Mitral Stenosis

Mitral stenosis is a narrowing or blockage of the opening of the mitral valve, which separates the upper and lower chambers on the left side of the heart Mitral Stenosis is the leading cause of congestive heart failure in developing countries. . Mitral stenosis is a narrowing of the mitral valve in the heart This prevents proper blood flow from moving between the left atrium (upper chamber of the heart) and ventricle (lower chamber of the heart) This in turn means there is a reduced amount of blood that is pumped out into the body from the left ventricle. . Mitral stenosis almost always results from rheumatic fever, a childhood illness that sometimes occurs after untreated strep throat or scarlet fever (see Bacterial Infections : Rheumatic Fever ).

When the valve has narrowed to less than 1.5 cm2 (normal, 4–6 cm2), the left atrial pressure must rise to maintain normal flow across the valve and a normal cardiac output. This results in a pressure difference between the left atrium and left ventricle during diastole. The pressure gradient and the length of the diastolic murmur reflect the severity of mitral stenosis; they persist throughout diastole when the lesion is severe or when the ventricular rate is rapid.

In mild cases, left atrial pressure and cardiac output may be essentially normal and the patient asymptomatic, but in moderate stenosis (valve area < 1.5 cm2)—especially with tachycardia, which shortens diastole and increases mitral flow rate—dyspnea and fatigue appear as the left atrial pressure rises. With severe stenosis, the left atrial pressure is high enough to produce pulmonary venous congestion at rest and reduce cardiac output, with resulting dyspnea, fatigue, and right heart failure. Recumbency at night further increases the pulmonary blood volume, causing orthopnea and paroxysmal nocturnal dyspnea. Severe pulmonary congestion may also be initiated by any acute respiratory infection, excessive salt and fluid intake, endocarditis, or recurrence of rheumatic carditis. As a result of long-standing pulmonary venous hypertension, anastomoses develop between the pulmonary and bronchial veins in the form of bronchial submucosal varices. These often rupture, producing mild or severe hemoptysis. In a few patients, the pulmonary arterioles become narrowed; this greatly increases the pulmonary artery pressure and accelerates the development of right ventricular hypertrophy and failure. These patients have relatively little dyspnea but experience fatigue on exertion.

Mitral stenosis can also be present at birth (congenital). Infants born with the disorder rarely live beyond age 2, unless they have surgery Typically, when rheumatic fever is the cause of mitral stenosis, the mitral valve cusps are partially fused together. . It is narrowed ('stenosed') when it is open. . The walls of the left atrium then become thickened (hypertrophied) and the atrium enlarges (dilates). These thrombi embolize in 20% of patients. The history of rheumatic fever may or may not be elicited systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), atrial myxoma, malignant carcinoid

Cause of Mitral Stenosis

Here are the list of the possible cause of Mitral Stenosis :

• The heart, the center of your circulatory system, consists of four chambers
• The condition may be present from birth (congenital), but it seldom occurs as a single defect. Congenital mitral stenosis is more often part of a complex heart deformity.
• Deposits of calcium ('calcification') in parts of the valve. This sometimes occurs in older people.
• The leaflets of the mitral valve connect to the heart muscle through a ring called the annulus
• The infection may cause the leaflets of the valve to thicken, limiting the valve's ability to open. The infection may cause the leaflets of the valve to thicken, limiting the valve's ability to open.
• Some congenital heart problems. It is then usually part of a complex heart deformity
• The main risk factor for mitral stenosis is a history of rheumatic fever.
• Mucopolysaccharidoses (of the Hunter-Hurler phenotype)

Symptoms of Mitral Stenosis

Some sign and symptoms related to Mitral Stenosis :

• This tends to occur on exercise at first, but occurs at rest if the stenosis becomes worse
• Severe mitral stenosis may result in high blood pressure in the lungs (pulmonary hypertension) and a low level of oxygen in the blood
• Difficulty breathing, sometimes during the night or when you are lying flat
• Palpitations (awareness of your heartbeat)
• Heart palpitations � sensations of a rapid, fluttering heartbeat
• Rarely, chest discomfort or chest pain
• Sensation of feeling the heart beat ( palpitations )
• Coughing up blood stained sputum may occur due to the congestion of blood and fluid in the lungs.

Treatment of Misitral Stenos

• Medications include diuretics (water pills), nitrates, or beta-blockers. Digoxin may be used to treat atrial fibrillation. Anti-coagulants (blood thinners) are used to prevent blood clots from forming and traveling to other parts of the body.
• ACE Inhibitors are medicines which help to reduce the amount of work the heart does and ease symptoms of heart failure.
• The data on beta-blockers are conflicting; beta-blockade may be useful for patients with exertional symptoms if the symptoms occur primarily at high heart rates.
• Anti - arrhythmic medication may be needed to control your heart rate if you develop atrial fibrillation.
• Digoxin may be used to treat atrial fibrillation.
• Warfarin ('anticoagulation') is usually advised if you develop atrial fibrillation. This helps to prevent blood clots from forming.

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