Mitral stenosis

Alternative Names

Symptoms

• Difficulty breathing
  • During or after exercise
  • When lying flat (orthopnea)
  • Awakening at night with difficulty breathing
• Cough
  • May have blood in the sputum (hemoptysis)
• Fatigue, tired easily
• Frequent respiratory infections (such as bronchitis)
• Chest discomfort (rare)
  • Tight, crushing, pressure, squeezing, constricting
  • Radiates to the arm, neck, jaw, or other areas
  • Increases with activity, decreases with rest
• Sensation of feeling the heart beat (palpitations)
• Swelling of feet or ankles
• Poor growth in children

Note: There are often no symptoms in adults. However, symptoms may appear or get worse with exercise or any activity that raises the heart rate.

Exams and Tests

The health care provider will listen to the heart and lungs with a stethoscope. A distinctive murmur, snap, or other abnormal heart sound may be heard. The typical murmur is a "rumbling apical diastolic murmur with pre-systolic accentuation." This means a rumbling sound is heard over the heart during the resting phase of the heart beat. The sound gets louder just before the heart begins to contract.

The exam may also reveal an irregular heartbeat or lung congestion. Blood pressure is usually normal.

In adults, mitral stenosis may be difficult to distinguish from left atrial myxoma (a tumor of the heart).

Narrowing or obstruction of the valve or enlargement of the atrium may show on:

• Echocardiogram
• Transesophageal echocardiogram (TEE)
• Doppler ultrasound
• Chest x-ray
• ECG (electrocardiogram)
• Cardiac catheterization
• MRI of the heart

This disease may also alter the results of the following tests:

• Swan-Ganz (right heart catheterization)
• Nuclear ventriculography (MUGA or RNV)

References

Otto CM, Bonow RO. Valvular heart disease. In: Zipes DP, Libby P, Bonow RO, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. St. Louis, Mo: WB Saunders; 2007: chap 62.