Mitral stenosis history and symptoms
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Mohammed A. Sbeih, M.D. [2]
Overview
After the initial episode of rheumatic fever, there is an approximate 20 year latent period before symptoms develop in mitral stenosis. Approximately half the patients will not have a recollection of having rheumatic fever. In the developed world, most patients develop symptoms between the age of 20 and 50. Initial symptoms are worsened by exercise or tachycardia. Symptoms may begin with an episode of atrial fibrillation, or may be triggered by pregnancy or other metabolic stress, such as an infection. The symptoms are initially those of left heart failure, and subsequently are those of right heart failure.
History and Symptoms
Initial Symptoms
Symptoms of mitral stenosis include:[1][2]
These symptoms are exacerbated by any condition that causes tachycardia including anemia, thyrotoxicosis, fever, pregnancy (particularly in the second trimester) and the onset of atrial fibrillation as the left atrium dilates.
Mid-course Symptoms of Left Heart Failure
The above plus:
- Chest discomfort
- Orthopnea
- Paroxysmal nocturnal dyspnea
- Hoarseness due to compression of the left recurrent laryngeal nerve by the left atrium[3]
- Cough can be caused by compression of a bronchus by the left atrium.
Later Symptoms of Right Heart Failure and Pulmonary Hypertension
The above plus:[4]
- Hemoptysis
- Thromboembolism
- Frequent respiratory infections such as bronchitis
- Ascites and edema (if right-sided heart failure develops)
- Fatigue, becoming tired easily
Congenital Mitral Stenosis
In infants and children, symptoms may be present from birth (congenital), and almost always develop within the first 2 years of life. Symptoms include:[5]
2018 AHA/ACC Guideline for the Management of Adults With Congenital Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines[6]
Recommendation for Congenital Mitral Stenosis
| Class I |
| 1. Adults with congenital mitral stenosis or a parachute mitral valve should be evaluated for other left-sided obstructive lesions(Level of Evidence: B-NR) |
References
- ↑ Carabello BA (2005). "Modern management of mitral stenosis". Circulation. 112 (3): 432–7. doi:10.1161/CIRCULATIONAHA.104.532498. PMID 16027271.
- ↑ Maganti K, Rigolin VH, Sarano ME, Bonow RO (2010). "Valvular heart disease: diagnosis and management". Mayo Clin Proc. 85 (5): 483–500. doi:10.4065/mcp.2009.0706. PMC 2861980. PMID 20435842.
- ↑ Mohamed AL, Zain MM (2004). "Hoarseness of Voice in a Patient with Mitral Stenosis and Ortner's Syndrome". Malays J Med Sci. 11 (2): 65–8. PMC 3433978. PMID 22973129.
- ↑ Scarlat A, Bodner G, Liron M (1986). "Massive haemoptysis as the presenting symptom in mitral stenosis". Thorax. 41 (5): 413–4. PMC 1020641. PMID 3750250.
- ↑ Collins-Nakai RL, Rosenthal A, Castaneda AR, Bernhard WF, Nadas AS (1977). "Congenital mitral stenosis. A review of 20 years' experience". Circulation. 56 (6): 1039–47. PMID 923042.
- ↑ Stout KK, Daniels CJ, Aboulhosn JA, Bozkurt B, Broberg CS, Colman JM; et al. (2019). "2018 AHA/ACC Guideline for the Management of Adults With Congenital Heart Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines". J Am Coll Cardiol. 73 (12): 1494–1563. doi:10.1016/j.jacc.2018.08.1028. PMID 30121240.