Which investigations are recommended to confirm a diagnosis of mitral stenosis in primary care?

In primary care, the key investigation recommended to confirm a diagnosis of mitral stenosis is an echocardiogram. Adults presenting with a murmur suggestive of valve disease, especially if accompanied by symptoms such as breathlessness or angina, signs like peripheral oedema, or an abnormal ECG, should be offered an echocardiogram to assess valve structure and function. Echocardiography is the definitive test to confirm mitral stenosis and evaluate its severity. Referral for echocardiography should also be considered in adults with a murmur and relevant risk factors such as family history, age over 75, or a history of atrial fibrillation. If valve disease is suspected and the patient has severe symptoms or exertional syncope, urgent echocardiography and specialist assessment within 2 weeks are recommended. Other investigations like NT-proBNP measurement may be used to assess heart failure but are not diagnostic for mitral stenosis itself. Therefore, echocardiography remains the cornerstone investigation in primary care to confirm mitral stenosis and guide further management or referral to specialist care.