Mitral stenosis general approach to mitral stenosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Raviteja Guddeti, M.B.B.S. [2]

Overview

Mitral stenosis is narrowing of the heart valve between the two left chambers of the heart (left atrium and left ventricle).

Pathophysiology

• The hallmark anatomical picture in mitral stenosis is commisural fusion.
• Because of closure of the mitral valve pressures build up in the left atrium which reflect back to the pulmonary bed.
• This build up of pressures in the pulmonary bed causes pulmonary hypertension causing right heart failure.
• Left ventricle is unaffected in pure mitral stenosis.

Causes

The cause of mitral stenosis is almost always rheumatic heart disease.

Differentiating Mitral stenosis from other Diseases

Mitral stenosis should be differentiated from:

• Cor triatriatum
• Atrial myxoma
• Pulmonary vein obstruction

Natural History and Complications

Natural History

Mitral stenosis is a disease of plateaus. It is intermittently progressive and has a prolonged clinical course before becoming severe.

Complications

Complications occur in the late stages of progression of the disease. They include:

• Atrial fibrillation
• Pulmonary hypertension
• Right heart failure
• Stroke - due to thrombus formation in the left atrium

Diagnosis

Symptoms

Symptoms of mitral stenosis occur late in the course of the disease as the disease progresses slowly over decades. Common symptoms include:

• Dyspnea
• Paroxysmal nocturnal dyspnea]]
• Orthopnea
• Hemoptysis
• Palpitations
• Emboli