Mitral Stenosis

The mitral valve is located in the left side chambers of the heart. It controls blood flow from the left atrium to the left ventricle. Normally, when it opens, the area is 3-4 cm2; when it closes, it doesn't allow blood to reverse flow from the left ventricle to the left atrium. Due to some diseases, the opening of the mitral valve is reduced, narrowing of the valve opening-mitral stenosis. This mitral stenosis results in enlargement of the left atrium chamber, increased pressure in the Lung circulation, and symptoms of decreased blood circulation.

Mitral valve stenosis is a serious heart condition that affects only a small number of people. Patients with this condition often feel tired and struggle to breathe because their heart's left chambers narrow at the valve. 

Symptoms of Mitral Stenosis

People usually notice symptoms after their mitral valve has narrowed by a lot. The first signs typically show up during physical activity or when the body is under stress. Common mitral stenosis symptoms include:

• Breathing problems, especially during exercise
• Feeling tired and weak
• Heart palpitations or irregular beats
• Chest pain or discomfort
• Coughing that sometimes brings up blood
• Swollen feet or ankles

Symptoms can take 15-20 years to appear after the original rheumatic fever.

Causes of Mitral Stenosis

• Most commonly, it results from a throat infection caused by Streptococcus bacteria.
• It is more common in low socioeconomic groups, congested living conditions, children, and women.
• Streptococcus infection in early age results in mitral stenosis in young adults. 
• Other rare causes are lupus, congenital, or some drugs.

Risk Factors

Some factors make you more likely to develop mitral stenosis:

• Women face a higher risk. 
• People living in developing regions see more cases because rheumatic fever remains common there.

Mitral Stenosis Complications

Mitral stenosis leads to serious health problems without treatment. 

• Some patients develop atrial fibrillation, which makes strokes more likely. 
• Pressure builds up in lung arteries and causes pulmonary hypertension. 
• Your heart might fail because it can't maintain normal blood flow. 
• Poor circulation can create blood clots that cause strokes or other embolic events.

Diagnosis of mitral stenosis

Doctors need several tests to confirm a narrowed mitral valve diagnosis. Your healthcare experience starts with a detailed examination. The doctor listens for a distinctive heart murmur that signals this condition.

Several key tests help doctors find mitral stenosis:

• Echocardiogram: This ultrasound examination creates detailed images of your heart and shows valve structure and blood flow. The test reveals stenosis severity by measuring your valve area (usually 4-5 cm²). Severe stenosis shows an area of 1.5 cm² or less.
• Electrocardiogram (ECG): This test records your heart's electrical activity. It can show left atrial enlargement or atrial fibrillation, which affects many patients.
• Chest X-ray: The results may show an enlarged left atrium, prominent pulmonary vessels, or fluid in the lungs.
• Exercise testing: This test helps doctors assess how symptoms change during physical activity.
• Complex cases might need cardiac catheterisation or specialised imaging like cardiac MRI.

Mitral Stenosis Treatment 

The approach to managing mitral valve stenosis depends on its severity. Mild cases often need regular monitoring. 

• Medication management:
  • Medications can't fix the valve, but they help control symptoms: 
  • Diuretics reduce fluid buildup in your lungs.
  • Blood thinners prevent clots if you have atrial fibrillation.
• Interventional procedures:
  • Balloon valvuloplasty: A catheter with a balloon inflates inside the narrowed valve to widen the opening. 
  • Surgical repair: The procedure has techniques to separate fused leaflets or remove calcium deposits.
  • Valve replacement: Doctors use mechanical or biological tissue valves when repair isn't possible.

When to See a Doctor

You should contact your doctor right away if you notice:

• Fast, fluttering or pounding heartbeats
• Chest pain
• Shortness of breath that gets worse, especially during activity

Regular follow-up appointments play a crucial role after diagnosis. Very severe mitral stenosis needs yearly echocardiograms. Less severe cases need checks every 3-5 years.

Get emergency care immediately if you faint, have sudden breathing problems, or have chest pain that doesn't go away.

Conclusion

People with mitral stenosis face daily challenges, but modern medical care brings new hope. Quick diagnosis and better outcomes happen when you spot early warning signs like breathlessness and fatigue.

Rheumatic fever causes most cases of this condition. Regular medical check-ups detect valve narrowing before symptoms get worse. Modern tools like echocardiograms create detailed images that help doctors make better treatment choices.

Your valve's narrowing determines your treatment path. Doctors might just monitor mild cases, but severe ones need procedures like balloon valvuloplasty or valve replacement. Good communication with your healthcare team plays a vital role throughout your care.

Many patients live well with mitral stenosis for years. Pay attention to your body's signals and never miss follow-up appointments. Get help right away if you have trouble breathing. You can enjoy life with this diagnosis when you understand your condition and work with doctors to maintain heart health.

FAQs

1. What are the main symptoms of mitral stenosis? 

The primary symptoms include shortness of breath (especially during physical activity), fatigue, irregular heartbeats, chest discomfort, and occasionally coughing up blood. Swelling in the feet or ankles may also occur.

2. How is mitral stenosis diagnosed? 

Diagnosis typically involves several tests, including an echocardiogram to visualise the heart's structure, an electrocardiogram (ECG) to record heart activity, chest X-rays, and sometimes exercise testing. In complex cases, cardiac catheterisation or MRI might be necessary.

3. What are the treatment options for mitral stenosis? 

Treatment for mitral stenosis depends on the severity of the condition. Mild cases may only require monitoring, while medications can help manage symptoms. For more severe cases, procedures such as balloon valvuloplasty, surgical repair, or valve replacement may be necessary.

4. How often should someone with mitral stenosis have check-ups? 

The frequency of check-ups depends on the severity of the condition. Those with very severe mitral stenosis should have yearly echocardiograms, while less severe cases may only need checks every 3-5 years. Regular follow-up appointments are essential for monitoring the condition's progression.

Dr. Nitin Modi

MBBS, MD, DNB, DM
CARE CHL Hospitals, Indore

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