Overview
Mitral stenosis is a functional or structural abnormality of the mitral valve caused by a variety of reasons, resulting in a decrease in the open area of the valve.
Mild stenosis symptoms are not obvious, with the progress of the disease may appear dyspnea, cough, hoarseness, hemoptysis and so on.
Mainly caused by rheumatic fever, but may also be related to valve degeneration, congenital developmental abnormalities, etc.
Long-term asymptomatic patients can be observed regularly; symptomatic patients can be treated with medication, intervention and surgery.
Definition
Mitral stenosis refers to a reduction in the open area of the mitral valve orifice and is caused by functional or structural abnormalities of the mitral valve due to a variety of reasons, the most common causative agent being rheumatic fever.
The heart has four chambers: the left atrium, the left ventricle, the right atrium, and the right ventricle. Between the left atrium and the left ventricle is a “one-way valve” that controls blood flow, the mitral valve. In normal adults, the area of the mitral valve is 4 to 6 cm2 (square centimeters). When the area of the mitral valve is less than 2 cm2, blood from the left atrium cannot flow smoothly into the left ventricle.
Morbidity
It is most common in young adults between the ages of 20 and 40.
It is more common in women, accounting for about 70% of cases.
Causes
Causes
Rheumatic fever
Repeated episodes of rheumatic fever lead to chronic inflammation and fibrosis of the valve, which can cause shortening, sclerosis, and deformation of the valve leaflets, and ultimately a reduction in the size of the valve orifice, which is the most common cause of mitral stenosis.
Valve degeneration
As the heart grows older, the mitral valve degenerates, with thickening and calcification of the valve membrane, causing restriction of leaflet movement and eventually leading to orifice stenosis.
Congenital Developmental Abnormalities
Less commonly, abnormal development of the valve itself or accessory structures results in restricted opening of the mitral valve leaflets, such as double-orifice mitral valve, parachute mitral valve, arched mitral valve, and supravalvular mitral annular stenosis.
Other rare causes
Connective tissue diseases (systemic lupus erythematosus, rheumatoid arthritis, scleroderma, etc.), infiltrative diseases, cardiac tuberculosis, and drug-associated valvulopathies generally have less severe stenosis.
Symptoms
Mild stenosis may be asymptomatic. As the disease progresses, dyspnea, cough, hoarseness, hemoptysis, etc. may occur.
Main Symptoms
Dyspnea
It is the most common and earliest symptom.
In the early stage, there is no dyspnea at rest, but dyspnea occurs with strenuous physical activity, emotional stress, sexual behavior, pregnancy, etc. In the late stage, dyspnea occurs at rest.
In the late stage, dyspnea occurs at rest.
In severe cases, sedentary breathing occurs, which is characterized by dyspnea when lying down and having to breathe half lying down or sitting down; paroxysmal nocturnal dyspnea, which is characterized by being forced to sit up at night after sleeping because of chest tightness and shortness of breath.
Coughing and hoarseness
Extreme enlargement of the left atrium compressing the bronchial tubes or the recurrent laryngeal nerve may cause coughing and hoarseness.
The cough is often dry when lying down and is noticeable in winter.
Hemoptysis
Hemoptysis refers to bleeding from the trachea, bronchial tubes, or lung tissue, with the blood being coughed out of the mouth through coughing.
It can be the first symptom of the disease.
It may be bloody sputum or blood-streaked sputum, or it may result in sudden hemoptysis with a large amount of fresh blood.
Other symptoms
Mitral facies: dark color, purplish redness in the zygomatic region (below the outside of the eyes) on both sides, and bruising of the lips and mouth.
Complications
Atrial fibrillation: palpitations, chest tightness, fatigue, dyspnea, dizziness, or even fainting may occur.
Acute pulmonary edema: severe dyspnea, coughing up pink foamy sputum, forced sitting position, cyanosis (bruising of lips and nails), irritability, sweating, etc. may occur.
Thromboembolism: including embolism in the body circulation and pulmonary embolism occurring in the brain, limbs, spleen, kidneys, mesentery, etc., which may present corresponding symptoms, such as cerebral embolism, which may present with vomiting, coma, or even death.
Heart failure: dyspnea, cough, sputum, hemoptysis, skin and mucous membrane bruising, abdominal distension, loss of appetite, nausea, vomiting, and edema of the lower limbs and other sagging parts can occur.
Infective endocarditis: acute cases may present with high fever, chills, chills, extreme weakness and fatigue; subacute cases may present with mild weakness and malaise, intermittent low-grade fever, and muscle aches and pains.
Lung infection: fever, cough, sputum, shortness of breath, chest pain, general malaise, etc. may occur.
Consultation
Department of Medicine
Cardiovascular Medicine
Routine physical examination reveals mitral stenosis, or symptoms such as dyspnea, cough, hemoptysis, fatigue, palpitation, etc., timely consultation is recommended.
Emergency Medicine
Sudden severe chest pain, dyspnea, etc., it is recommended to go to the Emergency Department immediately.
In case of loss of consciousness, respiratory and cardiac arrest, immediately call 120 emergency and perform cardiopulmonary resuscitation (CPR) on the patient at the same time.
Preparation
Preparing for your visit: registration, information preparation, common problems
Tips for medical treatment
Mitral stenosis often occurs in patients with rheumatic fever and requires special attention.
Preparation List
Symptom list
Pay particular attention to the time of onset of symptoms, specific manifestations, etc.
What are the main symptoms?
Is there a cough, hemoptysis?
Is there dyspnea?
Is there hoarseness?
What are the triggers and relievers of the symptoms?
How many times a day do these symptoms occur? How long do they last?
Medical History Checklist
Is there a family history of related medical conditions?
Is there a history of rheumatic fever?
Any drug or food allergies?
Any other medical conditions?
Checklist
Test results for the past 6 months, which can be brought with you to the doctor’s office
Blood Tests
Blood biochemistry
Cardiac enzymes
Echocardiogram
Chest X-ray
Electrocardiogram and 24-hour ambulatory electrocardiogram
Medication List
Medication used in the last 3 months, if available in boxes or packages, bring with you to the doctor’s office
Antibiotics: penicillin, cephalosporin antibiotics
Diuretics: furosemide, hydrochlorothiazide
Diagnosis
Diagnosis is based on
Medical history
Most have a history of rheumatic fever.
Clinical manifestations
Symptoms: dyspnea, cough, hoarseness, hemoptysis.
Signs: “mitral valve facies”, heart murmur may be found.
Laboratory tests
Mainly used to assess the general condition, investigate the cause of the disease and differential diagnosis.
They include routine blood tests, blood gas analysis, electrolytes, cardiac enzymes, liver function, kidney function and other tests.
Imaging examination
Chest X-ray
It can observe the structure and morphology of the lungs, heart and blood vessels with or without abnormalities to help diagnose the disease.
A pear-shaped heart shadow is indicative of a mitral valve heart.
Precautions
The test is radioactive, so women who are preparing for pregnancy or are already pregnant need to inform the doctor in advance.
Avoid carrying metal objects, such as necklaces, during the test.
Echocardiogram
It is a reliable method to confirm the diagnosis of mitral stenosis and evaluate the condition.
It can not only detect structural and functional abnormalities of the heart and blood vessels, but also observe in detail the structure and function of the mitral valve and other valves, and measure the area of the mitral valve orifice.
Precautions
Expose the chest as requested by the doctor before the examination.
A coupling agent will be applied to the skin at the examination site. Generally, the coupling agent does not damage the skin.
Maintain a certain position during the examination as required by the doctor and avoid moving around.
The coupling agent can be wiped off with tissue paper after the examination.
Electrocardiogram
By recording the waveform changes of the heart’s electrical activity, we can understand the occurrence and conduction of the heart’s electrical activity.
It can assist in the diagnosis and exclusion of other heart diseases.
The presence of “mitral P-waves” is indicative of the disease.
Precautions
Avoid strenuous exercise and emotional excitement before the examination, and remove electronic products and bracelets from the body.
During the examination, expose the skin of the forehead, bilateral wrists and ankles, position yourself according to the doctor’s requirements, keep breathing evenly and avoid moving.
Grading
Mitral stenosis can be categorized into mild, moderate and severe according to the mitral valve valve orifice area (MVA).
Mild stenosis: MVA is 1.5 to 2.0 cm2.
Moderate stenosis: MVA is 1.0 to 1.5 cm2.
Severe stenosis: MVA <1.0cm2.
Differential Diagnosis
Aortic valve insufficiency
Similarities: both may have a history of rheumatic fever and symptoms such as dyspnea and cough.
Differences: Aortic valve insufficiency is caused by lesions of the aortic valve itself, aortic root disease, and is difficult to distinguish based on symptoms alone, but can be clearly distinguished based on a typical heart murmur and echocardiography.
Left atrial mucinous tumor
Similarity: both may have symptoms such as dyspnea.
Difference: Dyspnea caused by left atrial mucinous tumor is persistent and can be present even without physical activity, and can be differentiated by echocardiography.
Treatment
Treatment principle: if the patient is asymptomatic for a long time, no special treatment is needed and regular observation is sufficient; if the patient is symptomatic, active treatment is needed, and drug treatment, intervention and surgical treatment can be adopted.
General treatment
Pay attention to rest, reduce physical labor and strenuous exercise.
Control sodium intake in diet.
Medication
There is no specific drug, mainly for the symptoms of the drug, but can not release the stenosis of the valve for the obstruction of blood flow.
To improve the dyspnea caused by heart failure, oral furosemide, hydrochlorothiazide and other diuretics can be used.
To control rheumatic fever activity, long-acting penicillin can be used.
Interventional and surgical treatment
Indications
Interventional or surgical treatment can be considered when the mitral valve orifice area (MVA) is <1.5 cm2.
The final decision to proceed with interventional or surgical treatment depends on a number of factors, including symptoms, anatomic conditions of the valve, other valvular pathologies, cardiac function, and surgical risk.
Surgical Procedures
Interventional Surgery
The main procedure is percutaneous balloon mitral valvuloplasty (PBMV), which is a transvenous application of a polyethylene balloon catheter to dilate mitral stenosis.
The advantages are safety, effectiveness, less trauma, and faster recovery.
For those who require surgical treatment, this procedure is the treatment of choice in the absence of left atrial thrombus or moderate or severe mitral regurgitation, and in the presence of appropriate valve anatomy (good leaflet condition).
Interventional procedures may not be performed in those with the following conditions
Left atrial thrombus.
Moderate or severe mitral regurgitation.
Combined severe aortic valve disease, severe organic tricuspid stenosis, severe functional tricuspid regurgitation combined with annular enlargement.
Combined severe coronary artery disease requiring coronary artery bypass grafting.
Severe valvular calcification or junctional calcification.
Surgery
Gradually replaced by interventional procedures.
These include closed junction dissection, junction dissection under direct visualization, and mitral valve replacement.
The main surgical procedure is mitral valve replacement. Closed junctional dissection (rarely used) and direct visualization of junctional dissection are mainly used when PBMC is not indicated.
Surgical Complications
Mitral valve restenosis, perivalvular leakage, infective endocarditis, and thrombosis may occur after surgery.
Prognosis
Cure
In asymptomatic mitral stenosis, the 10-year survival rate is >80%.
Once severe symptoms develop, the 10-year survival rate is only 0-15%.
Among the causes of death in patients with mitral stenosis, heart failure accounts for 60% to 70%, embolism in the physical circulation accounts for 20% to 30%, pulmonary embolism accounts for 10%, and infection accounts for 1% to 5%.
Hazards
It can cause dyspnea, cough, hoarseness, hemoptysis and other symptoms, which affects the normal work and study of patients, and also brings certain psychological pressure.
It can cause atrial fibrillation, acute pulmonary edema, thromboembolism, heart failure, infective endocarditis, lung infection and other complications, which not only make the condition more complicated, but also endanger the life in serious cases.
Daily
Daily Management
Dietary management
Balanced nutrition, high protein, high fiber, low fat diet.
Control sodium intake appropriately.
Small and frequent meals are recommended.
Avoid alcohol consumption.
Exercise management
Adhere to moderate exercise, can choose fast walking, jogging, playing tai chi, etc.. Or follow the doctor’s requirements for reasonable exercise, control the exercise time and choose suitable exercise programs.
Pay attention to safety when exercising, control the intensity of exercise, and do not engage in strenuous exercise.
If there is any discomfort during exercise, stop exercising immediately.
Life management
Ensure adequate sleep and avoid staying up late.
Maintain a healthy weight.
Avoid smoking.
Psychological Support
Avoid emotional excitement, as well as adverse emotions such as excessive tension, depression and anxiety.
Stress can be relieved by listening to soft music, chatting with friends and relatives, reading books, watching movies and TV dramas with soothing dramas.
In severe cases, you can go to a formal psychological counseling institution for consultation and treatment.
Safe use of medication
Take medication as prescribed by your doctor, and do not add, reduce or change medication on your own.
If any discomfort occurs during the use of medication, consult a doctor in a timely manner.
Follow-up and review
Regular checkups can detect changes in your condition, which will help your doctor understand the effect of your treatment and determine whether you need to change your treatment plan.
Asymptomatic patients with severe mitral stenosis and postoperative percutaneous balloon mitral valve dilatation (PBMC) should be followed up annually.
Patients with moderate mitral stenosis should be followed every 1 to 2 years.
Patients with mild mitral stenosis should be followed every 3 to 5 years.
Echocardiography and other tests are required for follow-up.
Prevention
Active treatment of the primary disease
Those with rheumatic fever should be actively treated to avoid causing rheumatic heart disease.
Patients with systemic lupus erythematosus, rheumatoid arthritis, scleroderma, etc., should actively control the disease.
Improve living habits
Pay attention to the indoor environment in your life, open windows more often to keep the indoor air circulating, in order to reduce the chance of exposure to pathogens.
Do more outdoor activities to breathe fresh air, you can do jogging, swimming and other sports to enhance their immunity and improve the ability to resist diseases.
Pay attention to weather changes and increase or decrease clothes appropriately.
Daily attention should be paid to nutrition, light diet, regular work and rest, quit smoking and drinking.