• Mitral Regurgitation

    (Mitral Insufficiency)

    Definition

    Mitral regurgitation is the leaking of blood from the left ventricle across the mitral valve, and into the left atrium. The flow of blood pumped by the heart is controlled by one-way valves. These valves assure that blood moves in only one direction. When the mitral valve leaks, some of the blood that should be pumped into the body instead goes backward into the left atrium. If the amount of blood that leaks is severe, mitral regurgitation can be a serious condition that requires care from your doctor. The sooner it is treated, the more favorable the outcome. If you suspect you have this condition, contact your doctor immediately.
    Function of the Mitral Valve in the Heart
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    Copyright © Nucleus Medical Media, Inc.
    Mitral Valve Regurgitation
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    Copyright © Nucleus Medical Media, Inc.

    Causes

    There are several causes for leaky heart valves. Birth defects can deform them. Infections can scar them. Heart attacks can damage them, and the mechanics of an enlarged heart can stretch out the opening so that the valve is no longer large enough to work effectively.
    • Rheumatic fever —infectious diseases of several kinds can afflict the inside of the heart, leading to scarring of the heart’s valves. Rheumatic fever used to be a common cause of mitral valve damage but is seen infrequently today in the United States.
    • Heart attack —inadequate blood supply to the heart can weaken the small muscles that hold the mitral valve in place, causing it to leak.
    • Congenital deformity—several different types of congenital heart defects distort the mitral valve.
    • Heart muscle disease—not only infections, but many other types of disease can weaken the heart muscle, stretching out the mitral valve ring so that the valve no longer closes. Among these causes are alcohol, certain drugs, radiation , muscular dystrophies, malnutrition, cancer , and a long list of inflammatory and metabolic disorders.
    • Mitral valve prolapse—abnormal closure of the valve with protrusion of a leaflet tip backward into the left atrium, causing it to leak. This may me congenital or acquired.

    Risk Factors

    The following factors increase your chance of developing mitral regurgitation. If you have any of these risk factors, tell your doctor:

    Symptoms

    The speed with which symptoms progress closely follow the cause of mitral disease. Acute (rapid) diseases cause rapid decline, while more indolent (chronic) diseases lead to slower onset of symptoms. The following symptoms may be caused by mitral regurgitation and should prompt a visit to your doctor.
    • Chronic, progressive fatigue
    • Shortness of breath, especially with exertion
    • Worsening shortness of breath when you lie down
    • New associated palpitations or racing heart rate (which may suggest the development of an abnormal heart rhythm as a result of the valve leakage)

    Diagnosis

    Your doctor will ask about your symptoms and medical history. A physical exam will be done. Leaking heart valves usually make sounds called murmurs that can be heard through a stethoscope. You will likely be referred to a cardiologist.
    Tests may include the following:

    Treatment

    Treatment options depend on the severity and natural history of the valve leakage and its effects on the heart’s size and function. Talk with your doctor about the best treatment plan for you. Treatment options include the following:

    Treat Underlying Disease

    Treat the underlying disease since correcting the underlying problem may render the mitral valve competent. The immediate treatment depends on the rapidity and severity of the symptoms. In chronic and slowly progressive mitral regurgitation, medications may be of some benefit in reversing effects on the heart’s size, however, there is no proven benefit directly to the valve. Ultimately, surgery is likely to be deemed necessary. In acute and rapidly declining disease, the benefit of medications is limited to short term stabilization until emergency surgery can ensue. If blood pressure begins to fall, IV medications may be needed. If insufficient to maintain the blood pressure, an intraaortic balloon pump (IABP) can be used for support.

    Surgery

    There are several open heart surgical procedures that can fix leaking valves. The type chosen will depend upon the particular nature of the valve and the expert recommendation of the surgeon. Generally, if the valve can be repaired, it is preferable to being completely replaced.

    Prevention

    To help reduce your chance of getting mitral regurgitation, take the following steps:
    • Prevent heart disease by controlling weight and blood pressure, exercising, eating heart-healthy foods, and watching your cholesterol levels
    • Avoid contact with streptococcal diseases including strep throat , tonsillitis, scarlet fever , and rheumatic fever
    • Limit alcohol intake

    RESOURCES

    US National Library of Medicine and the National Institutes of Health http://www.nlm.nih.gov/

    The Merck Manual–Second Home Edition http://www.merck.com/

    CANADIAN RESOURCES

    Canadian Cardiovascular Society http://www.ccs.ca/home/index%5Fe.aspx

    Heart and Stroke Foundation of Canada http://ww2.heartandstroke.ca/

    References

    Braunwald E. Valvular heart disease. In: Isselbacher K, et al. (Eds). Harrison's Principles of Internal Medicine. 14th ed. New York: McGraw-Hill; 1998.

    Wood AJJ. Adverse reactions to drugs. In: Isselbacher K, et al. (Eds.) Harrison's Principles of Internal Medicine . 14th ed. New York: McGraw-Hill; 1998.

    Wynne J, Braunwald E. The cardiomyopathies and myocarditides. In: Isselbacher K, et al. (Eds). Harrison's Principles of Internal Medicinem . 14th ed. New York: McGraw-Hill; 1998.

    Revision Information

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