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:
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.
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 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 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.
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 is medicine that may be given to help thin the blood to keep blood clots from forming.
Blood thinners: This medicine helps stop clots from forming in the blood. Clots can cause strokes, heart attacks, and death. Blood thinners may make it easier to bleed or bruise. While taking this medicine, use a soft toothbrush to prevent bleeding gums. If you shave, use an electric shaver.
Diuretics: This medicine is often called water pills. Diuretics help your body get rid of extra fluid (edema) in your legs and ankles. This medicine may also help get rid of extra fluid in your lungs or around your heart. It may also decrease your blood pressure. You may urinate more often when taking diuretics.
Heart medicine: This medicine may be given to make your heart beat stronger or more regularly. There are many different kinds of heart medicines. Talk with your caregiver to find out what your 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 (increased body temperature).
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 also cough up blood.
You have signs or symptoms of a heart attack:
Chest pain or discomfort that spreads to your arms, jaw, or back.
New, sudden back pain.
Nausea (feeling sick to your stomach).
Trouble breathing.
Sweating.
Lips or nailbeds that turn blue or white in color.
This is an emergency. Call 911 or 0 (operator) for an ambulance to get to the nearest hospital or clinic. Do not drive yourself!
You have signs and symptoms of a stroke: The following signs and symptoms may happen suddenly:
A very bad headache. This may feel like the worst headache of your life.
Too dizzy to stand.
Weakness or numbness in your arm, leg, or face. This may happen on only one side of your body.
Confusion and problems speaking or understanding.
Not able to see out of one or both of your eyes.
This is an emergency. Call 911 or 0 (operator) for an ambulance to get to the nearest hospital. Do not drive yourself!
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.
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.
