Q. What is the treatment process of mitral stenosis?

Presence of symptoms or any complications is an indication for treatment. Apart from penicillin prophylaxis no other treatment is warranted for an asymptomatic patient. Asymptomatic patients even with mild to moderate stenosis should avoid heavy unaccustomed exertion as it may precipitate pulmonary edema. Periodic evaluation including echocardiographic examination should be advised. Young women with mitral stenosis should plan pregnancy as even those with mild to moderate stenosis may become symptomatic during pregnancy.

Medical Treatment

Scope of medical treatment is limited and it is only palliative and not specific. Patients with mild to moderate mitral stenosis with minimal symptoms may be managed on medical treatment. Similarly patients who are not candidates for any intervention may be managed on medication. The principles are to relieve symptoms by diuretics, decrease heart rate and prevent thrombo embolic complications in patients with atrial fibrillation or in those with large left atrial chambers. In patients with sinus tachycardia without severe pulmonary artery hypertension beta blockers are the drug of choice. Beta blockers have to be given cautiously in those with severe pulmonary hypertension as sudden death may be precipitated. Beta blockers, calcium channel blockers or digoxine may be given to control ventricular rate in those with atrial fibrillation. In the absence of pulmonary hypertension and atrial fibrillation digoxine has limited role. Rheumatic fever and infective endocarditis prophylaxis needs to be advised.