Mitral Valve Regurgitation
Mitral valve regurgitation is also known as mitral insufficiency.
It is a disorder in which the mitral heart valve does not close
properly, causing blood to leak (regurgitate) into the left atrium
when the left ventricle contracts. The heart has to pump harder
as a result of this regurgitation. Mitral valve regurgitation can
be an acute (sudden and generally more severe) problem or a chronic
What causes mitral valve regurgitation?
The underlying cause of your heart valves problem closing
is related to a weakened or damaged valve. This damage to the
valve can be caused by a myocardial infarction (heart attack),
by infective endocarditis, or other conditions that affect the
heart valves. Damage to the mitral valve can cause it to protrude
(or prolapse) into the atrium, which creates the opening
for blood to flow back into the left atrium. About 5% of individuals
have mitral valve prolapse. Rheumatic heart disease can damage
the mitral valve leaflets, and accounts for about one-third of
all mitral regurgitation. Chronic mitral regurgitation may be
inherited or caused by disorders such as atherosclerosis, hypertension
(high blood pressure), left ventricle enlargement, connective
tissue disorders such as Marfans syndrome, other congenital
defects, endocarditis, cardiac tumors, untreated syphilis, and
others. Acute mitral regurgitation may become chronic.
Mitral regurgitation (both acute and chronic mitral regurgitation)
affects approximately 5 out of 10,000 people.
Can mitral valve regurgitation be prevented?
The best way to protect against mitral valve regurgitation is
to quickly address any of the conditions listed above that could
cause the disorder. You should discuss any history of heart valve
disease with your doctor. Your doctor may prescribe antibiotic
therapy to be taken prior to any medical or dental procedures
that could introduce infective agents into your blood. This includes
normal cleaning of your teeth. Ask your doctor is you have any
questions about if this applies to you. Treat strep infection
promptly to prevent rheumatic fever.
What are the symptoms of mitral valve regurgitation?
Often, no symptoms are present. Symptoms can occur suddenly or
gradually, and might include:
- Shortness of breath
- Rapid respirations
- Sensation of feeling the heart beat (palpitations)
- Chest pain
- Fatigue and exhaustion (may result from low cardiac output)
- Weight loss
How is mitral valve regurgitation diagnosed?
Your doctor will take your history and perform a physical exam.
Your doctor will listen to your heart for a murmur. He/she may
also listen to your lungs for signs of fluid buildup. Your doctor
might also look for signs of right-sided heart failure, which
might include ankle edema, enlarged liver, distended nek veins,
or other symptoms.
Certain diagnostic tests or imaging methods are useful in diagnosing
mitral valve regurgitation. They include:
- Coronary angiography
- Chest X-ray
- Swan-Ganz (left heart catherization) pressure readings
- Chest MRI scan
- Radionucleotide scans
- CT scan o the chest
How is mitral valve regurgitation treated?
Most people have no symptoms. If symptoms develop, activity may
be restricted. A low-sodium diet may be recommended.
If symptoms are severe, hospitalization may be required. If acute
mitral valve regurgitation is the result of recent endocarditis,
heart attack or ruptured cordae, emergency surgery might be required.
Surgery includes repair or replacement of the damaged valve.
Medications are used to treat the symptoms and underlying conditions
associated with mitral valve regurgitation. If a bacterial infection
exists, your doctor will prescribe antibiotic therapy. Antiarrhythmics
may be needed to control irregular rhythms.
Vasodilators reduce the workload of the heart. Digitalis may
be used to strengthen the heartbeat, and diuretics to remove excess
fluid such as fluid in the lungs. Anticoagulants or antiplatelet
medications may be used to prevent clot formation if atrial fibrillation
is present (atrial fibrillation increases the chances of clot
If blood pressure cannot be maintained, a device called an intra-aortic
balloon pump (IABP) can help reduce the backflow of blood.