What are heart valves?
There are four valves in the heart. They allow blood to be directed around the heart and when working normally ensure the blood flows in one direction. They open and close with every heartbeat – that’s 100,000 times a day!
Heart Valves
What is a murmur?
A murmur is the sound blood makes as it travels through a valve which is thickened or leaking.
What is the mitral valve?
The mitral valve is a valve situated on the left hand side of the heart. It is a one way valve that allows blood to move from the top chamber of the heart (left atrium) to the bottom chamber of the heart (the main pump – the left ventricle).
What is mitral stenosis?
Mitral stenosis is a condition where the mitral valve becomes thickened or calcified and is less able to open. As a result, the blood flow across the valve into the main pumping chamber (the left ventricle) is reduced.
What causes mitral stenosis?
There are a number of causes of mitral stenosis. The most common cause is Rheumatic fever. If you had an illness with prolonged fever when young, this may be relevant.
Other causes include:
- Valve degeneration (age related wear and tear)
- Congenital disorders (people born with an abnormal heart valve).
What are my treatment options?
Mitral stenosis is a chronic (long term) condition. It can be graded into three categories: mild, moderate and severe.
Mild or moderate mitral stenosis do not usually cause symptoms or any strain on the heart.
Regardless of the severity of mitral stenosis, if you have no symptoms, it is likely that the Heart Valve Team will keep you under review with a clinic visit and echocardiogram (echo or cardiac ultrasound) intermittently as the valve disease can progress. Patients with mitral stenosis are often followed up for many years without any symptoms. Follow up intervals will be determined by the Valve Team looking after you and depends on the severity and progression of your mitral stenosis. Patients with mild aortic regurgitation usually do not require long-term monitoring. Patients with mild mitral stenosis usually require only very intermittent monitoring. Occasionally on-going monitoring of this type of valve disease is not required and the Heart Valve Team will discuss the reasons for this with you.
If your mitral stenosis becomes severe and you develop symptoms, the heart becomes stretched or weakened you may be referred for surgery.
Before seeing a surgeon, you will have a series of tests to decide whether you are suitable for either surgical or percutaneous (key-hole) treatment:
Surgical replacement: The existing valve is removed and replaced with either a tissue or mechanical valve.
Percutaneous intervention: A balloon is inflated inside the valve to improve leaflet mobility and valve opening. This is done under general anaesthetic.
Most people with mitral stenosis will not require any treatment and will just require regular monitoring of their condition.
What tests will I need?
Most people with mitral stenosis will have an ECG and an echocardiogram. Other tests as outlined below may also be performed.
Electrocardiogram (ECG)
Stickers are placed on the chest and the electrical activity of the heart is recorded.
Echocardiogram (Echo or cardiac ultrasound)
During this test an ultrasound probe is place on the chest and moving pictures of the heart are produced. The test takes around 30 minutes.
Angiogram
This is an x-ray dye test of your heart arteries performed under local anaesthetic.
Transoesophageal echocardiogram (TOE)
This is a day case procedure similar to an endoscopy which takes place under sedation. A probe is passed into the gullet and detailed pictures of the heart are obtained using ultrasound.
Lifestyle
As with any type of heart disease, it is important that you follow a healthy diet and keep your weight within a normal range.
Smoking
If you smoke, it is advisable that you stop. Your GP can guide you to support available to help you stop smoking.
Exercise
For most patients there is no limitation for exercising. You can discuss this with your healthcare professional.
Pregnancy
If you are planning to get pregnant you should discuss this with your healthcare professional first and let them know immediately if you become pregnant.
Endocarditis
Bacteria can enter the blood stream via many sources, most commonly the mouth and skin. In patients with abnormal valves these bacteria can attach to the heart valves causing infection known as endocarditis.
It is therefore important to take good care of your teeth by brushing your teeth twice a day and visiting your dentist for regular check-ups (at least once a year). If you have toothache or an abscess it is important that you get treated for this quickly. Make sure you tell your dentist you have a heart valve condition.
In mitral stenosis, it is important to know if you are feeling unwell due to your heart.
You must let the Valve Team know if you develop any heart symptoms in between clinic appointments by calling the valve nurses on 0113 392 5298.
Important symptoms are listed below.
Symptoms
If you experience any new symptoms between clinic appointments then it is important that you let your healthcare professional know.
Call the valve nurses on 0113 392 5298 if you develop:
- Increasing shortness of breath (especially on exertion or when lying flat)
- Palpitations (rapid or irregular heartbeat)
- Difficulty exercising
- Unexplained sweats or fever