Although mitral valve stenosis is a lifelong disease, symptoms usually take 10 to 20 years to develop and can take as long as 40 years.^{1, 2} Early symptoms are often mild and hard to distinguish from other forms of heart disease.

In the later stages of mitral valve stenosis, the left atrium may become damaged, causing more noticeable symptoms.

You may not have any symptoms until an aggravating event-such as exercise, stress, pregnancy, infection, or an irregular heartbeat-occurs. Or you may have only a few symptoms, regardless of how far the stenosis has progressed. It is important that your doctor monitor your condition for physical changes in your heart and lungs that you might not be aware of.

Additional symptoms of mitral valve stenosis are related to developing heart failure and include an irregular heart rhythm (most often due to atrial fibrillation).

Other less common symptoms include:

• Hoarseness and vocal cord paralysis (Ortner's syndrome).
• Difficulty swallowing (dysphagia).
• Chest pain.
• Skin color changes, such as pink to purple shades of the cheeks (mitral facies) or dark bluish hues in various areas of the body due to reduced blood flow (cyanosis). Skin color changes occur rarely and usually only in the end stages of the disease.

Because these symptoms could be caused by various heart and lung problems, it may be difficult at first to connect them to mitral valve stenosis.

Symptoms may not become severe for another 3 to 10 years after they first become noticeable. It is often the development of one or more complications of mitral valve stenosis that leads to its diagnosis.