BACKGROUND: Chronic rheumatic heart disease is the commonest cause of mitral valve disease in India. Atrial fibrillation particularly in mitral valve stenosis is a major factor for mortality and morbidity. METHODS: This hospital based observational study was performed in the cardiology department of Madras Medical College. All the RHD patients with mitral valve involvement were undergone Electrocardiogram and echocardiography. RESULTS: In this study consecutive 150 patients with mean age of 39.9 were enrolled. Female 77% and male were 23%. Isolated mitral valve stenosis was found in 49(32.7%) and combined MS with MR was 101(67.3%). Atrial fibrillation was found in 41(27%), of which 53% were aged > 50 years. CONCLUSION: Rheumatic mitral valve disease is more common in females as compared to males. Out of 150 patients 41 patients had atrial fibrillation. Combined MS with MR is more common than isolated MS. Echocardiography and ECG are the important modality for evaluation and management of patients with valvular heart disease.