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  • Mitral valve stenosis

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  • 394.0 Mitral stenosis
  • 394.2 Mitral stenosis with insufficiency
  • 396.0 Mitral valve stenosis and aortic valve stenosis
  • 396.1 Mitral valve stenosis and aortic valve insufficiency
  • 746.5 Congenital mitral stenosis

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  • I05.0 Rheumatic mitral stenosis
  • I05.2 Rheumatic mitral stenosis with insufficiency
  • I34.2 Nonrheumatic mitral (valve) stenosis
  • Q23.2 Congenital mitral stenosis

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Description

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  • Narrowing of the mitral valve2
  • Causes reduced blood flow
  • Limited blood flow between left atrium and left ventricle
  • Increased volume and pressure of left ventricle
  • Atrial fibrillation and dysrhythmia-induced thrombi
  • Decreased blood flow can cause decreased cardiac output (CO) leading to lightheadedness, fainting, chest pain
  • Decreased blood flow to the rest of the body and brain
  • Four types2

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Essentials of Diagnosis

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General Considerations

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  • Worsens over time, neither exercise or diet improves the stenosis
  • Education on disease management reduces hospitalization
  • Patients with significant mitral stenosis should not participate in competitive sports
  • Strenuous activity should be limited for symptomatic mitral valve stenosis
  • Signs and symptoms should be monitored
  • Emphasis on wellness and prevention

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Demographics

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  • Affects women twice as often as men
  • Occurs in only 40% of all rheumatic heart disease cases
  • Can be congenital, present from birth
  • Can be caused by age-induced dysfunction of the valve from calcification or atherosclerosis
  • More common in patients with history of rheumatic fever

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Signs and Symptoms

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  • Pulmonary hypertension
  • Pulmonary edema
  • Right ventricular failure
  • Decreased CO
  • Peripheral edema
  • Cough with pink, frothy sputum
  • Dyspnea on exertion
  • Hemoptysis
  • Shortness of breath2
  • Anginal chest pain that increases with exercise
  • Orthopnea2
  • Fatigue, weakness2
  • Fainting, dizziness with activity
  • Palpitations
  • Dysphagia
  • Hoarseness

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Functional Implications

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  • Symptoms depend on degree of stenosis
  • Mild-to-moderate stenosis generally does not cause symptoms
  • Severe mitral stenosis causes progressive shortness of breath and increased risk of left atrial overload
  • Minimial at first and patients may be unaware of reduced cardiovascular capacity until it becomes severe
  • Higher risk of atrial arrhythmias and embolic events
  • Can cause syncope, chest pain, heart failure, deadly cardiac arrhythmias if untreated

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Possible Contributing Causes

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  • Causes of mitral stenosis2
    • Age-related calcification of mitral valve
    • Congenital valve dysfunction
    • Rheumatic fever
    • Recurrent strep infections
    • Use of medications such as ergot preparation
    • Congenital heart defect
    • Blood clots or tumor can block mitral valve
    • Radiation exposure to chest
    • Systemic lupus erythematosus
    • Rheumatoid arthritis
    • Coronary artery disease
    • Hyperlipoproteinemia
    • Hypertension
    • Diabetes mellitus
    • Older age

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Differential Diagnosis

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  • Acute coronary syndrome
  • Mitral regurgitation
  • Aortic stenosis
  • Cor triatriatum (triatrial heart)
  • Aortic regurgitation
  • Idiopathic pulmonary ...

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