or trouble breathing that is getting worse over time.
  
  
• Your heart is beating faster than normal for you, and you feel fluttering in your chest.

When should I seek immediate care?

Call 911 or seek immediate care if:

• The veins in your neck look swollen or are bulging out.
  
  
• Your arm or leg feels warm, tender, and painful. It may look swollen and red.
  
  
• You suddenly feel lightheaded and have trouble breathing.
  
  
• You have new and sudden chest pain. You may have more pain when you take deep breaths or cough. You may cough up blood.
  
  
• Call 911 or an ambulance if you have any signs of a heart attack:
  
  
  • Discomfort in the center of your chest that feels like squeezing, pressure, fullness, or pain, that lasts for more than a few minutes or keeps returning
    
    
  • Discomfort or pain in your back, neck, jaw, stomach, or one or both of your arms
    
    
  • Feeling sick to your stomach
    
    
  • Having trouble breathing
    
    
  • A sudden cold sweat, particularly in combination with chest discomfort or trouble breathing
    
    
  • Feeling very lightheaded or dizzy, particularly in combination with chest discomfort or trouble breathing
  
  
• You have signs of a stroke: The following signs are an emergency. Call 911 immediately if you have any of the following:
  
  
  • Weakness or numbness in your arm, leg, or face (may be on only one side of your body)
    
    
  • Confusion and problems speaking or understanding speech
    
    
  • A very bad headache that may feel like the worst headache of your life
    
    
  • Not being able to see out of one or both of your eyes
    
    
  • Feeling too dizzy to stand

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.

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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.

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