Insight into the heart from subtle details: diagnosis and differentiation of mitral stenosis

Author: Zhang Haibo, Chief Physician, Beijing Anzhen Hospital, Capital Medical University

Reviewer: Wang Fang, Chief Physician, Beijing Hospital

In the heart, an oasis of life, valves are like guarding soldiers, ensuring the correct flow of blood. But when the loyal gatekeeper, the mitral valve, is eroded, the harmonious rhythm of the heart will be disrupted.

Today, we will delve into the mysteries of the heart, explore the diagnosis and identification of mitral stenosis, and show you how modern medicine, under the guidance of ultrasound, can uncover the mystery of the disease and let the heart play a healthy melody again.

1. Diagnosis of Mitral Stenosis

The diagnosis of mitral stenosis mainly relies on medical examinations, among which the most critical is cardiac ultrasound examination. Cardiac ultrasound, also known as echocardiography, uses ultrasound technology to clearly display the structure and functional status of the heart, providing doctors with an intuitive basis for diagnosis.

1. Cardiac ultrasound

Cardiac ultrasound is the "gold standard" for diagnosing mitral stenosis. On ultrasound images, doctors can observe the activity of the mitral valve, including the movement amplitude and thickness of the valve leaflets, and whether there is calcification. When the mitral valve is narrowed, the movement amplitude of the valve leaflets will decrease, the valve leaflets will thicken and may be accompanied by calcification, all of which indicate the presence of mitral stenosis.

Figure 1 Original copyright image, no permission to reprint

2. Auscultation

Auscultation is one of the basic methods for diagnosing heart diseases. In patients with mitral stenosis, doctors can detect a diastolic rumbling murmur in the apex through auscultation. This characteristic murmur is one of the important signs of mitral stenosis. However, it should be noted that although auscultation can initially indicate the possibility of mitral stenosis, it cannot be used as a basis for diagnosis.

3. Other auxiliary examinations

In addition to cardiac ultrasound and auscultation, electrocardiogram and chest X-ray can also help diagnose mitral stenosis, although they cannot directly confirm mitral stenosis and need to be combined with other test results for comprehensive judgment. Electrocardiogram can record the electrical activity of the heart, which helps to find possible arrhythmias and other problems; chest X-ray can show the shape and size of the heart, which helps to evaluate the functional status of the heart.

2. Identification of Mitral Stenosis

Among heart valve diseases, mitral stenosis has certain overlap in clinical manifestations and examination results with diseases such as aortic stenosis and mitral regurgitation, so they need to be differentiated.

1. Differentiation between mitral stenosis and aortic stenosis

Mitral stenosis and aortic stenosis have different murmur locations on auscultation examinations: the former is located in the apex of the heart, while the latter is located in the aortic valve area. In addition, cardiac ultrasound can clearly distinguish between the two diseases and determine which valve has a problem by observing the structural and functional abnormalities of the valve.

Figure 2 Original copyright image, no permission to reprint

2. Differentiation between mitral stenosis and mitral regurgitation

Although both mitral stenosis and mitral regurgitation are mitral valve diseases, their pathological mechanisms and clinical manifestations are different. Mitral stenosis is mainly manifested by limited valve opening, which leads to increased left atrial pressure and pulmonary congestion; while mitral regurgitation is manifested by lax valve closure, which leads to blood reflux into the left atrium. During cardiac ultrasound examination, doctors can observe the different manifestations of these two diseases and distinguish them.

In addition, it should be noted that mitral stenosis and mitral regurgitation may coexist, which is usually caused by rheumatic lesions leading to thickening and calcification of the valve, chordae tendineae, and papillary muscles. Therefore, it is necessary to comprehensively consider various examination results and clinical manifestations during diagnosis to ensure an accurate diagnosis.