Monitoring mitral valve stenosis that has no symptoms

When you are diagnosed with mitral valve stenosis, you may have no symptoms. This first stage of the disease, called the asymptomatic phase, can last for 10 to 20 years. There are no symptoms because the mitral valve, whose normal area is 4.0 to 5.0 cm², usually must narrow to 2 cm² before symptoms develop. You may also remain asymptomatic even after your mitral valve has narrowed beyond this threshold.

However, even if you have no symptoms and feel fine, there are several things you need to keep in mind.

Regular medical screening

Despite a lack of visible signs, serious damage can still occur while you are asymptomatic, and you still may need to undergo surgery or other medical treatment at this time. Your doctor may suggest surgery if you have:¹

• An increased risk of dangerous blood clots (thromboembolism). For example, you might have an irregular heart rhythm called atrial fibrillation. Or you might have had a blood clot block an artery (embolism) before.
• High blood pressure in the lungs (pulmonary hypertension).
• A need for surgery outside of the heart as well.
• Plans to become pregnant, or you are pregnant.
• Mitral valves that are still in fairly good condition.

If your stenosis is moderate to severe and you develop atrial fibrillation, you may also need surgery, although there is controversy surrounding this issue.²

To make sure that you do not have any of the conditions described above, it is important that you visit your doctor regularly to monitor the progression of your stenosis and watch out for any complications.

In addition to visiting your doctor regularly to screen for symptoms of mitral valve stenosis, you also need to watch carefully for its symptoms:

• Pounding of the heart (palpitations)
• Fatigue or weakness
• Shortness of breath
• Coughing up blood

It may be difficult to detect some symptoms of mitral valve stenosis since they can be mild or be caused by another condition. For example, a condition such as asthma could also force you to experience shortness of breath. For this reason, you should contact your doctor if you think you are experiencing symptoms of mitral valve stenosis.

Some people may experience an embolism (the blockage of an artery by a blood clot, such as a stroke) as their first symptom of mitral valve stenosis. If a thrombus (clot) breaks free from the surface of your heart and travels through your bloodstream, it becomes an embolism. If the embolism blocks one of your blood vessels and cuts off blood supply to an area of your body, it is called an embolic event.

Rheumatic fever

After you have had rheumatic fever, you may need to take preventive antibiotics on an ongoing basis to prevent a recurrence. This is especially important if you had this illness while a child, as it can recur and may worsen heart valve damage such as mitral valve stenosis.

Although rheumatic fever is rare in the United States, it can be contracted while traveling in a country where it is still prevalent. You may also contract rheumatic fever if you have regular contact with large groups of people who potentially carry the type of bacteria (streptococcus) that causes rheumatic fever. The same bacteria causes strep throat, so you need to be wary if you have regular contact with young children.

If you have never had rheumatic fever but do have mitral valve stenosis, you still need to be concerned, particularly if you have regular contact with those who may carry the bacteria that causes it. If you do come down with strep throat, it should be treated promptly.

Preventive antibiotics for rheumatic fever may consist of either daily or weekly doses of antibiotics.

References

Citations

1. Vahanian A, Palacios IF (2004). Percutaneous approaches to valvular disease. Circulation, 109:1572–1579.

2. Bonow RO, et al. (1998). ACC/AHA guidelines for the management of patients with valvular heart disease: Executive summary. A report to the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients With Valvular Heart Disease). Circulation, 98(18): 1949–1984.

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