Mitral Valve Regurgitation

Condition Basics

What is mitral valve regurgitation?

Mitral valve regurgitation means that one of the valves in your heart—the mitral valve—is letting blood leak backward into the upper area of your heart.

Heart valves work like one-way gates. They help 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 the lower heart chamber.

When the mitral valve is damaged, 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 usually aren't a problem. But more severe cases weaken the heart over time and can lead to heart failure.

What causes it?

The cause of mitral valve regurgitation depends on the type. It may happen because of problems like calcium buildup on the mitral valve. Heart failure, a heart attack, or a heart infection may also cause this to happen. This condition can also happen in people who have mitral valve prolapse.

What are the symptoms?

Symptoms of chronic mitral valve regurgitation may take decades to appear. They include being tired or short of breath when you're active. A heart murmur might be the first sign your doctor notices. Acute mitral valve regurgitation is an emergency. Symptoms include severe shortness of breath, fast heart rate, lightheadedness, weakness, confusion, and chest pain.

How is it diagnosed?

When your doctor suspects that you have mitral valve regurgitation, he or she will ask about your past health, do a physical exam, and order tests, such as an echocardiogram, to check your heart.

How is mitral valve regurgitation treated?

For chronic mitral valve regurgitation, you may take medicines to treat problems caused by the regurgitation or to treat a heart problem that is causing it. Or you may need surgery to repair or replace your mitral valve. If your condition is acute, you need surgery right away to repair or replace the valve.

Symptoms

Symptoms of chronic mitral valve regurgitation may take decades to appear. They include being tired or short of breath when you are active.

Because you may not have symptoms, a specific type of heart murmur might be the first symptom your doctor notices.

If your heart weakens because of your mitral valve, you may start to have signs of heart failure. They include:

  • Shortness of breath with activity. This can later develop into shortness of breath at rest and at night.
  • Extreme tiredness and weakness.
  • A buildup of fluid in the legs and feet. This buildup is called edema.

Acute mitral valve regurgitation is an emergency. Symptoms come on quickly. They include severe shortness of breath, fast heart rate, lightheadedness, weakness, confusion, and chest pain.

When to Call a Doctor

Call 911 or other emergency services immediately if you have:

  • Symptoms of a heart attack, including chest pain or pressure.
  • Symptoms of a stroke.
  • Loss of consciousness (syncope).
  • Symptoms of acute mitral valve regurgitation including severe shortness of breath, fast heart rate, lightheadedness, weakness, confusion, and chest pain.

Call a doctor now if you have:

  • Symptoms of heart failure, such as shortness of breath, fatigue, and swelling in the legs and feet.
  • Mitral valve regurgitation (MR) and are having symptoms of infection such as fever with no other obvious cause. Be alert for signs of infection if you have recently had any dental, diagnostic, or surgical procedure.
  • Irregular heartbeats.
  • Fainting episodes.
  • Palpitations.
  • Shortness of breath.
  • Been less able to exercise at your usual level.
  • Excessive fatigue (without other explanation).
  • Been coughing up blood.

Watchful waiting

Watchful waiting is a wait-and-see approach. If you don't have symptoms of MR, your doctor will still want to see you for regular checkups. Your doctor will want to see you as soon as you have symptoms for the first time. If your doctor has talked with you about what to do if you have symptoms, follow your doctor's instructions. Contact your doctor if your symptoms get worse.

Exams and Tests

When your doctor suspects that you have mitral valve regurgitation, he or she will ask about your past health and do a physical exam.

Your doctor may also order tests to check your heart. Tests may include:

  • An echocardiogram. This uses ultrasound to see how serious the valve problem is.
  • An electrocardiogram (EKG, ECG). This looks for abnormal heart rhythms.
  • A chest X-ray to check heart size.
  • An MRI test to see how well the heart is pumping blood and to check how severe the problem is.
  • Cardiac catheterization to see how serious the problem is.

Acute mitral valve regurgitation causes sudden symptoms and is much less common.

Learn more

Treatment Overview

Treatment for chronic mitral valve regurgitation includes regular tests to check how well the valve and the heart are working. You may take medicine to treat problems caused by the regurgitation. Or you may take medicine to treat a heart problem that's causing it.

You may need to have your mitral valve repaired or replaced. Your doctor will check many things to see if repair or replacement is right for you. These things include the cause of the regurgitation, the anatomy of the valve, if you have symptoms, and how well your heart is pumping blood.

Treatment for acute mitral valve regurgitation occurs while you are in the hospital or the emergency room. You need surgery right away to repair or replace the valve.

Self-Care

You can live life more fully by doing things that help keep your heart and body healthy. Here's how.

  • Make healthy lifestyle changes.
    • If you smoke, try to quit. Medicines and counseling can help you quit for good. Avoid secondhand smoke too.
    • Your doctor will also recommend that you follow a heart-healthy diet and limit how much sodium you eat.
    • Be active, but ask your doctor what level of exercise is safe for you. You may need to be careful with physical activity if you have symptoms, irregular heart rhythms, or changes in your heart size or function. But regular activity, even low-level activity like walking, will help keep your heart healthy. If you want to start being more active, talk to your doctor first. Your doctor will help you create a safe exercise plan.
    • If you need to lose weight, try to reach and stay at a healthy weight.
  • Take care of yourself.
    • See your doctor right away if you have new symptoms or symptoms that get worse.
    • Go to your checkup appointments. And get the tests you need to assess your heart, such as echocardiograms.
    • Manage other health problems, such as high blood pressure, diabetes, and high cholesterol.
    • Practice good dental hygiene, and have regular checkups. Good dental health is especially important. That's because bacteria can spread from teeth and gums to the heart valves.
    • Get a flu vaccine every year. And get a pneumococcal vaccine shot. If you've had one before, ask your doctor if you need another dose.
    • Talk with your doctor if you have concerns about sex and your heart. He or she can help you know if or when it's okay for you to have sex.

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Surgery

With chronic mitral valve regurgitation, surgery to repair or replace the mitral valve might be recommended. Whether surgery is right for you depends on many things, including the cause of the condition.

Primary mitral valve regurgitation.

Surgery is the only cure for primary mitral valve regurgitation. That's because the abnormal shape of the mitral valve is causing the regurgitation. Repair is most often preferred over replacement. The decision whether to repair or replace the valve depends on the type of damage.

Secondary mitral valve regurgitation.

If another heart problem is causing the valve to not close right, treatment of the heart problem, such as heart failure, may be right for you. Some people might need surgery to repair or replace the valve.

With acute mitral valve regurgitation, urgent surgery to repair or replace the valve is usually needed. In some cases, surgery to correct the cause of the acute condition may also be needed.

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Credits

Current as of: August 31, 2020

Author: Healthwise Staff
Medical Review:
Rakesh K. Pai MD, FACC - Cardiology, Electrophysiology
Martin J. Gabica MD - Family Medicine
E. Gregory Thompson MD - Internal Medicine
Adam Husney MD - Family Medicine
Michael P. Pignone MD, MPH, FACP - Internal Medicine

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