Mitral Regurgitation

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(Mitral Insufficiency)

Definition

The flow of blood pumped by the heart is controlled by one-way valves. These valves assure that blood moves in only one direction. Mitral regurgitation occurs when the heart's mitral valve leaks blood into the upper chamber from the lower chamber.

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 better the outcome. If you suspect that you have this condition, contact your doctor right away.

Mitral Valve Regurgitation

Causes

There are several causes for leaky heart valves. Birth defects can deform them. Infections can scar them. Heart attacks can damage them. The mechanics of an enlarged heart can stretch out the opening so that the valve is no longer large enough to work effectively.

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 be congenital or acquired.
Rheumatic fever —infectious disease 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 it is not common today in the United States.
Heart attack —reduced 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—many 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 many inflammatory and metabolic disorders.

Risk Factors

Factors that may increase your chance of developing mitral regurgitation include:

A history of rheumatic fever or other serious infectious disease
Inflammatory diseases such as lupus and rheumatoid arthritis
Storage diseases such as hemochromatosis and glycogen storage disease
Heart disease
Muscle disease
Malnutrition
Alcoholism
Radiation exposure
Exposure to certain drugs such as lithium, sulfonamides, cancer chemotherapy , and phenothiazines

Symptoms

The speed with which symptoms progress closely follow the cause of mitral disease. Acute diseases cause rapid decline, while more chronic diseases lead to slower onset of symptoms. The following symptoms may be caused by mitral regurgitation:

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

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.

Images may need to be taken of your heart. This can be done using:

Treatment

Treatment options depend on the severity and 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

Correcting the underlying problem may help the mitral valve function. The treatment depends on the symptoms. In chronic and slowly progressive mitral regurgitation, medications may help reverse effects on the heart’s size. Ultimately, surgery will likely be needed. In acute and rapidly declining disease, the benefit of medications is limited to short term stabilization until emergency surgery occurs.

Surgery

There are several open heart surgical procedures that can fix leaking valves. The type chosen will depend on the valve and the expert recommendation of the surgeon. The valve may be repaired, if it is an option, or it will be 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, and scarlet fever
Avoid IV drug use
Limit alcohol intake

RESOURCES

American Heart Association http://www.heart.org

National Heart, Lung, and Blood Institute http://www.nhlbi.nih.gov

CANADIAN RESOURCES

Canadian Cardiovascular Society http://www.ccs.ca

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

Reviewer: Michael J. Fucci, DO ; Michael Woods, MD
Review Date: 05/2013 -
Update Date: 05/10/2013 -

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

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