Mitral Stenosis

GENERAL INFORMATION:

What is mitral valve stenosis? Mitral (MI-trul) stenosis (sten-O-sis) is also called "MS". It is a disease of the mitral valve. The mitral valve is one of the doors in the heart. MS is a condition where the two leaflets of the mitral valve get thicker and stiffer. The two small leaflets of the mitral valve come from the front and back of the valve and meet in the middle. "Stenosis" means narrow or tight. A stenosis causes the valve opening to get smaller. A smaller opening makes it harder for blood to flow through the heart.

Where is the mitral valve?

• The heart has 4 chambers (rooms). The two upper chambers are called atria (A-tree-uh) and the two lower chambers are called ventricles (VEN-trik-ulls). When the heart "beats", the atria pump blood through valves (doors) into the ventricles. The ventricles then pump blood out of the heart back into the body.
  
  
• The mitral valve is the door between the left atria and the left ventricle. The left atrium receives blood with oxygen from the lungs, then pumps the blood through the mitral valve into the left ventricle. The left ventricle pumps blood with oxygen out to the body.

What causes mitral stenosis? Mitral stenosis is often caused by having had rheumatic (rew-MA-tik) fever. Rheumatic fever can cause an infection in the mitral valve. It can also cause an infection (in-FECK-shun) called endocarditis (end-o-kar-DI-tis) in the endocardium (end-o-KAR-di-um). The endocardium is the inner lining of the heart muscle. An infection in either the mitral valve or the endocardium can damage the leaflets in the mitral valve. Another cause of mitral valve damage is age. As some people get older, calcium or other material can build up on the leaflets of the mitral valve. This build up can cause the leaflets to work poorly. Mitral stenosis can also be caused by a problem with your heart when you were born (birth defect). Rheumatic fever, age, and birth defects are the most common causes of MS. There are also less common causes.

Signs and Symptoms: Often there are no signs or symptoms of mitral stenosis until you are between 30 and 40 years of age. The following are signs and symptoms of MS:

• Feeling short of breath or coughing during exercise or activities like climbing stairs.
  
  
• Difficulty sleeping flat or with just one pillow.
  
  
• Coughing when lying down.
  
  
• Fatigue (feeling tired) that gets worse over time.
  
  
• Feeling dizzy.
  
  
• Fainting.
  
  
• Coughing up blood-tinged sputum (spit).
  
  
• Hoarseness when you talk.
  
  
• Heart beating fast and sometimes not regular.
  
  
• Swelling of the feet and ankles.

Care:

• Many tests will be done so your caregiver can tell how well your mitral valve is working. You may have some or all of the following tests. These tests may be done more than once as you are being treated. Ask your caregiver for CareNotes™ handout on the following tests for more information:
  
  
  • 12-lead ECG: This test, also called an EKG, helps caregivers look for damage or problems in different areas of the heart. Caregivers may need to prepare your skin by shaving off some hair, or cleaning it with a gritty lotion. Sticky pads are placed on your chest, arms, and legs. Each sticky pad has a wire that is hooked to a machine or TV-type screen. A short period of electrical activity in your heart muscle is recorded. Caregivers will look closely for certain problems or changes in how your heart is working. This test takes about 5 to 10 minutes. It is important that you lie as still as possible during the test. You may need this test more than once.
    
    
  • Echocardiogram:
    
    
    • This test is also called an echo. It is a type of ultrasound, using sound waves to show pictures of the size and shape of your heart. An echo also looks at how your heart moves when it is beating. These pictures are seen on a TV-like screen.
      
      
    • This test is done while lying down on your back. Clear jelly will be squirted on your chest to help the ultrasound sensor slide easily. The sensor will be rubbed across your chest to see your heart from different angles. You may hear a barking or whooshing noise, which is the sound of your blood flow. Caregivers may ask you to pedal a bike during the test (exercise echo) or you may get medicine before the test to increase blood flow to your heart muscle (stress echo). This test can tell how well your heart is pumping. An echo can also find problems, such as fluid around the heart or problems with your heart valves.
    
    
  • Cardiac catheterization: This is a test to see how well your heart is working. Your arteries (blood vessels) may also be checked to see if they are blocked. A special tube is threaded into your heart through a blood vessel in your leg or arm. Dye may be given so x-ray pictures of your arteries show up better on a TV-like screen.
    
    
  • Chest x-ray: This is a picture of your lungs and heart. Caregivers use it to see how your lungs and heart are doing. Caregivers may use the x-ray to look for signs of infection like pneumonia, or to look for collapsed lungs. Chest x-rays may show tumors, broken ribs, or fluid around the heart and lungs.
    
    
  • Cardiac blood pool imaging: This test shows how well your heart is pumping. It can also be called a "gated blood pool scan" or a MUGA scan. You are given a small, safe amount of radioactive dye in an IV. Caregivers then take pictures of your heart.
    
    
  • Holter Monitoring: A Holter monitor is a way to record your heartbeat continuously for 1 to 3 days. EKG sticky pads are placed on your chest. The pads are then connected with wires to a small machine about the size of a transistor radio. The machine can be connected to your belt so it does not interfere with your everyday activities. Your caregivers look at the reading to see problems with your heartbeat.
    
    
  • Transesophageal echocardiogram: Also called a TEE, a transesophageal (trans-eh-so-uh-G-ull) echocardiogram (eh-ko-KAR-d-o-gram) ultrasound test is done to see how well your heart and mitral valve are working. In a regular ECHO, the probe is rubbed on your chest to get pictures of your heart. During a TEE, a tiny transducer (a camera-like device) is connected to the end of a tube and put down your throat and into your esophagus. Your esophagus (uh-SOF-uh-gus) is the tube that runs from your throat to your stomach. It lies near your heart. Very clear pictures of your mitral valve and the blood flowing through it can be taken because the transducer is so close to your heart.
  
  

Treatment: Treatment of mitral stenosis depends on how well your mitral valve is working. You may have one or more of the following treatments:

• Heart medicine.
  
  
• Diuretic medicine (water pills).
  
  
• Antibiotic (an-ti-bi-AH-tik) medicine.
  
  
• Blood thinning medicine.
  
  
• Low sodium, low fat diet.
  
  
• Surgery to repair or replace your mitral valve.

CARE AGREEMENT:

You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.

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