When should a patient with mitral stenosis be referred to a cardiologist for further evaluation?

Refer a patient with mitral stenosis to a cardiologist for further evaluation if they have moderate or severe mitral valve disease, regardless of symptoms, as specialist assessment is recommended for all adults with moderate or severe valve disease ¹.

Urgent referral (within 2 weeks) should be considered if the patient presents with severe symptoms such as angina or breathlessness on minimal exertion or at rest, or if there is exertional syncope associated with a murmur suggestive of valve disease ¹.

Additionally, referral is indicated if the patient is pregnant or considering pregnancy and has moderate or severe mitral stenosis, due to the increased risks and need for specialist management in this population ¹.

For asymptomatic patients with mild mitral stenosis, routine echocardiographic monitoring every 3 to 5 years is advised, with referral triggered by progression to moderate or severe disease or development of symptoms ¹.

In patients with heart failure symptoms and mitral stenosis, consider beta-blocker therapy and refer to heart failure guidelines if left ventricular dysfunction is present, implying the need for specialist input ¹.

While the UK guidelines focus on severity and symptomatology for referral, literature also emphasizes the importance of timely specialist evaluation to guide intervention decisions and monitor disease progression, supporting early referral in moderate to severe cases (Saxena, 2015).