Mitral stenosis is a heart valve defect. There is a narrowing of the opening of the mitral valve.
What is mitral stenosis?
In medicine, mitral stenosis is also known as mitral valve stenosis. There is a narrowing of the mitral valve that separates the left ventricle from the atrium. The stenosis leads to an impairment of the blood flow between the left ventricle and the left atrium. See ablogtophone for ICB which stands for Intracerebral Hemorrhage.
The mitral valve normally has an opening area of between 4 and 6 cm². If this area drops to around 2 cm², this is called mitral stenosis or mitral valve stenosis. This creates a severe narrowing, which usually leads to pronounced symptoms. The symptoms are even more severe when the opening area of the heart valve falls below 1 cm².
Mitral stenosis is one of the most common acquired heart defects. Females suffer from the disease more often than males. Overall, mitral valve stenosis accounts for around 20 percent of all heart valve defects. In Europe, around three to four percent of all people suffer from a disease of their heart valves.
In most cases, the cause of mitral stenosis is rheumatic fever. This is caused by exposure to bacteria such as class A streptococci. This often affects the inner lining of the heart. The bacteria cause inflammation of the inner lining of the heart (endocarditis), which later spreads to the mitral valve.
The heart valve is made up of tissue from the inner lining of the heart. Sometimes mitral stenosis does not appear until 20 or even 30 years after rheumatic fever. In the case of acute rheumatic fever, heart valve defects occur in about half of all patients. The mitral valve calcifies, which in turn causes it to narrow and restrict movement.
Mitral insufficiency is often caused by inflammatory-degenerative processes or a heart attack that has been survived. There is a risk that these processes will affect parts of the heart that are important for the stabilization and opening of the valve apparatus. If these structures are impaired, the mitral valve leaflets fold over into the atrium as the heart pumps.
In the case of mitral regurgitation, physicians differentiate between primary (organic) and secondary (functional) triggers. The most common primary causes include infections that directly damage the mitral valve. A secondary cause, on the other hand, is an underlying disease that is negatively affecting the mitral valve. Occasionally, autoimmune diseases are responsible for the occurrence of mitral stenosis. In some patients, the heart valve defect is already congenital.
Symptoms, Ailments & Signs
Mitral stenosis becomes noticeable through shortness of breath. It is caused by blood backing up in the lungs. The back pressure causes the liquid part of the blood to be pressed into the lung tissue, which makes it difficult for the oxygen to be transported into the blood, causing the patient to suffer from breathing problems.
In most cases, shortness of breath occurs during physical exertion, since the heart is more active during this time. In severe cases, breathing difficulties are also possible at rest. Some patients also suffer from coughing up blood (hemoptysis). This causes solid blood components to escape into the lungs, which leads to a red discoloration of the sputum.
If the mitral stenosis lasts for a long time, changes in the heart are possible due to the pressure. There is a risk that the expansion of the left atrium will trigger atrial fibrillation. Atrial fibrillation is associated with disturbances in blood flow, so that there is a risk of blood clots forming. If these are carried over into the body, further clinical symptoms occur.
The strain on the right heart results in a backlog of blood in the right heart, which can manifest itself in leg edema or an enlarged liver. Some patients also suffer from blue discolored skin.
Diagnosis & course of disease
If mitral stenosis is suspected, the doctor first looks at the patient’s medical history. A physical examination will then take place. The doctor uses a stethoscope to listen for suspicious heart sounds. Other possible examination methods are an ECG, an X-ray examination, computed tomography (CT), magnetic resonance imaging (MRI) and echocardiography or Doppler echocardiography.
A right heart or left heart catheter examination is also possible. The course of mitral stenosis is usually more favorable than that of other heart valve defects. Without appropriate therapy, however, the patient’s life expectancy is significantly reduced in severe cases. Those affected are at risk of death from right heart failure or an embolism.
As a rule, mitral stenosis can lead to life-threatening conditions and complaints for the patient. The disease primarily leads to shortness of breath, which can also lead to a loss of consciousness and, in the worst case, to the death of the patient. Likewise, the individual organs are no longer supplied with sufficient oxygen, so that they can be damaged.
Those affected suffer from a bloody cough and severe fatigue and exhaustion. Mitral stenosis also enlarges the liver, which can cause pain and other discomfort. The reduced oxygen transport also causes the skin to turn blue. If the mitral stenosis is not treated, the affected person can also die from this disease.
In most cases, treatment is carried out by taking medications that can relieve the symptoms of mitral stenosis. Usually there are no complications. These usually only occur if the disease is not treated early. In severe cases, surgery may also be necessary. Whether this disease will result in a reduced life expectancy cannot be universally predicted.
When should you go to the doctor?
Disorders and irregularities in the heart rhythm are signs of a health problem that needs to be investigated and treated. If there are problems with breathing activity, clarification by a doctor is also necessary. If there is shortness of breath, an increased pulse rate or a tendency to tire quickly, there is cause for concern.
If everyday duties cannot be carried out due to exhaustion or fatigue, a doctor should be consulted. Sleep disturbances, headaches, malaise and a feeling of illness should be evaluated by a doctor. If the general resilience decreases and physical activities can no longer be carried out as usual, a doctor is needed. If you withdraw from social or sporting activities, if you become irritable or feel less well-being, you should consult a doctor.
If states of fear or panic arise due to shortness of breath, the person concerned needs help. A pale complexion and a blue discoloration of the lips indicate an insufficient supply of oxygen to the organism. A doctor’s visit is necessary to prevent a life-threatening condition. Swelling or a feeling of pressure inside the body are further indications of an existing disease. If functional disorders occur, if a diffuse pain sensation develops or if digestion is impaired, a doctor is needed. If you cough up blood, you need to see a doctor as soon as possible.
Treatment & Therapy
Mitral stenosis is treated either conservatively or surgically. In mild cases, the patient must rest physically and take medications such as diuretics. If there is also pulmonary hypertension, vasodilators such as nitrates are administered. If there is a risk of a cardiac embolism due to atrial fibrillation, the patient is given beta- blockers or blood- thinning drugs to counteract the embolism.
If conservative treatment is not sufficient to improve the mitral stenosis, surgical therapy can be useful to expand or restore the narrowed mitral valve. Balloon dilatation is one of the proven procedures.
A balloon is inserted into the mitral valve region with a small catheter and inflated, which causes the heart valve to expand. Another procedure is the commisurotomy. In this method, the surgeon removes the calcified valve tissue, restoring the mitral valve to function properly.
Outlook & Forecast
Mitral stenosis is one of the more slowly progressive diseases. This means that it often takes years for it to manifest itself clinically in those affected. Mitral stenoses are also often associated with bacterial infections and degenerative processes. In the long term, the disease leads to a significantly reduced pumping capacity of the affected heart. This often manifests itself in a clinical appearance with shortness of breath and a reduced resilience of the patient.
A completely untreated mitral stenosis would certainly lead to an early death of the patient. However, the prognosis is different for each individual patient, especially because the mitral stenoses usually progress gradually until they finally become clinically noticeable. The patient’s heart changes anatomically and functionally to adapt to the disease as much as possible. However, this works differently for each patient.
In the case of patients who require surgery, the survival rate over the next 8 years is 89%. The prognosis of those affected essentially depends on how strong the pumping capacity of the diseased heart is. In those patients who have a more normal pump function, the 10-year survival rate is approximately 72%. Whereas in patients with impaired pump function, the 10-year survival rate is 32%. Sudden deaths are generally relatively rare at around 0.8%.
In order to prevent mitral stenosis, it is advisable to avoid general underlying diseases. So it is important to counteract a heart attack or diabetes, which can be done, for example, through a healthy diet.
Follow-up care for mitral stenosis is important after an operation in which a special miter clip was used. After a night in the clinic’s intensive care unit, the patient is transferred to the normal hospital ward for about three to five days. There he can soon get up and move again. In most cases, symptoms such as shortness of breath improve shortly after the procedure.
After the operation, the patient receives certain medications, such as acetylsalicylic acid (ASA) or clopidogrel. Both belong to the drug group of platelet aggregation inhibitors. These have the property of counteracting the clumping of thrombocytes (platelets) in the blood, which can prevent the formation of a dangerous blood clot. While clopidogrel is given for about a month, acetylsalicylic acid, which has a weaker effect, is given for at least six months.
If the patient also suffers from symptoms such as heart failure, other drugs such as ACE inhibitors, beta-blockers, diuretics or aldosterone antagonists must be taken. Every three to six months after the operation, a follow-up examination takes place at the doctor’s office. A cardiologist should also be visited once a year to check the condition of the heart and mitral valve. It is also advisable to participate in an outpatient heart failure group after completion of the inpatient rehabilitation measures.
You can do that yourself
Adaptation and self-help when mitral stenosis is detected depend very much on the severity of the stenosis and on possible side effects such as atrial fibrillation. In serious cases, which are also expressed through physical weakness and shortness of breath, any physical exertion should be avoided. Even if the subjective feeling is better than would be expected from the objective findings, peaks in physical and mental stress should be avoided as far as possible. Emotional or psychological stress peaks should be avoided if possible, because the sudden release of stress hormones by the sympathetic nervous system due to the increasing blood pressure puts additional strain on the left atrium.
In the case of less serious mitral stenoses, which are hardly noticed subjectively in the normal course of the day, endurance sports such as golf and Nordic walking are recommended without incalculable peak loads. On the other hand, ball sports such as soccer, tennis and handball should be avoided because they are associated with strong and previously unforeseeable stress peaks. Sports with high static loads such as weightlifting and bodybuilding can have an equally unfavorable effect. Those affected should therefore refrain from such sports. How high the individual load may be should be clarified beforehand by a thorough examination of the mitral stenosis.
Relaxation techniques that contribute to deep relaxation and relieve the heart through mental exercises such as meditation or yoga are also helpful.