Rheumatic Mitral Stenosis - Causes, Symptoms, Diagnosis, and Treatment

Introduction

The mitral valve is one of the heart's four valves, and this keeps blood flowing in the right direction. Each valve has flaps that close and open during the heartbeat; if this fails, this affects the heart rate, reduces blood flow, and leads to serious complications.

What Are the Causes of Rheumatic Mitral Stenosis?

The causes of mitral valve stenosis may help understand the triggers behind the cause and know how the heart typically works. The mitral valve is one of the four valves in the heart. Each flap is called a leaflet that closes and opens once during a heartbeat. If this valve does not close or open properly, the blood flow through the heart is reduced. The valve opening narrows. It makes the heart force harder and forces blood through the small opening. Blood flow in between the upper left and lower left chambers may decrease.

The causes of rheumatic mitral stenosis are:

• Rheumatic Fever: The complication of strep throat is the common cause of mitral valve stenosis. This fever damages the mitral valve, leading to mitral valve stenosis. The disease symptoms may not be seen until many years after rheumatic fever.

• Calcium Deposits: The mitral valve may develop calcium deposits. The structures that support the mitral valve flaps may become narrower. The disorder is known as mitral annular calcification or MAC for short. Symptoms of mitral stenosis can result from severe MAC. Even with surgery, treating it is challenging. Aortic valve issues frequently occur in people with calcium surrounding the mitral valve.

• Congenital Heart Defects: Babies with congenital heart defects have narrowed mitral valves causing conditions over time.

• Radiation Therapy: The cancer treatment directly in the chest area can sometimes cause the mitral valve to harden and thicken. The heart valve can damage typically after 20 to 30 years of radiation therapy.

• Other Health Conditions: Rarely, autoimmune diseases like lupus and others can lead to mitral valve stenosis.

What Are the Symptoms of Rheumatic Mitral Stenosis?

The symptoms of mitral valve stenosis worsen slowly. In some cases, they may not have any symptoms or mild ones for many years. The symptoms of mitral valve stenosis can occur at any age, even during childhood. The symptoms are:

• Fatigue occurs due to increased activity.

• Dizziness or fainting.

• Dyspnea, shortness of breath, especially when lying down.

• Swollen legs or feet.

• Irregular heart sounds (heart murmur).

• Coughing up blood.

• Chest pain.

• The sensation of a fast, fluttering, and pounding heartbeat.

When the heart rate rises, as it does during exercise, symptoms of mitral valve stenosis may develop or worsen. Symptoms may be brought on by anything that creates stress on the body, such as pregnancy or diseases.

What Are the Risk Factors of Rheumatic Mitral Stenosis?

The risk factors of rheumatic mitral stenosis are:

• Aging: Older individuals increase the risk of rheumatic mitral stenosis.

• Untreated Strep Infections: Untreated strep throat and rheumatic fever can increase the risk of mitral valve stenosis.

• Illegal Drug Use: MDMA, 4-methylenedioxymethamphetamine, increases the risk of mitral valve stenosis.

• Radiation Therapy: Radiation may lead to mitral valve shape and structure changes. Occasionally, patients who get radiation treatment for specific forms of cancer in the chest region may develop mitral valve stenosis.

• Use of Certain Medication: Migraine drugs contain medicines called ergot alkaloids. Ergot alkaloids rarely cause heart valve scarring that leads to mitral stenosis. Older weight loss drugs that contain Dexfenfluramine and Fenfluramine are also linked to heart valve disease and other conditions.

What Are the Complications of Rheumatic Heart Failure?

Untreated rheumatic mitral valve stenosis can lead to complications like:

• Blood Clots: Irregular heartbeats and mitral valve stenosis can lead to blood clot formation. These clots can travel to the brain and lead to stroke.

• Irregular Heartbeats: Irregular heart murmurs, known as arrhythmias. This can lead to chaotic heart rhythm and irregular rhythm called atrial fibrillation. The risk increases with increasing age.

• High Blood Pressure in Lung Arteries: Condition like pulmonary hypertension. The narrowed mitral valve blocks and slows blood flow. The decreased blood flow leads to increased pressure in lung arteries.

• Right-Sided Heart Failure: High pressure and blood flow change can increase the heart's strain. The heart works harder to pump blood to the right heart chambers. These extra efforts lead to weakening heart muscles and, eventually, failure.

How Is Rheumatic Mitral Stenosis Diagnosed?

Detecting symptoms of rheumatic mitral stenosis can be done through regular checkups and referring to specialists. A cardiologist usually diagnoses by doing the following tests:

• Physical Exam: The easiest sign of mitral stenosis is detecting a heart murmur. A stethoscope is used to listen to the heart and breathing routine.

• Electrocardiogram: Electrical activity of the heart is measured using sensors attached to the skin of the chest and detect heart rhythm problems.

• Echocardiogram: Ultrasound waves provide heart images. The common test used to diagnose mitral stenosis.

• Cardiac Catheterization: The device is inserted in the vessel and threaded up in the heart. This can measure pressures within the heart and identifies rheumatic mitral stenosis.

• Chest X-Ray: X-rays can help diagnose the shape and structure of the heart and identify the cause of mitral stenosis.

What Is the Treatment Provided for Rheumatic Mitral Stenosis?

The treatment for rheumatic mitral stenosis is especially done by replacement and repair, reducing symptoms for years. The medications and other treatments can help in preventing complications. The possible treatments include:

• Medications: Medicines are used to alleviate the symptoms of mitral valve stenosis. Blood thinners, also known as anticoagulants, can help avoid blood clots if patients have atrial fibrillation, a kind of abnormal heart rhythm. Also, long-term courses of antibiotics are used to prevent heart conditions.

• Balloon Valvuloplasty: This surgery aims to repair a mitral valve with a narrowed aperture. It makes use of a tiny balloon and a catheter, which is a hollow, flexible tube. The balloon-tipped catheter is inserted into an artery by the medical professional, typically in the groin. A mitral valve is a target. The mitral valve opening is made wider by the inflation of the balloon. The balloon has lost its air. The catheter and balloon are then taken out.

• Valve Repair With Open Heart Surgery: An open heart surgery called an open valvotomy might be performed if a catheter treatment is not an option. The procedure is also known as a surgical commissurotomy. It eliminates calcium buildup and other scar tissue obstructing the mitral valve opening.

• Mitral Valve Replacement: If the mitral valve cannot be fixed, it may need to be replaced surgically. A mechanical valve or a valve manufactured from cow, pig, or human heart tissue is used to replace the damaged valve. A biological tissue valve is constructed from human or animal tissue. With time, biological tissue valves degrade and may require replacement. Blood thinners are required for life to prevent blood clots in people with mechanical valves.

Conclusion:

Rheumatic mitral valve stenosis is a common condition that may not change an individual's health much. Still, if left untreated, it can lead to many complications and damage to the heart. Steps and methods taken to prevent and treat the conditions help to work and help the valve to function better. There are risks and benefits of valve repair and medication. Consult the healthcare provider before undergoing the treatment.