What is mitral valve stenosis?

Mitral valve stenosis is a narrowing in the opening of the mitral valve in the heart. The mitral valve is located between the upper and lower parts of your heart on the left side. Before each heart beat, the upper part of your heart fills with oxygen-rich blood that has passed through your lungs and the mitral valve opens. Then your heart muscle squeezes to push blood into the lower part. At the end of the squeeze, the valve closes tightly so that blood flows in just 1 direction through your heart.

A mitral valve that can’t open all the way reduces the amount of blood that can flow through your heart. This is called stenosis. Over time, the stenosis can cause high blood pressure in the upper left part of your heart and in your lungs. This can cause trouble breathing and damage your heart.

What is the cause?

Several things can cause mitral valve stenosis:

• Scarring of the mitral valve by rheumatic fever or other diseases.
• A buildup of calcium on the valves. Calcium is a mineral that you get from food. Calcium goes into your blood, and in some people, calcium builds up on the valve as blood flows through it. Why this happens in some people but not others is not known.
• An abnormal mitral valve that you were born with that is partly stuck together. This stops the valve from opening normally.
• Some medicines can cause narrowing of the mitral valve.

What are the symptoms?

Symptoms may include:

• Feeling very tired
• Shortness of breath and trouble doing things such as climbing stairs or even making a bed
• Suddenly waking up feeling short of breath
• Palpitations (feeling that your heart is beating harder, faster, or slower than usual or that it is skipping beats)
• Swelling of the ankles
• Long-lasting cough or coughing up blood

You may have few or no symptoms for a long time. If your symptoms worsen, you need treatment to prevent permanent heart damage.

How is it diagnosed?

Your healthcare provider will ask about your symptoms and medical history and examine you. Your provider will use a stethoscope to listen for the sound of a heart murmur caused by the blocked valve.

Tests may include:

• A chest X-ray
• An ECG (also called an EKG or electrocardiogram), which measures and records your heartbeat. You may have an ECG while you are resting or while you exercise on a treadmill.
• An echocardiogram, which uses sound waves (ultrasound) to see how well your heart is pumping
• Heart catheterization, which uses a small tube called a catheter inserted into a blood vessel, dye, and X-rays to show blood flow through the mitral valve

How is it treated?

If the narrowed valve is not causing any symptoms, you may not need treatment.

If you have abnormal heart rhythms, shortness of breath, or other symptoms, your healthcare provider may prescribe:

• A low-salt diet or medicine to help get rid of extra water in your body
• Medicines to help your heart pump better
• A blood thinner to prevent small blood clots that could cause a stroke

You may need balloon valvuloplasty, which uses a small tube with a balloon at one end to stretch and open the valve.

If your symptoms are severe, you may need surgery to open the fused valve or to replace it with an artificial heart valve. Two types of artificial heart valves are available:

• Mechanical valves are made completely from man-made materials. When you have a mechanical valve, you must take blood-thinning drugs for the rest of your life to reduce the risk of blood clots. The main advantage of mechanical valves is that they usually last 20 years or more.
• Biological valves are made from human or animal tissue. The main advantage of a biological valve is that you do not need to take blood-thinning drugs for the rest of your life. These valves usually do not last for more than 15 years.

How can I take care of myself?

Follow the full course of treatment prescribed by your healthcare provider.

A healthy lifestyle may also help:

• Eat a healthy diet. Ask your provider about the benefits of talking to a dietician to learn what you need in a healthy diet.
• Try to keep a healthy weight. If you are overweight, lose weight.
• Stay fit with the right kind of exercise for you.
• Limit caffeine.
• Learn to manage stress. Ask for help at home and work when the load is too great to handle. Find ways to relax, for example take up a hobby, listen to music, watch movies, or take walks. Try deep breathing exercises when you feel stressed.
• If you smoke, try to quit. Talk to your healthcare provider about ways to quit smoking.
• If you want to drink alcohol, ask your healthcare provider how much is safe for you to drink.
• Try to get at least 7 to 9 hours of sleep each night.

Ask your healthcare provider:

• How and when you will hear your test results
• How long it will take to recover
• What activities you should avoid and when you can return to your normal activities
• How to take care of yourself at home
• What symptoms or problems you should watch for and what to do if you have them

Make sure you know when you should come back for a checkup. A healthy lifestyle may also help:

Tell all healthcare providers you see that you have mitral valve stenosis. Damaged, abnormal, or artificial heart valves are more likely to get infected by bacteria, which can cause severe problems. Antibiotics can prevent this. Ask your healthcare provider if you should take an antibiotic before any kind of dental work or surgery. This includes having your teeth cleaned or procedures involving the bladder, vagina, or rectum.

How can I help prevent mitral stenosis?

Mitral stenosis is often a result of rheumatic fever. See your healthcare provider if you have a sore throat without other symptoms or if you have been exposed to strep throat. Treating strep throat infections with antibiotics can usually prevent rheumatic fever.