Mitral Valve Regurgitation

What is mitral valve regurgitation?

The mitral valve is one of the heart's four valves. Heart valves help the blood flow through the heart's four chambers.

The mitral valve is located between the left atrium and left ventricle. The mitral valve has two flaps that open and close with each heartbeat. When the mitral valve closes, it prevents blood from flowing backward into the left atrium. When the mitral valve opens, blood can flow forward into the left ventricle and deliver oxygen-rich blood to the body as it should. When the mitral valve does not open and close as it should and becomes leaky, it's called mitral valve regurgitation. It’s also known as mitral insufficiency. In mitral valve regurgitation, some blood leaks backward through the valve instead of flowing forward into the ventricle the way it should. Because of this, the heart has to work harder than it should to get blood out to the body. If the regurgitation gets worse, some blood may start to back up into the lungs. A very small amount of mitral regurgitation is common. But some people have severe mitral valve regurgitation.

Mitral valve regurgitation can be acute or chronic. With the acute condition, the valve suddenly becomes leaky. In this case, the heart doesn’t have time to adapt to the leak in the valve. Symptoms with acute mitral regurgitation are often severe. In the chronic form, the valve gradually becomes leakier over time. This gives the heart time to adapt to the leak. With chronic mitral regurgitation, the symptoms may range from mild to severe.

What causes mitral valve regurgitation?

A range of conditions can cause mitral valve regurgitation. They include:

• Floppy mitral valve (mitral valve prolapse).

• Rheumatic heart disease from untreated infection with strep bacteria.

• Coronary artery disease or heart attack.

• Certain autoimmune diseases, such as rheumatoid arthritis.

• Infection of the heart valves.

• Heart problems present at birth (congenital).

• Support structures of the mitral valve breaking (rupture).

• Certain medicines.

• Abnormal function of the heart muscle (cardiomyopathy).

• Trauma or injury.

Acute mitral valve regurgitation is more likely to happen after a heart attack. It’s also more likely to happen after rupture of the tissue or muscle that supports the mitral valve. It can happen after an acute injury or heart valve infection.

Who is at risk for mitral valve regurgitation?

You are more likely to develop mitral valve regurgitation if you:

• Don't get treated for a strep infection and develop rheumatic heart disease.

• Use illegal I.V. (intravenous) drugs. These raise the risk for heart valve infection.

• Don't get prompt treatment for health conditions that can lead to the disorder, like coronary heart diseases.

Some risk factors you can’t change. For example, some conditions that can lead to mitral valve regurgitation are partly genetic.

What are the symptoms of mitral valve regurgitation?

Most people with chronic mitral valve regurgitation don’t notice any symptoms for a long time. People with mild or moderate mitral regurgitation often don’t have any symptoms. If the regurgitation becomes more severe, symptoms may start. They may be stronger and happen more often over time. They may include:

• Shortness of breath with exertion.

• Shortness of breath when lying flat.

• Tiredness (fatigue).

• Reduced ability to exercise.

• Unpleasant awareness of your heartbeat.

• Palpitations.

• Swelling in your legs, abdomen, and the veins in your neck.

• Chest pain (less common).

Acute, severe mitral valve regurgitation is a medical emergency. It can cause serious symptoms such as:

• Symptoms of shock, such as pale, cold, and clammy skin, loss of consciousness, or rapid breathing.

• Severe shortness of breath.

• Cough with clear or pink, frothy sputum (mucus).

• Abnormal heart rhythms that make the heart unable to pump well.

How is mitral valve regurgitation diagnosed?

Your health care provider will take your health history and give you a physical exam. Using a stethoscope, your provider will check for heart murmurs and other signs of the condition. You may also have tests such as:

• Echocardiogram to assess severity.

• Stress echocardiogram to assess exercise tolerance.

• Electrocardiogram (ECG) to assess heart rhythm.

• Cardiac MRI scan.

• Transesophageal echocardiogram.

• Cardiac catheterization.

• Chest X-ray. In patients with chronic MR, an enlargement of the heart is visible.

How is mitral valve regurgitation treated?

Treatment varies depending on the cause for the condition. It also varies depending on how severe and sudden the condition is. And it depends on your overall health. Mitral valve regurgitation can increase risk for other heart rhythm problems such as atrial fibrillation.

If you have mild or moderate mitral valve regurgitation, you may not need any treatment. Your health care provider may just choose to watch your condition. You may need regular echocardiograms over time if you have moderate mitral valve regurgitation. Your provider might also prescribe medicines such as:

• Angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARB), and beta-blockers to help reduce the workload of the heart when a person’s pump function is not working as well.

• Medicines to slow the heart rate if you develop atrial fibrillation.

• Water pills (diuretics) to reduce swelling and improve symptoms.

• Blood thinners (anticoagulants) to help prevent blood clots if you have atrial fibrillation.

Surgery may be needed with severe mitral valve regurgitation. Surgery is often needed right away for acute severe mitral valve regurgitation. The surgeon may be able to repair the mitral valve. In some cases, a replacement valve is needed. Your surgeon might use a valve made of pig, cow, or human heart tissue. Artificial mechanical valves are another option. Talk with your surgeon about which one is right for you. Your surgeon might do open surgery or a minimally invasive repair. If you have atrial fibrillation, the surgeon may do a Maze procedure. This is a type of heart surgery that can reduce the future risk of atrial fibrillation. In some cases, a clip can be used to reduce the amount of mitral regurgitation. This can eliminate the need for surgery or delay it. Moderate or severe mitral regurgitation can cause problems during pregnancy. Valve surgery may be needed before a person becomes pregnant.

What are possible complications of mitral valve regurgitation?

Mitral valve regurgitation can cause complications such as:

• Atrial fibrillation, in which the atria of the heart don’t contract well. This leads to increased risk of stroke.

• Elevated blood pressure in the lungs (pulmonary artery hypertension).

• Dilation of the heart.

• Heart failure.

• Bacterial infection of the heart valves. This is more likely after valve replacement surgery.

To reduce the risk of these complications, your health care provider may prescribe:

• Blood-thinning medicine that prevents blood clots.

• Medicines to reduce the stress load of the heart.

• Antibiotics before certain medical and dental procedures. In most cases, you will only need antibiotics if you have had valve surgery or a previous bacterial infection of the heart valves.

Living with mitral valve regurgitation

You'll need to see your health care provider for regular monitoring. See your provider right away if your symptoms change. Note your symptoms when exercising. Symptoms may get worse during physical activity. Talk with your provider about your exercise program and what is right for you. If you have progressive mitral regurgitation, your provider may advise against competitive sports. Tell all your health care providers and dentists about your medical history.

Your provider may want to treat you for heart problems related to mitral valve regurgitation. Treatment may include:

• A low-salt, heart-healthy diet (to decrease blood pressure and the stress on your heart).

• Blood pressure lowering medicines.

• Medicines to reduce the risk of arrhythmias (abnormal heart rhythms).

• Reduction of caffeine and alcohol to reduce risk of arrhythmias.

• Stopping smoking.

When to contact your doctor

If you notice your symptoms are slowly getting worse, plan to see your health care provider. You may need surgery or a medicine change.

Contact your health care provider or get medical care right away if:

• You notice sudden new symptoms, such as:

  • A bluish tinge of your fingertips, palms, and toes.

  • Cold, clammy skin.

• Call 911 or get immediate medical care if:

  • You have severe shortness of breath or chest pain.

Key points about mitral valve regurgitation

• With mitral valve regurgitation, the heart’s mitral valve is leaky. Some blood flows back into the left atrium from the left ventricle.

• You may not have symptoms for many years.

• Chronic mitral valve regurgitation may get worse and need surgery.

• Acute, severe mitral valve regurgitation is a medical emergency that requires immediate surgery.

• See your health care provider for regular checkups to monitor your condition. If your symptoms get worse or become severe, see your provider right away.

Next steps

These tips can help you get the most from a visit to your health care provider:

• Know the reason for your visit and what you want to happen.

• Before your visit, write down questions you want answered.

• Bring someone with you to help you ask questions and remember what your provider tells you.

• At the visit, write down the name of a new diagnosis and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.

• Know why a new medicine or treatment is prescribed and how it will help you. Know what the side effects are. And know when they should be reported.

• Ask if your condition can be treated in other ways.

• Know why a test or procedure is recommended and what the results could mean.

• Know what to expect if you do not take the medicine or have the test or procedure.

• If you have a follow-up appointment, write down the date, time, and purpose for that visit.

• Know how you can contact your provider if you have questions.