When viewing this topic in a different language, you may notice some differences in the way the content is structured, but it still reflects the latest evidence-based guidance.

Last reviewed: 16 Mar 2025
Last updated: 01 Oct 2024

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • history of rheumatic fever
  • dyspnoea
  • orthopnoea
  • opening snap on auscultation
  • diastolic murmur
  • loud P2
  • neck vein distension
  • paroxysmal nocturnal dyspnoea
  • haemoptysis
  • hoarseness
  • peripheral oedema
  • ascites

Other diagnostic factors

  • 40-50 years old in rheumatic mitral stenosis, 70-90 years old in mitral annular calcification (MAC)-related disease
  • loud first heart sound (S1)
  • irregularly irregular pulse
  • flushed cheeks

Risk factors

  • streptococcal infection
  • female sex
  • ergot medications
  • serotonergic medications
  • systemic lupus erythematosus (SLE)
  • amyloidosis
  • bronchial carcinoid syndrome
  • atherosclerotic risk factors

Diagnostic investigations

1st investigations to order

  • ECG
  • CXR
  • trans-thoracic echocardiography

Investigations to consider

  • trans-oesophageal echocardiography (TEE)
  • cardiac catheterisation
  • dynamic exercise testing

Treatment algorithm

Contributors

Authors

Blase Carabello, MD
Blase Carabello

Professor Emeritus, East Carolina University

Director Valve Program, Roper St Francis Health Care

Charleston

SC

Disclosures

BC declares that he has no competing interests.

Peer reviewers

John R. Charpie, MD, PhD

Associate Professor of Pediatrics

Medical Director

Pediatric Cardiothoracic Intensive Care Unit

University of Michigan Congenital Heart Center

C.S. Mott Children's Hospital

Ann Arbor

MI

Disclosures

JRC declares that he has no competing interests.

David Leaf, MD, MPH

Professor of Medicine

VA Greater Los Angeles Healthcare System

UCLA School of Medicine

Los Angeles

CA

Disclosures

DL declares that he has no competing interests.

Use of this content is subject to our disclaimer