Mitral Regurgitation

Mitral valve regurgitation, also known as mitral regurgitation, is a condition in which the mitral valve leaflets do not seal tightly. This valvular defect allows blood to flow backward in your heart and is often referred to as a leaking heart valve.

When the mitral valve does not function properly, blood can not efficiently flow through your heart and body. Mitral valve regurgitation is also called mitral insufficiency, or incompetence. The condition - which can be caused by a mitral valve prolapse - often leaves the patient fatigued and short of breath.

According to the Mayo Clinic, as many as one in five people (20%) over the age of fifty-five have some degree of mitral regurgitation. Treatment of mitral valve regurgitation depends on the severity and progression of your condition, signs and symptoms. You may need heart surgery to repair or replace the mitral valve. Left unchecked, severe mitral valve regurgitation can lead to congestive heart failure or serious heart rhythm irregularities (arrhythmias).

What Are Mitral Valve Regurgitation Symptoms?

Signs and symptoms of mitral regurgitation depend on how severely and quickly the disorder develops. Most often, mitral regurgitation is mild and develops slowly. Because many patients have no symptoms (commonly referred to as asymptomatic, you may be completely unaware that you have mitral regurgitation.

According to the U.S. National Library of Medicine, when signs and symptoms of mitral valve regurgitation develop, they do so because the heart is unable to compensate for the valve defect.

Mitral regurgitation is often detected when your doctor hears a heart murmur with a stethescope. Sometimes, however, the disorder develops quickly (less than one year), and you may experience an abrupt onset of symptoms. Indicators of mitral valve regurgitation include:

• Shortness of breath, especially with exertion or when you lie down
• Fatigue, especially during times of increased activity
• Cough, especially at night or when lying down
• Heart palpitations - sensations of a rapid, fluttering heartbeat
• Swollen feet or ankles
• Heart murmur
• Excessive urination

Again, please remember that mitral regurgitation can be asymptomatic. So, please remember to get regular, annual check-ups if you have been diagnosed with a heart murmur, mitral valve prolapse or mitral regurgitation.

Diagnosing The Severity Of Mitral Regurgitation

An echocardiogram is often used to determine the severity of mitral regurgitation -- which can be mild, moderate or severe. The two main determinants in quantifying the severity of mitral regurgitation are:

• Regurgitation volume (RVOL) which is the difference between the mitral and aortic stroke volumes; and
• Effective regurgitant orifice (ERO) which ratio of regurgitant volume to regurgitant time velocity integral

The table below shows how regurgitation volume and effective regurgitant orifice measurements are used to diagnose mitral regurgitation in patient’s with degenerative mitral disease.

A transesophageal echocardiogram, MRI, stress echo or cardiac catheterization may also be used to further diagnose the valvular disorder, the cardiac damage and the recommended surgical treatment of your mitral regurgitation.

Treatment

The choice of treatment depends on the symptoms present and the condition and function of the heart.
Patients with high blood pressure or a weakened heart muscle may be given medications to reduce the strain on the heart and help improve the condition.
Anticoagulant or antiplatelet medications (blood thinners) may be used to prevent clots from forming in patients with atrial fibrillation.
Digitalis may be used to strengthen the heartbeat, along with diuretics (water pills) to remove excess fluid in the lungs.
A low-sodium diet may be helpful. Most people have no symptoms; but if a person develops symptoms, activity may be restricted.
Hospitalization may be required for diagnosis and treatment of severe symptoms. Surgical repair or replacement of the valve is recommended if heart function is poor, symptoms are severe, or the condition gets worse. Once the diagnosis of mitral regurgitation is made, you should have regular follow-ups with a specialist to determine whether you need surgery.
In the past, patients with heart valve problems such as mitral regurgitation were given antibiotics before dental work or an invasive procedure, such as colonoscopy. The antibiotics were given to prevent an infection of the damaged heart valve. However, antibiotics are now used much less often before dental work and other procedures.

Prognosis

The outcome varies based on the underlying conditions. Usually the condition is benign, so no therapy or restriction is necessary. Symptoms can usually be controlled with medication. In severe cases, valve repair or valve replacement may be needed.

Possible Complications

• Arrhythmias (abnormal heart rhythms), including atrial fibrillation and lethal arrhythmias
• Clots to other areas
• Endocarditis (infection of the heart valve)
• Heart failure
• Pulmonary emboli (blood clots in the lungs)
• Stroke

When to Contact a Medical Professional

Call your health care provider if you have symptoms of mitral valve regurgitation, or if symptoms worsen or do not improve with treatment.
Also call your health care provider if you are being treated for this condition and develop signs of infection, which include:

• Chills
• Fever
• General ill feeling
• Headache
• Muscle aches

Prevention

Treat strep infections promptly to prevent rheumatic fever. Prompt treatment of disorders that can cause mitral regurgitation reduces your risk.
Any invasive procedure, including dental work and cleaning, can introduce bacteria into your bloodstream. The bacteria can infect a damaged mitral valve, causing endocarditis. Always tell your health care provider and dentist if you have a history of heart valve disease or congenital heart disease before treatment.

Alternative Names

Chronic mitral valve regurgitation; Mitral valve insufficiency

Posted in: CVS,Mitral Regurgitation