Mitral stenosis

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Last reviewed: December 2018

Last updated: January 2018

Summary

Fusion of the leaflet commissures reducing orifice area. Usually occurs as a consequence of rheumatic fever.

Causes decreased filling of the left ventricle, while simultaneously increasing left atrial pressure, producing the syndrome of heart failure.

As disease progresses, pulmonary hypertension and right heart failure occur.

Mild disease can be treated symptomatically with diuretics. Moderate to severe disease requires mechanical correction of the valve obstruction by valvotomy, valve repair, or valve replacement.

Definition

Mitral stenosis is a narrowing of the mitral valve orifice, usually caused by rheumatic valvulitis producing fusion of the valve commissures and thickening of the valve leaflets.

History and exam

Key diagnostic factors

presence of risk factors
hx of rheumatic fever
dyspnoea
orthopnoea
opening snap on auscultation
diastolic murmur
loud P2
neck vein distension
paroxysmal nocturnal dyspnoea
haemoptysis
hoarseness
peripheral oedema
ascites

Full details

Other diagnostic factors

40 to 50 years old
loud S1
irregularly irregular pulse
flushed cheeks

Full details

Risk factors

streptococcal infection
female sex
ergot medications
serotogenic medications
SLE
amyloidosis
bronchial carcinoid syndrome

Full details

Diagnostic investigations

1st investigations to order

ECG
CXR
trans-thoracic echocardiography

Full details

Investigations to consider

trans-oesophageal echocardiography
cardiac catheterisation
dynamic exercise testing

Full details

Treatment algorithm

ONGOING

non-pregnant

pregnant

Contributors

Authors VIEW ALL 

Blase Carabello, MD

Blase Carabello

Professor of Medicine

Icahn School of Medicine

Chairman

Mount Sinai Beth Israel Department of Cardiology

New York

NY

Disclosures

BC declares that he has no competing interests.

Peer reviewers VIEW ALL 

John R. Charpie, MD, PhD

Associate Professor of Pediatrics

Medical Director

Pediatric Cardiothoracic Intensive Care Unit

University of Michigan Congenital Heart Center

C.S. Mott Children's Hospital

Ann Arbor

MI

Disclosures

JRC declares that he has no competing interests.

David Leaf, MD, MPH

Professor of Medicine

VA Greater Los Angeles Healthcare System

UCLA School of Medicine

Los Angeles

CA

Disclosures

DL declares that he has no competing interests.

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