Mitral valve regurgitation, also known as mitral insufficiency, occurs when the heart's mitral valve does not close tightly. This condition can lead to symptoms like shortness of breath during activity, fatigue, or dizziness, depending on how advanced it is.
The mitral valve is responsible for separating the left atrium from the left ventricle. Conditions like congenital defects, underlying heart issues, or genetic syndromes can prevent the valve from sealing, causing blood to leak backward.
If you suspect you have mitral valve regurgitation, you should consult a cardiologist or a primary care physician. Treatment options may include medications like blood pressure reducers and diuretics, or potentially surgery, depending on the cause.
Main symptoms
The most common symptoms associated with mitral valve regurgitation include:
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Shortness of breath, especially during physical exertion or when lying down.
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Persistent or excessive fatigue.
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Heart palpitations or a racing heartbeat.
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Swelling in the feet and ankles (edema).
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Dizziness and occasional fainting spells.
Because this condition often develops gradually over several years, many people do not notice symptoms right away.
However, in cases of a heart attack, infectious endocarditis, or sudden chest trauma, symptoms can appear abruptly. This is considered a medical emergency and can be life-threatening. Learn more about heart attack symptoms and how they present.
How to confirm a diagnosis
A cardiologist or general practitioner will diagnose mitral valve regurgitation based on your symptoms and diagnostic test results. Common tests include an electrocardiogram (ECG) and an echocardiogram, which allow doctors to visualize the heart's structure and function.
In certain situations, a specialist may also recommend cardiac catheterization. This procedure provides a detailed internal view of the heart to more accurately assess how the valves are performing.
Degrees of mitral valve regurgitation
Mitral valve regurgitation is typically classified by its severity into three stages. According to the American Heart Association and the American College of Cardiology, these stages are defined by specific echocardiographic criteria and the presence of symptoms to guide clinical decision-making.
1. Mild mitral valve regurgitation
Mild regurgitation usually does not cause symptoms and is not considered dangerous. It typically requires no treatment and is often discovered during a routine physical if a doctor hears a heart murmur through a stethoscope.
2. Moderate mitral valve regurgitation
This stage involves non-specific symptoms that are generally not severe, such as mild fatigue. While immediate treatment is often unnecessary, the condition requires consistent monitoring.
Doctors will usually perform follow-up exams every 6 to 12 months. These may include echocardiograms or chest X-rays to ensure the valve function has not declined.
3. Severe mitral valve regurgitation
Severe regurgitation causes noticeable symptoms like coughing, shortness of breath, and significant swelling in the lower extremities. At this stage, doctors usually recommend medication or surgery to repair or replace the valve.
Possible causes
Several factors can lead to the development of mitral valve regurgitation:
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Congenital heart defects present from birth.
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Underlying heart conditions like heart failure, atrial fibrillation, or a previous heart attack.
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Rheumatic fever.
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Side effects from certain medications or radiation therapy.
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Infectious endocarditis (an infection of the heart lining).
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Physical trauma to the chest, often from accidents.
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Genetic disorders, such as Marfan syndrome.
Most cases develop because of changes to the valve's physical structure or the heart's overall shape, which interferes with proper closure. The condition can progress quickly or slowly depending on the cause and is more common in older adults.
Treatment options
Treatment plans are tailored to the severity of the regurgitation and may include the following:
1. Medical monitoring
Mild cases often do not require active intervention. Instead, regular check-ups are scheduled to monitor the heart's health over time.
During this phase, doctors often suggest lifestyle improvements. These include eating a balanced diet and engaging in low-impact exercise, such as walking.
2. Use of medications
If symptoms are present or the condition is chronic, a physician may prescribe specific medications:
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Diuretics: These help the body eliminate excess fluid, reducing swelling and pressure in the lungs and legs.
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Anticoagulants: Also known as blood thinners, these help prevent blood clots, particularly in patients with atrial fibrillation.
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Antihypertensives: These manage blood pressure, as hypertension can place additional strain on the mitral valve.
While these drugs manage symptoms and reduce strain, they do not fix the structural issue of the valve itself.
3. Heart surgery
In severe cases, a cardiologist may recommend heart surgery, such as a valvuloplasty. This procedure aims to repair or replace the damaged valve to prevent complications like heart failure or pulmonary hypertension.
Care during treatment
Maintaining a heart-healthy lifestyle is a critical part of managing mitral valve regurgitation:
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Attend regular medical appointments to manage high blood pressure.
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Maintain a weight that is healthy for your body type.
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Quit smoking and avoid tobacco products.
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Limit or avoid caffeine and alcoholic beverages.
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Follow an exercise routine approved by your doctor.
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Focus on a nutritious, balanced diet.
Women with this condition who wish to become pregnant should seek a medical evaluation first. Pregnancy increases the heart's workload, and it is vital to ensure the valve can handle the added stress. Close coordination between a cardiologist and an obstetrician is necessary during and after pregnancy.
Additionally, patients who have had a valvuloplasty may need to take antibiotics before certain dental procedures. This helps prevent infectious endocarditis, an infection that can settle on repaired heart valves.
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Mitral valve regurgitation occurs when the heart's mitral valve fails to close properly, causing blood to leak backward and potentially leading to fatigue and shortness of breath.
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Diagnosis is usually confirmed through diagnostic tests like an echocardiogram or electrocardiogram, which allow specialists to evaluate the heart's structure and overall function.
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Treatment ranges from routine medical monitoring and lifestyle changes for mild cases to medications or surgical repair for more severe stages of the condition.