Mitral Valve Stenosis

Exams and Tests

Mitral valve stenosis is a "quiet" condition—it often has no symptoms in its early stages and may not be diagnosed until you've had the disease for some time. If you are not having symptoms, such as shortness of breath or pounding of the heart, the first indication of mitral valve stenosis could be a suspicious heart murmur that your doctor hears during a routine checkup.

Medical history and physical examination

A review of your medical history and a physical examination can predict whether you have mitral valve stenosis and help determine future treatment. Your doctor will ask about your lifestyle, activity level, and any conditions that you or any of your immediate family members have had. Your doctor will want to know about any symptoms you are having and if you have ever had:

• Rheumatic fever, an infection caused by an untreated strep throat infection.
• Endocarditis, an infection of the lining of the heart's valves and chambers.
• A congenital heart defect, which is a structural heart problem or abnormality present since birth.
• Atrial fibrillation, a persistent irregular heartbeat.
• Symptoms of heart failure, such as shortness of breath, swelling in the feet and ankles, and dizziness, fainting, fatigue, or weakness.

During the physical exam, the doctor will take your blood pressure, check your pulses, listen to your heart (possibly while you are lying on your left side) and lungs, and look for signs of fluid buildup (edema). Findings that may indicate a problem with your heart or heart valves include:

• A distinctive heart murmur—heard best while lying on your left side—and a specific extra heart sound, called an opening snap. These characteristic sounds can be easily missed or attributed to other heart or lung conditions, especially in people who are older, overweight, or have preexisting heart conditions.
• Swelling, especially in the legs, ankles, and feet, due to fluid buildup in the body (edema).
• Bulging neck veins caused by a backup of blood outside the heart.
• Fine crackles heard in the lungs, which are evidence of fluid buildup in the lungs.
• In severe cases, redness or flushing of the cheek area (mitral facies), especially in people who have fair complexions.

Echocardiogram

An echocardiogram is used to determine whether mitral valve stenosis is present and to estimate its severity. Echocardiography uses high-pitched sound waves to produce an image of the heart. Specifically, an echocardiogram can show structural problems of the heart that may affect the mitral valve.

Transesophageal echocardiography is often used in people when evaluating the heart through a thick chest wall is difficult. For this procedure, a device that uses ultrasound waves to produce an image of the heart is inserted through the mouth and down the throat into the esophagus. This test is often used—at the end of a mitral valve surgery, before the surgeon closes the incision—to see whether the valve is working properly.

Echocardiography should be considered if the doctor suspects mitral valve stenosis, whether or not symptoms are present, or if you have associated conditions such as heart failure or atrial fibrillation.

Your doctor can use an echocardiogram to:

• View the mitral valve opening and closing.
• Measure the size of the valve opening. A normal mitral valve opens between 4.0 cm² and 5.0 cm². Technically, stenosis is present when the valve area is less than 4.0 cm². Symptoms do not usually develop until the mitral valve opens less than 2 cm², and no intervention is usually required until it is less than 1.0 cm² to 1.5 cm².²
• Indirectly measure the pressure on the valve to determine the severity of mitral valve stenosis.
• View the general appearance and function of the left ventricle, the heart's main pumping chamber.
• Assess how much the leaflets of the mitral valve are damaged.
• Estimate the blood pressure in the pulmonary arteries.
• Assess the condition of the other heart valves.
• Measure the size of the left atrium.

You will likely have regular echocardiograms so your doctor can keep track of any changes in your condition. How often you get an echocardiogram depends on the severity of your mitral valve stenosis. Your doctor may recommend an echocardiogram every year if you have severe stenosis, every 1 to 2 years if you have moderate stenosis, or every 3 to 5 years if you have mild stenosis.²

An echocardiogram can also help determine whether other heart conditions are also present, such as mitral valve regurgitation or aortic valve regurgitation.

Electrocardiogram

Electrocardiogram is used to measure the electrical activity in the heart by attaching small metal discs called electrodes to the chest, arms, and legs. The electrodes are also connected to a machine that translates the electrical activity into line tracings on paper. These tracings are often analyzed by the machine and then carefully reviewed by a doctor for abnormalities. This test is usually part of the standard evaluation of a person with symptoms of mitral valve stenosis.

An electrocardiogram (EKG or ECG) can:

• Verify how your heart is beating and whether it is in normal sinus rhythm.
• Help determine whether the heart chambers are enlarged.
• Screen for evidence of heart attack or poor blood flow to the heart (ischemia).

Chest X-ray

A chest X-ray may show evidence of mitral valve stenosis, such as enlargement of the upper left heart chamber (left atrium), enlargement of the pulmonary arteries, and too much blood and backup of fluid in the lungs (pulmonary edema). Calcium deposits on the heart valves occasionally may be seen on a chest X-ray, especially if the buildup is severe.

An EKG and chest X-ray find evidence of mitral valve stenosis only if it has caused other problems. These include enlargement of the heart (dilation), a thickened heart muscle (hypertrophy), an abnormal left atrium, an irregular heartbeat (arrhythmia), or an insufficient blood flow to the heart (ischemia).

Cardiac catheterization

Cardiac catheterization is usually done before any surgery for mitral valve stenosis to evaluate your heart, the degree of stenosis, and the heart (coronary) arteries. During a cardiac catheterization, the pressure in the heart chamber above the mitral valve (left atrium) is compared to the pressure in the chamber of the heart below the mitral valve (left ventricle). A large pressure buildup in the left atrium confirms the diagnosis of mitral valve stenosis and helps determine how severe it is.

This test may be needed when results of echocardiography are inconclusive or inconsistent with your symptoms. It can also identify other heart conditions that may cause symptoms similar to mitral valve stenosis. For example, it can evaluate the coronary arteries and check for coronary artery disease. Knowing the condition of the coronary arteries may affect later treatment decisions for mitral valve stenosis.

More Information: How do other valve problems affect the diagnosis and treatment of mitral valve stenosis? How often should I have an echocardiogram for mitral valve problems? Should I consider cardiac catheterization? How does my doctor determine which valve problem I may have? Chart of diagnostic tests used for mitral valve problems

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Author:	Robin Parks, MS	Last Updated: March 18, 2008
Medical Review:	E. Gregory Thompson, MD - Internal Medicine Stephen Fort, MD, MRCP, FRCPC - Interventional Cardiology
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