Mitral stenosis is a narrowing of the mitral valve, located between the left atrium and the ventricle. In order to push the blood through the narrow opening, the muscular wall of the atrium swells, and the pressure in that chamber is gradually increasing. This pressure is transferred back through the pulmonary veins to the lungs and fills the lungs with the blood. In order for the blood to flow through the lungs at normal speed, the right ventricle needs to pump more and more intensely, which means that right ventrile expands, too.
The main symptom of mitral stenosis is the loss of breath caused by congestion of the lung (lungs filled with blood). this symptoms is the most pronounced after physical activities, but it can also occur during the rest. The patient may be coughing up sputum filled with blood, become more sensitive to acute bronchitis attacks, and have chest pains, similar to those in angina pectoris.
Since the blood pressure is growing throughout the bloodstream, the patient will feel general exhaustion, have swollen ankles, and other symptoms that alert to cardiac decompensation. If this happens, the symptoms in the chest are usually weak because the fluid – due to the heart failure – is accumulating in other parts of the body, and not in the lungs.
After the rheumatic fever, almost 60% of the patients develop some type of heart disease, and almost 75% of these patients have a certain degree of mitral stenosis. However, in recent years the number of patients with rheumatic fever has decreased, and so is the number of people who have mitral stenosis.
General weakness and loss of breath will, obviously, cause negative effect on a patient, especially if that person is a pregnant woman, or someone who has some type of infection in the chest, or a person with overactive thyroid. However, the greatest danger comes from atrial fibrillation because embolus formation occurs. Atrial fibrillation occurs in nearly 50% of patients with mitral stenosis, and emboluses are created in almost half of them. But if you are under 45, you have a good chance of avoiding this complication.
What to do?
Contact your doctor if you have any of these symptoms. Occasionally, the mitral stenosis is detected by chance, for example, on a regular medical examination. After the examination, in which the doctor pays the attention to the heart and lungs, he will be able to diagnose mitral stenosis by listening to the heart with a stethoscope, but he will probably refer you to the heart disease specialist for other tests. This will include X-rays and electrocardiograms (ECG) to see if the left atrium is enlarged. If you have an atrial fibrillation, the ECG will show it. The specialist may also want an echocardiographic finding for another confirmation of the diagnosis.
Self-help: if the disease has not physically disabled you, you will be able to live a normal life and you do not have to treat the mitral stenosis. However, always ask your doctor for antibiotics if you are having an operation or tooth extraction to protect you against bacterial endocarditis.
Professional help: if you are having problems with breathing, your doctor may prescribe a diuretic that will allow you to get rid of fluid from the body. However, some diuretics cause a potassium loss that needs to be replaced; that is why your doctor will also prescribe potassium tablets.
Atrial fibrillation is usually regulated by beta-blockers or heart relaxants, and you can also get anticoagulants to prevent embolism. If the mitral stenosis is so strong that it limits your daily activity, a surgery is recommended. The operation will, for example, be necessary if you are pregnant (pregnancy will make the symptoms of mitral stenosis even worse). The operation is called valvulotomy. This operation inevitably implies a small danger; but, if you are healthy, the healing prospects are very good, and the symptoms may not appear in years. If your symptoms reappear you may ask for another valvulotomy, or maybe replace a sick valve with an artificial. 80% of people who had this surgery have lived for at least five more years.