Mitral stenosis

Mitral stenosis is a disorder in which the mitral valve does not fully open. This restricts the
flow of blood.

Causes
Blood that flows between different chambers of your heart must flow through a valve. The
valve between the 2 chambers on the left side of your heart is called the mitral valve. It opens
up enough so that blood can flow from the upper chamber of your heart (left atria) to the
lower chamber (left ventricle). It then closes, keeping blood from flowing backwards.

Mitral stenosis means that the valve cannot open enough. As a result, less blood flows to the
body. The upper heart chamber swells as pressure builds up. Blood and fluid may then collect
in the lung tissue (pulmonary edema), making it hard to breathe.

In adults, mitral stenosis occurs most often in people who have had rheumatic fever. This is a
disease that can develop after an illness with strep throat that was not properly treated.

The valve problems develop 5 to 10 years or more after having rheumatic fever. Symptoms
may not show up for even longer. Rheumatic fever is becoming rare in the United States
because strep infections are most often treated. This has made mitral stenosis less common.

Rarely, other factors can cause mitral stenosis in adults. These include:

Calcium deposits forming around the mitral valve

Radiation treatment to the chest

Some medicines

Children may be born with mitral stenosis (congenital) or other birth defects involving the
heart that cause mitral stenosis. Often, there are other heart defects present along with the
mitral stenosis.

Mitral stenosis may run in families.

Symptoms
Adults may have not symptoms. However, symptoms may appear or get worse with exercise
or other activity that raises the heart rate. Symptoms will most often develop between ages 20
and 50.

Symptoms may begin with an episode of atrial fibrillation (especially if it causes a fast heart
rate). Symptoms may also be triggered by pregnancy or other stress on the body, such as
infection in the heart or lungs, or other heart disorders.

Symptoms may include:

Chest discomfort that increases with activity and extends to the arm, neck, jaw or
other areas (this is rare)

Cough, possibly with bloody phlegm

Difficulty breathing during or after exercise (This is the most common symptom.)

Waking up due to breathing problems or when lying in a flat position

Fatigue

Frequent respiratory infections, such as bronchitis

Feeling of pounding heart beat (palpitations)

Swelling of feet or ankles

In infants and children, symptoms may be present from birth (congenital). It will almost
always develop within the first 2 years of life. Symptoms include:

Cough

Poor feeding, or sweating when feeding

Poor growth

Shortness of breath

Exams and Tests

The health care provider will listen to the heart and lungs with a stethoscope. A murmur,
snap, or other abnormal heart sound may be heard. The typical murmur is a rumbling sound
that is heard over the heart during the resting phase of the heartbeat. The sound often gets
louder just before the heart begins to contract.

The exam may also reveal an irregular heartbeat or lung congestion. Blood pressure is most
often normal.
Narrowing or blockage of the valve or swelling of the upper heart chambers may be seen on:

Chest x-ray

CT scan of the heart

Echocardiogram

ECG (electrocardiogram)

MRI of the heart

Transesophageal echocardiogram (TEE)

Treatment
Treatment depends on the symptoms and condition of the heart and lungs. People with mild
symptoms or none at all may not need treatment. For severe symptoms, you may need to go
to the hospital for diagnosis and treatment.

Medicines which can be used to treat symptoms of heart failure, high blood pressure and to
slow or regulate heart rhythms include:

Diuretics (water pills)

Nitrates, beta-blockers

Calcium channel blockers

ACE inhibitors

Angiotensin receptor blockers (ARBs)

Digoxin

Drugs to treat abnormal heart rhythms

Anticoagulants (blood thinners) are used to prevent blood clots from forming and traveling to
other parts of the body.

Antibiotics may be used in some cases of mitral stenosis. People who have had rheumatic
fever may need long-term preventive treatment with an antibiotic such as penicillin.

In the past, most people with heart valve problems were given antibiotics before dental work
or invasive procedures, such as colonoscopy. The antibiotics were given to prevent an
infection of the damaged heart valve. However, antibiotics are now used much less often. Ask
your doctor whether you need to use antibiotics.
Some people may need heart surgery or procedures to treat mitral stenosis. These include:

Percutaneous mitral balloon valvotomy (also called valvuloplasty). During this

procedure, a tube (catheter) is inserted into a vein, usually in the leg. It is threaded up
into the heart. A balloon on the tip of the catheter is inflated, widening the mitral valve
and improving blood flow. This procedure may be tried instead of surgery in people
with a less damaged mitral valve. Even when successful, the procedure may need to
be repeated months or years later.

Surgery to repair or replace the mitral valve. Replacement valves can be made from
different materials. Some may last for decades, and others can wear out and need to be
replaced.

Children often need surgery to either repair or replace the mitral valve.

Outlook (Prognosis)
The outcome varies. The disorder may be mild, without symptoms, or may be more severe
and become disabling over time. Complications may be severe or life threatening. In most
cases, mitral stenosis can be controlled with treatment and improved with valvuloplasty or
surgery.

Possible Complications
Complications may include:

Atrial fibrillation and atrial flutter

Blood clots to the brain (stroke), intestines, kidneys, or other areas

Congestive heart failure

Pulmonary edema

Pulmonary hypertension

When to Contact a Medical Professional

Call your provider if:

You have symptoms of mitral stenosis.

You have mitral stenosis and symptoms do not improve with treatment, or new
symptoms appear.

Prevention
Follow your provider's recommendations for treating conditions that can cause valve disease.
Treat strep infections promptly to prevent rheumatic fever. Tell your provider if you have a
family history of congenital heart diseases.

Other than treating strep infections, mitral stenosis itself often cannot be prevented. However
but complications from the condition can be prevented. Tell your provider about your heart
valve disease before you receive any medical treatment. Discuss whether you need preventive
antibiotics.

Alternative Names
Mitral valve obstruction; Heart mitral stenosis; Valvular mitral stenosis

References
Carabello BA. Valvular heart disease. In: Goldman L, Schafer AI, eds. Goldman's Cecil
Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 75.

Nishimura. RA, Otto CM, Bownow RO, et al. 2014 AHA/ACC guideline for the management
of patients with valvular heart disease: a report of the American College of
Cardiology/American Heart Association Task Force on Practice Guidelines J Thorac
Cardiovasc Surg. 2014;148(1):e1-e132. PMID: 24939033
www.ncbi.nlm.nih.gov/pubmed/24939033.

Otto CM, Bonow RO. Valvular heart disease In: Mann DL, Zipes DP, Libby P, Bonow RO,
Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 10th
ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 63.

Wilson W, Taubert KA, Gerwitz M, et al. Prevention of infective endocarditis: guidelines

from the American Heart Association: a guideline from the American Heart Association
Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee, Council on
Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on
Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research
Interdisciplinary Working Group. Circulation. 2007;116(15):1736-1754. PMID: 17446442
www.ncbi.nlm.nih.gov/pubmed/17446442.

Review Date 2/24/2016

Updated by: Michael A. Chen, MD, PhD, Associate Professor of Medicine, Division of
Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle,
WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M.
Editorial team.

Browse the Encyclopedia

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Mitral stenosis

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Atrial fibrillation or flutter

Blood clots

Heart failure - overview

Pulmonary edema

Rheumatic fever

Stress and your health

Stroke

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