Mitral valve stenosis is a "quiet" condition-it often has no symptoms in its early stages and may not be diagnosed until you've had the disease for some time. If you are not having symptoms, such as shortness of breath or pounding of the heart, the first indication of mitral valve stenosis could be a suspicious heart murmur that your doctor hears during a routine checkup.

Medical history and physical examination

A review of your medical history and a physical examination can predict whether you have mitral valve stenosis and help determine future treatment. Your doctor will ask about your lifestyle, activity level, and any conditions that you or any of your immediate family members have had. Your doctor will want to know about any symptoms you are having and if you have ever had:

• Rheumatic fever, an infection caused by an untreated strep throat infection.
• Endocarditis, an infection of the lining of the heart's valves and chambers.
• A congenital heart defect, which is a structural heart problem or abnormality present since birth.
• Atrial fibrillation, a persistent irregular heartbeat.
• Symptoms of heart failure, such as shortness of breath, swelling in the feet and ankles, and dizziness, fainting, fatigue, or weakness.

During the physical exam, the doctor will take your blood pressure, check your pulses, listen to your heart (possibly while you are lying on your left side) and lungs, and look for signs of fluid buildup (edema). Findings that may indicate a problem with your heart or heart valves include:

• A distinctive heart murmur-heard best while lying on your left side-and a specific extra heart sound, called an opening snap. These characteristic sounds can be easily missed or attributed to other heart or lung conditions, especially in people who are older, overweight, or have preexisting heart conditions.
• Swelling, especially in the legs, ankles, and feet, due to fluid buildup in the body (edema).
• Bulging neck veins caused by a backup of blood outside the heart.
• Fine crackles heard in the lungs, which are evidence of fluid buildup in the lungs.
• In severe cases, redness or flushing of the cheek area (mitral facies), especially in people who have fair complexions.

Echocardiogram

An echocardiogram is used to determine whether mitral valve stenosis is present and to estimate its severity. Echocardiography uses high-pitched sound waves to produce an image of the heart. Specifically, an echocardiogram can show structural problems of the heart that may affect the mitral valve.

Transesophageal echocardiography is often used in people when evaluating the heart through a thick chest wall is difficult. For this procedure, a device that uses ultrasound waves to produce an image of the heart is inserted through the mouth and down the throat into the esophagus. This test is often used-at the end of a mitral valve surgery, before the surgeon closes the incision-to see whether the valve is working properly.