Occurs when there is obstruction to flow through the mitral valve during diastole

Aetiology

• Most common cause is rheumatic heart disease
• Other causes include:
  • Mitral annular calcification (age-related)
  • Congenital mitral stenosis (rare)
  • Mucopolysaccharidosis (metabolic disorder affecting connective tissue)
  • Carcinoid syndrome, causing valve disease
  • Systemic disease, including SLE and rheumatoid arthritis

Clinical features

Symptoms

• Typically presents with gradual exertional dyspnoea and reduced exercise tolerance
• Palpitations - AF is common in patients with AF
  • Mitral stenosis causes the pressure in the left atria to remain elevated, so the atria enlarges → can cause AF

Signs

• Mid-diastolic murmur best heard at the apex
• Tapping apex beat
• Malar flush
• Elevated JVP (prominent ‘a’ wave)

Investigations

• CXR: may show evidence of pulmonary oedema and left atrial enlargement
• ECG: may show P-mitrale, right ventricular hypertrophy, right axis deviation
• Echocardiogram: main method to assess the severity and consequences of mitral stenosis
• Cardiac MRI: may show valvular vegetations

Management

Medical