Mitral Stenosis — Symptoms, Causes and Treatment in Hyderabad
Mitral stenosis is a narrowing of the mitral valve — the valve between the left atrium and left ventricle — that restricts blood flow from the lungs into the heart's main pumping chamber. In India, it remains predominantly a disease of rheumatic origin, affecting younger patients than in Western countries. Left untreated, it progresses to severe breathlessness, atrial fibrillation, pulmonary hypertension, and heart failure.
What is mitral stenosis?
The mitral valve normally opens widely to allow blood to pass freely from the left atrium into the left ventricle during each heartbeat. In mitral stenosis, the valve leaflets — thickened, scarred, and often calcified from rheumatic fever — cannot open fully. The resulting obstruction raises pressure in the left atrium and pulmonary circulation, eventually causing pulmonary hypertension and right heart strain.
Causes
- Rheumatic heart disease — By far the most common cause in India. A streptococcal throat infection triggers an immune reaction that inflames and damages the heart valves. The mitral valve is most commonly affected, and symptoms may appear 10 to 20 years after the initial episode.
- Congenital mitral stenosis — A rare condition present from birth due to abnormal development of the mitral valve.
- Calcific mitral stenosis — A degenerative condition caused by calcium deposition in older patients, distinct from rheumatic heart disease.
Symptoms
- Breathlessness on exertion — The earliest and most common symptom, which may gradually progress to breathlessness even at rest.
- Fatigue and reduced exercise tolerance — Patients may feel easily tired and unable to perform routine physical activities comfortably.
- Palpitations — Often associated with atrial fibrillation and irregular heart rhythm.
- Haemoptysis — Coughing up blood due to rupture of dilated pulmonary veins.
- Hoarseness — Caused by compression of the left recurrent laryngeal nerve by an enlarged left atrium, also known as Ortner syndrome.
- Peripheral oedema and ascites — Swelling of the legs and fluid accumulation in the abdomen due to right-sided heart failure in advanced stages.
Grading severity
| Mild MS | Valve area above 1.5 cm². MVG below 5 mmHg. Usually minimal symptoms. |
| Moderate MS | Valve area 1.0–1.5 cm². MVG 5–10 mmHg. Significant exertional breathlessness. |
| Severe MS | Valve area below 1.0 cm². MVG above 10 mmHg. Rest symptoms, pulmonary hypertension, AF. |
Treatment
- Rheumatic heart disease — By far the most common cause in India. A streptococcal throat infection triggers an immune reaction that inflames and damages the heart valves. The mitral valve is most commonly affected, and symptoms may appear 10 to 20 years after the initial episode.
- Congenital mitral stenosis — A rare condition present from birth due to abnormal development of the mitral valve.
- Calcific mitral stenosis — A degenerative condition caused by calcium deposition in older patients, distinct from rheumatic heart disease.