Mitral stenosis

Last reviewed: 29 Dec 2022
Last updated: 13 Jan 2022



History and exam

Key diagnostic factors

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

Other diagnostic factors

  • 40 to 50 years old
  • loud first heart sound (S1)
  • irregularly irregular pulse
  • flushed cheeks
Other diagnostic factors

Risk factors

  • streptococcal infection
  • female sex
  • ergot medications
  • serotonergic medications
  • systemic lupus erythematosus (SLE)
  • amyloidosis
  • bronchial carcinoid syndrome
More risk factors

Diagnostic investigations

1st investigations to order

  • ECG
  • CXR
  • trans-thoracic echocardiography
More 1st investigations to order

Investigations to consider

  • trans-oesophageal echocardiography
  • cardiac catheterisation
  • dynamic exercise testing
More investigations to consider

Treatment algorithm






Blase Carabello, MD
Blase Carabello

Jack Rose Distinguished Professor of Medicine

Brody School of Medicine

East Carolina University




BC declares that he has no competing interests.

Peer reviewers

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



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



DL declares that he has no competing interests.

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