Mitral Valve Regurgitation
Overview
What is mitral valve regurgitation (MR)?
Mitral valve regurgitation means that one of the valves in your heart—the mitral valve—is letting blood leak backward into the heart.
Heart valves work like one-way gates, helping blood flow in one direction between heart chambers or in and out of the heart. The mitral valve is on the left side of your heart. It lets blood flow from the upper to lower heart chamber.
See a picture of the heart with its chambers and blood flow
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When the mitral valve is damaged—for example, by an infection—it may no longer close tightly. This lets blood leak backward, or regurgitate, into the upper chamber. Your heart has to work harder to pump this extra blood.
Small leaks are usually not a problem. But more severe cases weaken the heart over time and can lead to heart failure.
What causes mitral valve regurgitation?
There are two forms of mitral valve regurgitation: chronic and acute.
- Chronic mitral valve regurgitation, the most common type, develops slowly. Many people with this problem may have a valve that is prone to wear and tear. As the person gets older, the valve gets weak and no longer closes tightly. Other causes include heart failure, rheumatic fever, congenital heart disease, a calcium buildup in the valve, and other heart problems.
- Acute mitral valve regurgitation develops quickly and can be life-threatening. It happens when the valve or nearby tissue ruptures suddenly. Instead of a slow leak, blood builds up quickly in the left side of the heart. Your heart doesn't have time to adjust to this sudden buildup of blood the way it does with the slow buildup of blood in chronic regurgitation. Common causes of acute regurgitation are heart attack and a heart infection called endocarditis.
What are the symptoms?
If you have mild to moderate chronic mitral valve regurgitation, you may never have symptoms. If you have moderate to severe disease, you may not have symptoms for decades.
If your heart weakens because of your mitral valve, you may start to have symptoms of heart failure. Call your doctor if you have any of these symptoms:
- Shortness of breath with activity, which later develops into shortness of breath at rest and at night.
- Extreme tiredness and weakness.
- A buildup of fluid in the legs and feet, called edema.
Acute mitral valve regurgitation is an emergency. Symptoms come on rapidly and include severe shortness of breath at rest, coughing, and fast heartbeat.
How is mitral valve regurgitation diagnosed?
Because you may not have symptoms, a specific type of heart murmur may be the first sign your doctor notices. Further tests will be needed to check your heart. Tests may include:
- Echocardiograms, which use ultrasound to see how serious the valve problem is.
- An electrocardiogram (EKG) to look for abnormal heart rhythms.
- A chest X-ray to check heart size.
- Cardiac catheterization to see how serious the problem is and to look for coronary artery disease.
Tests for acute regurgitation may include one or more of these same tests, as well as a transesophageal echocardiogram. In this test, a sound-wave device is passed down the esophagus to take clearer pictures of the heart.
Finding out that something is wrong with your heart is scary. You may feel depressed and worried. This is a common reaction. Sometimes it helps to talk to others who have similar problems. Ask your doctor about support groups in your area.
How is it treated?
Treatment for chronic cases includes regularly checking your heart to make sure it is working properly. Treatment also includes preventing infection and treating symptoms as they develop. Your doctor may have you take medicines, including:
- Vasodilators, usually ACE inhibitors, to help widen blood vessels and help the heart work better.
- Diuretics to treat symptoms of heart failure and reduce the workload on your heart.
- Anticoagulants, such as warfarin (Coumadin), to prevent blood clots if you also have a heart rhythm problem called atrial fibrillation.
- Beta-blockers, calcium channel blockers, or antiarrhythmics, to control heart rate.
- Antibiotics, taken before dental work or surgery, to prevent infections.
You may need surgery to repair or replace your mitral valve if you get symptoms of heart failure, if the size of your left ventricle (your heart's main pumping chamber) increases, or if your heart weakens.
Some doctors believe it's best to repair or replace the valve before you develop severe symptoms because it leads to better long-term health. On the other hand, surgery is a major procedure that has its own risks and complications. Even if you have no symptoms, talk to your doctor about the benefits of surgery, as well as your heart's condition, your age, and your overall health.
Treatment for acute mitral valve regurgitation occurs while you are in the hospital or the emergency room. Because heart failure usually occurs with acute regurgitation, vasodilators are given by IV. You need surgery right away to repair or replace the valve.
If you have chronic mitral valve regurgitation, your doctor may want you to make some lifestyle changes to ease the load on your heart.
- You may need to be careful about physical activity. Talk to your doctor before starting an exercise program.
- If you have a physically demanding job, you may need to change careers.
- You may need to cut down on salt in your diet.
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| Author: | Douglas Dana Kathe Gallagher, MSW | Last Updated: June 7, 2006 |
| Medical Review: | Adam Husney, MD - Family Medicine Caroline S. Rhoads, MD - Internal Medicine Stephen Fort, MD, MRCP, FRCPC - Interventional Cardiology | |
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