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Mitral Valve Stenosis

Mitral Valve Stenosis

Overview

Picture of the heart

What is mitral valve stenosis?

Mitral valve stenosis is a heart problem in which the mitral valve doesn't open as wide as it should. The valve becomes stiff or scarred, or the valve flaps become partially joined together.

See a picture of mitral valve stenosis .

Mitral valve stenosis can lead to heart failure ; a stroke; an infection in the heart ( endocarditis ); or a fast, slow, or uneven heartbeat ( arrhythmia ). Fortunately, mitral valve stenosis can be treated.

Mitral valve stenosis is not common in developed countries such as the United States, Canada, and western Europe.

How does the mitral valve work?

Your heart has four chambers and four valves. The valves have flaps, or leaflets. The flaps open and close to keep blood flowing in the proper direction through your heart.

The mitral valve connects the heart's upper left chamber (left atrium) to the lower left chamber (left ventricle). When the heart pumps, blood forces the flaps open, and blood flows from the left atrium to the left ventricle. Between heartbeats, the flaps close tightly so that blood does not leak backward through the valve.

With mitral valve stenosis, not as much blood can flow into the left ventricle. More blood stays in the left atrium, and blood may back up into the lungs.

See a picture of the heart and its chambers, valves, and blood flow .

See a picture of a normal mitral valve .

What causes mitral valve stenosis?

Nearly all cases of mitral valve stenosis are caused by rheumatic fever . This fever results from an untreated strep infection, most often strep throat . But many people who have mitral valve stenosis don't realize that they had rheumatic fever.

What are the symptoms?

Symptoms usually don't develop until 10 to 20 years after stenosis starts, and they may take as long as 40 years to develop.

When symptoms first appear, they usually are mild. You may only have a few symptoms, even if your mitral valve is very narrow. An early symptom is shortness of breath when you are active. This shortness of breath may seem normal to you.

Symptoms later in the disease may include:

  • Shortness of breath even when you have not been very active or when you are resting.
  • Feeling very tired or weak.
  • Pounding of the heart ( palpitations ).

Call your doctor if your symptoms get worse or you have new symptoms.

How is mitral valve stenosis diagnosed?

Mitral valve stenosis may not be diagnosed until you've had the disease for some time. If you don't have symptoms, the first clue might be a heart murmur your doctor hears during a routine checkup.

Your doctor will ask you questions about your past health and do a physical exam. If your doctor thinks you might have the disease, he or she may do more tests. These may include:

  • An echocardiogram . This ultrasound test lets your doctor see a picture of your heart, including the mitral valve.
  • An electrocardiogram (EKG or ECG). This test can check for problems with your heart rhythm.
  • A chest X-ray . This shows your heart and lungs and can help your doctor find the cause of symptoms such as shortness of breath.

These tests also help your doctor find what caused the stenosis and how severe it is.

How is it treated?

Treatment depends on how severe the disease and your symptoms are.

  • You'll probably need only regular checkups if you have mild or no symptoms.
  • You may need medicines to relieve symptoms or treat complications.
  • You may need your mitral valve repaired or replaced if you have severe symptoms, your valve is very narrow, or you are at risk for other problems, such as heart failure.

You will likely need regular echocardiograms so your doctor can check for any changes in your mitral valve and heart.

If your stenosis is mild, you'll probably be able to do your usual activities, get mild exercise, and play some sports. But if your stenosis is moderate or severe, you may need to avoid intense exercise. But your doctor can help you choose an activity or exercise that is safe for you.

You may need to limit sodium in your diet.

Health Tools Health Tools help you make wise health decisions or take action to improve your health.

Health Tools help you make wise health decisions or take action to improve your health.


Decision Points focus on key medical care decisions that are important to many health problems. Decision Points focus on key medical care decisions that are important to many health problems.
  Heart Valve Problems: Should I Choose a Mechanical Valve or Tissue Valve to Replace My Heart Valve?

Cause

Nearly all cases of mitral valve stenosis are caused by rheumatic fever, which can follow an untreated strep throat infection. But many people who have mitral valve stenosis don't realize that they had rheumatic fever.

Other less common causes include:

  • A congenital (from birth) heart defect.
  • Infection of the valve or heart muscle ( endocarditis ).
  • Hardening of the valve or its parts because of aging or severe kidney disease.
  • Conditions that cause scarring of the valve (such as lupus or rheumatoid arthritis ).
  • The diet medicine fen-phen. It was taken off the U.S. market in 1997 because of its link to heart valve disease.

Symptoms

Although mitral valve stenosis is a lifelong disease, symptoms usually take 10 to 20 years to develop and can take as long as 40 years. After you develop symptoms, they may not become severe for up to 10 years. 1

Early symptoms are often mild. In the later stages, the left atrium may become damaged, causing more severe symptoms.

Symptoms of mitral valve stenosis include:

  • Shortness of breath.
  • Fatigue or weakness.
  • A pounding heart (palpitations).
  • Coughing up blood.
  • An irregular heart rhythm (because of heart failure from stenosis).

Other less common symptoms include:

  • Hoarseness and vocal cord paralysis.
  • Trouble swallowing.
  • Chest pain.
  • Skin color changes, such as pink to purple shades on the cheeks or a dark blue color on the body from reduced blood flow. Skin color changes occur rarely and usually only in the end stages of the disease.

You may not have any symptoms unless you exercise, are stressed, are pregnant, or have an infection or an irregular heartbeat. Or you may have only a few symptoms, no matter how bad your stenosis is.

What Increases Your Risk

Risk factors for mitral valve stenosis are:

  • History of rheumatic fever . But since most people don't know that they had rheumatic fever, they may not know they are at risk.
  • Aging. Wear and tear of the valve over time may cause it to harden and narrow.
  • Being female. More women than men get this problem.

Diabetes and Marfan's syndrome can sometimes lead to stenosis. Any condition that scars the valves, such as endocarditis , also may cause stenosis.

When to Call a Doctor

Call 911 or other emergency services immediately if you have:

Call a doctor immediately if you have:

  • Symptoms of heart failure , such as shortness of breath, swelling in the feet and ankles, and not being able to exercise at your usual level.
  • Mitral valve stenosis and are having symptoms of infection, such as fever with no other obvious cause.
  • Fainting episodes.
  • Excessive fatigue without another explanation.

Who to see

Health professionals who can evaluate symptoms and order further tests as needed include:

A cardiovascular surgeon may do surgical repair or replacement of heart valves.

Exams and Tests

Mitral valve stenosis often has no symptoms in its early stages. It may not be diagnosed until you've had the disease for some time. One or more complications may lead to its diagnosis.

The first sign of mitral valve stenosis could be a heart murmur that your doctor hears during a routine checkup.

A review of your medical history and a physical exam can help your doctor find out if you have mitral valve stenosis. Your doctor also can use them to plan your treatment.

Medical history

Your doctor will ask about your lifestyle, activity level, and family health history . Your doctor will want to know about your symptoms. He or she will ask if you have ever had:

Physical exam

During the physical exam, the doctor will:

  • Listen for a certain heart murmur and other sounds that indicate a heart valve is not working right.
  • Take your blood pressure.
  • Check your pulse.
  • Look for swelling that can be a sign of too much fluid in your body.

Echocardiogram

An echocardiogram is used to find out if you have mitral valve stenosis and to see how bad it is. Your doctor can check your heart valve and take pictures of your heart.

In transesophageal echocardiography , a device is inserted down your throat and into your esophagus to make pictures of your heart. This may be done if your doctor wants to see a different view of your heart.

You will likely have regular echocardiograms so your doctor can keep track of any changes in your condition. Your doctor may recommend an echocardiogram every year if you have severe stenosis, every 1 to 2 years if you have moderate stenosis, or every 3 to 5 years if you have mild stenosis. 1

Electrocardiogram

Electrocardiogram is used to measure the electrical activity in the heart. Small metal discs called electrodes are attached to your chest, arms, and legs. The electrodes are connected to a machine that translates the electrical activity into line tracings on paper. Your doctor looks at the tracings to check for problems.

Chest X-ray

A chest X-ray may show evidence of mitral valve stenosis. The test may show enlargement of the upper left heart chamber (left atrium) or the pulmonary arteries . Calcium deposits on the heart valves sometimes may be seen, especially if the buildup is severe.

Cardiac catheterization

Cardiac catheterization is usually done before any surgery for mitral valve stenosis to evaluate your heart, the degree of stenosis, and the health of your coronary arteries. Knowing the condition of the coronary arteries may affect later treatment decisions for stenosis.

Treatment Overview

Treatment of mitral valve stenosis depends on how bad your symptoms are.

Stenosis without symptoms

If you don't yet have symptoms or you have mild, stable symptoms, your doctor may only watch your condition with regular echocardiograms . Your doctor will want you to call if you notice symptoms or if you have a change in symptoms you already have.

Stenosis with symptoms

If you develop symptoms, your doctor may prescribe medicine that lowers your blood pressure and reduces fluid buildup. For more information, see Medications.

Repair or replace the mitral valve

If your stenosis gets worse, your doctor might suggest repairing or replacing your mitral valve.

Repairing the valve can be done by:

  • Balloon valvotomy, a catheter procedure that stretches the valve open.
  • Commissurotomy, an open-heart surgery to remove calcium deposits and other scar tissue from the valve.

Mitral valve replacement surgery replaces the damaged valve with a new valve.

For more information, see Surgery.

Ongoing Concerns

Mitral valve stenosis can be an easy condition to overlook in its mild form. But as it gets worse, it often has serious complications. These are serious problems that need treatment.

The most common complications are:

Other complications include:

  • Fluid buildup in the lungs.
  • Spitting up blood.
  • High blood pressure in the lungs.
  • Blood clots that travel through blood vessels to the heart, brain, kidneys, intestines, arms, or legs.

For more information, see the topics Heart Failure, Atrial Fibrillation, and Endocarditis.

Living With Mitral Valve Stenosis

Long-term mitral valve stenosis can cause serious heart damage. But you can help yourself live fully by working with your doctor and having a healthy lifestyle.

Get check-ups

Talk to your doctor about how often you need to be examined. You will likely have regular echocardiograms so your doctor can keep track of any changes in your condition. How often you get the test depends on how bad your stenosis is.

Call your doctor if your symptoms get worse or you have new symptoms. For more information, see When to Call a Doctor.

Exercise with care

Ask your doctor what level of exercise is safe for you. Exercise helps keep your heart and body healthy. But when you have mitral valve stenosis, exercise can put extra strain on your heart and cause symptoms like fluid buildup in your lungs. So exercise with care and be aware of any symptoms like shortness of breath. If you don't exercise, talk to your doctor before you start.

If your stenosis is mild and you don't have symptoms, your doctor may encourage you to do low-level aerobic exercise.

If your stenosis is moderate or severe and you have symptoms, you should avoid strenuous activity. You may be able to do low-level activities to help keep your heart healthy.

People who have severe stenosis may need to be cautious about their level of physical activity. You may be able to do certain types of exercise that won't strain your heart.

Limit your sodium

Depending on how bad your symptoms are, your doctor may advise you to limit sodium . If you consume too much sodium, it will cause your body to retain excess fluid. Excess fluid in the body will cause swelling, trouble breathing, fatigue, and other side effects.

Cutting back on sodium usually includes avoiding foods such as potato chips, pretzels, processed meats and cheeses, canned soups, and fast foods.

When you shop for groceries, check labels carefully for hidden sodium.

Medications

Medicines are often used to relieve the symptoms and prevent complications of mitral valve stenosis. Usually they are also prescribed after surgery to repair or replace the valve.

For symptoms

Diuretics ("water pills") reduce fluid buildup and related swelling. They may also lower blood pressure in the upper left heart chamber (left atrium) and relieve breathing problems.

For complications

Medicines used to treat complications include:

  • Heart rate or rhythm medicines. If you have an arrhythmia, such as atrial fibrillation, you may have medicine to lower your heart rate or keep it regular.
  • Anticoagulants. If you have atrial fibrillation, had surgery to replace or repair your heart valve, or have a mechanical heart valve, you might take an anticoagulant . These medicines help prevent dangerous blood clots.
  • Heart failure medicines. If you have heart failure, you may take medicines that relieve your symptoms and slow down how quickly heart failure gets worse. These medicines help lower your blood pressure, reduce fluid buildup, and help your heart to not work so hard.
  • Antibiotics. If you have an artificial valve , you may need to take antibiotics before you have certain dental or surgical procedures. You will likely take antibiotics after surgery to repair or replace a valve. If you have had rheumatic fever, you may take antibiotics to avoid getting it again.

Surgery

You may need surgery to repair or replace your mitral valve if medicines don't control your symptoms or if your doctor thinks that you need more treatment.

Deciding whether you need surgery and if so, when, depends on the severity of your disease, the possibility that it will get worse, and the risks of surgery.

For more information about the decision to repair or replace a mitral valve, see Mitral Valve Stenosis: Repair or Replace the Valve?

Repair

You may have one of the following procedures to repair the valve:

  • Balloon valvotomy : This procedure is the preferred treatment for mitral valve stenosis. A doctor uses a catheter and a tiny balloon to stretch open the narrowed valve. It is minimally invasive.
  • Repair surgery (commissurotomy) : This is typically an open-heart surgery using a heart-lung bypass machine. A surgeon removes calcium deposits and other scar tissue from the valve leaflets to widen the valve.

Replace

Mitral valve replacement surgery might be done if the valve is damaged beyond repair. This surgery is typically an open-heart surgery using a heart-lung bypass machine.

If you have valve replacement surgery, a mechanical or tissue valve will be used to replace your heart valve. Before you have surgery, you and your doctor will decide which type of valve is right for you. To help with this decision, see:

Click here to view a Decision Point. Heart Valve Problems: Should I Choose a Mechanical Valve or Tissue Valve to Replace My Heart Valve?

Other Places To Get Help

Organizations

Society of Thoracic Surgeons
 
633 North Saint Claire Street
Floor 23
Chicago, IL 60611
Phone: (312) 202-5800
Fax: (312) 202-5801
Web Address: www.sts.org
 

The Society of Thoracic Surgeons provides patient information on surgeries of the chest and throat that are done by cardiothoracic surgeons. These surgeries include heart, lung, and throat surgery. The patient information section of the website describes diseases, surgeries, patient options, and what to expect after surgery. And using the website, you can search for surgeons in your area.


American Heart Association (AHA)
7272 Greenville Avenue
Dallas, TX  75231
Phone: 1-800-AHA-USA1 (1-800-242-8721)
Web Address: www.heart.org
 

Visit the American Heart Association (AHA) website for information on physical activity, diet, and various heart-related conditions. You can search for information on heart disease and stroke, share information with friends and family, and use tools to help you make heart-healthy goals and plans. Contact the AHA to find your nearest local or state AHA group. The AHA provides brochures and information about support groups and community programs, including Mended Hearts, a nationwide organization whose members visit people with heart problems and provide information and support.


National Heart, Lung, and Blood Institute (NHLBI)
P.O. Box 30105
Bethesda, MD  20824-0105
Phone: (301) 592-8573
Fax: (240) 629-3246
TDD: (240) 629-3255
Email: nhlbiinfo@nhlbi.nih.gov
Web Address: www.nhlbi.nih.gov
 

The U.S. National Heart, Lung, and Blood Institute (NHLBI) information center offers information and publications about preventing and treating:

  • Diseases affecting the heart and circulation, such as heart attacks, high cholesterol, high blood pressure, peripheral artery disease, and heart problems present at birth (congenital heart diseases).
  • Diseases that affect the lungs, such as asthma, chronic obstructive pulmonary disease (COPD), emphysema, sleep apnea, and pneumonia.
  • Diseases that affect the blood, such as anemia, hemochromatosis, hemophilia, thalassemia, and von Willebrand disease.

References

Citations

  1. Bonow RO, et al. (2008). 2008 Focused update incorporated into the ACC/AHA 2006 Guidelines 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 (Writing committee to revise the 1998 Guidelines for the management of patients with valvular heart disease). Circulation, 118(15):

Other Works Consulted

  • Bonow RO, et al. (2008). 2008 Focused update incorporated into the ACC/AHA 2006 Guidelines 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 (Writing committee to revise the 1998 Guidelines for the management of patients with valvular heart disease). Circulation, 118(15):
  • Carabello BA (2011). Mitral stenosis. In V Fuster et al., eds., Hurst's The Heart, 13th ed., vol. 2, pp. 1738–1744. New York: McGraw-Hill.
  • Oakley RE, et al. (2008). Choice of prosthetic heart valve in today's practice. Circulation, 117(2): 253–256.
  • Otto CM, Bonow RO (2012). Valvular heart disease. In RO Bonow et al., eds., Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine, 9th ed., vol. 2, pp. 1468–1539. Philadelphia: Saunders.
  • Rodriguez L, Gillinov AM (2007). Mitral valve disease. In EJ Topol, ed., Textbook of Cardiovascular Medicine. Philadelphia: Lippincott Williams and Wilkins.

Credits

By Healthwise Staff
Primary Medical Reviewer Rakesh K. Pai, MD, FACC - Cardiology, Electrophysiology
Specialist Medical Reviewer John A. McPherson, MD, FACC, FSCAI - Cardiology
Last Revised November 18, 2011

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