A Simple Guide to Mitral Stenosis (A Heart Valve Disease), Diagnosis, Treatment and Related Conditions

This book describes Mitral Stenosis (A Heart Valve Disease), Diagnosis and Treatment and Related Diseases

Mitral Stenosis is a congenital valvular disease
Where the mitral valves release less blood and close tightly
Blood may leak slowly in the ventricle from the atrium
This may cause strain on the left atrial myocardium

The mitral valve makes a mid-late diastolic murmur
Loud first heart sound with an opening snap in early diastole
The tight valve flaps make a rumbling sound as they shut.
The echocardiogram show the valve movement in the heart

Treatment is to reduce the heart's workload by medications
Diuretic and digoxin are given to treat chest congestion or palpitations
Blood-thinning medicines reduce the risk of blood clots forming
Surgery is needed if the stenosed mitral valves reduce the blood flowing

-An original poem by Kenneth Kee

I had a patient who was found to have mitral stenosis only when she gave birth to her only daughter 30 years ago.
For 10 years she was treated with medication to improve the function of her heart without problem.
A new heart specialist saw her and decided that she was fit for valve replacement.
So after consulting with her family she went ahead with operation.
Her operation was only 90% successful. She had to take warfarin, a blood thinner for life and medical reviews every month initially and now every 6 monthly.

Mitral Stenosis (MS) is a disorder in which the mitral valve does not open fully inducing limitation of blood flow.

The mitral valve is the bileaflet valve that permits the blood from the upper chamber of the heart (left atrium) to flow into the lower chamber (left ventricle).

It then closes preventing blood from flowing backwards into left atrium.

Mitral stenosis indicates that the mitral valve cannot open adequately.

As a result less blood streams out of the heart to the body.

The upper heart chamber becomes swollen as pressure builds up.

Blood and fluid may then accumulate in the lung tissue (pulmonary edema) making it hard to breathe.

In adults mitral stenosis occurs most often in those who have had rheumatic fever which may develop after untreated or poorly treated streptococcal throat or scarlet fever.
The mitral stenosis develops 5-10 years or more after the incident of rheumatic fever

Calcification of the mitral valve leaflets
Congenital heart disease.
Infective endocarditis,
Mitral annular calcification,
Endomyocardial fibroelastosis,
Malignant carcinoid syndrome,

Symptoms are:
Breathlessness
Hemoptysis
Fatigue
Palpitations
Swelling of feet or ankles
Signs
Malar flush on the cheeks
Raised jugular venous pressure
Laterally displaced apex beat
Right ventricular heave

Heart sounds:typical of mitral stenosis are a loud first heart sound, an opening snap, and a diastolic rumble.
CXR: may show left atrial enlargement and interstitial edema (Kerley A and B lines)
Echocardiography is the most specific and sensitive study to diagnose and quantify the severity of mitral valve stenosis.
ECG
TEE (Trans-esophageal echocardiography)
Cardiac catheterization (seldom done now)

At present, no medical therapy can alleviate a fixed obstruction of the mitral valve
Diuretics
Beta-blockers,
Calcium channel blockers
Anticoagulants
Preventive antibiotics

Surgical treatment has improved survival rate of MS:
Mitral valvotomy (surgical or percutaneous)
Mitral valve replacement and repair (valvuloplasty)

TABLE OF CONTENT
Introduction
Chapter 1 Mitral Stenosis
Chapter 2 Causes
Chapter 3 Symptoms
Chapter 4 Diagnosis
Chapter 5 Treatment
Chapter 6 Prognosis
Chapter 7 Mitral Regurgitation
Chapter 8 Aortic Stenosis
Epilogue