Mitral valve regurgitation
Mitral valve regurgitation is a dangerous condition, and many people who have the condition do not realize it because it can be asymptomatic. Normally blood flows in one direction upon the contraction of the left ventricle: out through the aortic valve. However, mitral valve regurgitation essentially involves a process whereby blood abnormally leaks backwards into the left atrium. Other common names for mitral valve regurgitation include mitral incompetence, mitral insufficiency, or simply mitral regurgitation.
Definition & Facts
Mitral valve regurgitation, whether mild or severe, is present in an estimated one out of every ten individuals over the age of 75 in the United States today as well as an additional four million individuals. A common related condition is mitral valve prolapse, which is considered to be a cause of mitral valve regurgitation.
Essentially, mitral valve regurgitation is a leak in the heart valve. The valve does not close properly and some blood escapes and leaks (regurgitates) into the heart's atrium chamber. Over time, the leakage may worsen, causing more severe symptoms and the need for treatment.
There are two basic types of mitral valve regurgitation: chronic (develops gradually) and acute (develops suddenly). There are also two types of chronic mitral valve regurgitation: primary (problem with the heart valve itself) and secondary (problem in another area of the heart, specifically the ventricle, that causes the valve to leak)
Symptoms & Complaints
Other slightly less common symptoms that appear in more severe cases of mitral valve regurgitation include these:
- Heart palpitations
- Dizziness or fainting.
- Racing pulse.
- Swelling (edema) in the extremities, especially hands and feet.
In certain rare cases, mitral valve regurgitation can develop suddenly. This is called acute mitral valve regurgitation. Symptoms tend to be sudden and severe and include the following:
- Rapid heart rate
- Severe difficulty breathing and shortness of breath.
- Chest pain.
- Enlarged heart (cardiomegaly)
Complications of more severe cases of chronic or acute mitral valve regurgitation can include these dangerous conditions:
- Irregular heartbeat or atrial fibrillation.
- Heart failure.
- Congestion of the heart and lungs (pulmonary edema).
- Blood clot in the left atrium of the heart.
- Infection of the valve and inner lining of the heart – the endocardium (endocarditis).
Mitral valve regurgitation can be caused by a number of factors. Essentially, mitral valve regurgitation is caused by a damaged or defective heart valve (primary mitral valve regurgitation) or ventricle (secondary mitral valve regurgitation), which can be the result of several different types of issues, including these:
- Degenerative damage. In this case, with time and age, the valve ceases to close completely due to tissue stretching and weakening.
- Rheumatic fever that leads to rheumatic heart disease. Following an episode of rheumatic fever, some people's heart valves become inflamed and damaged. This can cause scarring which leads to improper functioning and thus leakage.
- Mitral valve prolapse. As mentioned previously, mitral valve prolapse is a related condition thought to be one of the causes of mitral valve regurgitation. With prolapse, the valve is wobbly or floppy (giving this condition its nickname, "floppy mitral valve") and unable to prevent blood from regurgitating into the atrium.
- Heart attack (myocardial infarction). For individuals with a history of a heart attack, there is often damage to the ventricle and/or the mitral valve.
- Valve infection (infective endocarditis). An infection in the valve itself can cause the valve to close improperly.
- Hypertrophic cardiomyopathy. This condition causes a thickening of the heart muscle, which in turn affects the function of the mitral valve.
Diagnosis & Tests
Mitral valve regurgitation is often detected during routine health exams or follow-up doctor's visits for other related conditions. Various tests can be used to determine whether an individual is experiencing mitral valve regurgitation including these:
- Echo test (echocardiogram). Also known as a "heart ultrasound," the echocardiogram shows the doctor what the heart looks like inside the body. It can detect anomalies such as an enlarged left atrium or an improperly closing valve.
- Stethoscope test. By listening to the heart beat through a stethoscope, the doctor can detect murmurs and irregular beat patterns.
- EKG test (electrocardiogram). The electrocardiogram measures the electrical activity going on in the heart to detect abnormalities.
- Chest X-ray. With an X-ray of the chest, the doctor can see the size of the heart and detect what may be causing shortness of breath and if there is any congestion in the lungs.
- MRI (magnetic resonance imaging). A MRI test checks the heart for any abnormalities in its function or structure.
- Cardiac catheterization. A catheter is inserted into a vein up into the heart in order to check overall heart function, blood flow and congenital heart defects.
Treatment & Therapy
There are several treatment options for this well-known condition. What treatment is given will depend on the severity and type of symptoms. In general, treatments fall into two categories: medication or surgical correction. Medications may include the following:
- ACE (Angiotensin-converting enzyme) inhibitors.
- Blood thinners.
- Beta blockers.
- High blood pressure medication.
Prevention & Prophylaxis
For other cases, avoiding exposure to the bacteria that can cause rheumatic fever and infective endocarditis can be a preventative step. Streptococcus and staphylococcus are two of the more common bacteria that cause rheumatic fever and infective endocarditis, respectively. Those with a pre-existing heart condition may opt to take prophylactic antibiotics before having dental surgery or other kinds of surgery that put them at risk for bacterial infection.
Insofar as the risk for mitral valve regurgitation is exacerbated by having had a heart attack, taking steps to prevent heart attacks and improve overall cardiovascular health may help prevent mitral valve regurgitation. Such steps include adopting a healthy diet and engaging in regular exercise.