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Mitral regurgitation; chronic Causes and Risks:
Regurgitation (leaking from insufficient valve closure) is caused by any disorder that weakens or damages the valve. Insufficient closure of the mitral valve causes blood to backflow to the left atrium. The blood flow to the body (cardiac output) is decreased because of the backflow. The heart may pump harder to try to compensate for the decreased blood flow to the body.
About 5% of individuals have mitral valve prolapse , involving weakening and ballooning out of the valve, which is a common cause of mitral regurgitation. Rheumatic heart disease causes thickening, rigidity, and retraction of the mitral valve leaflets and accounts for about one-third of all mitral regurgitation. Chronic mitral regurgitation may be inherited or caused by disorders such as atherosclerosis , hypertension ( high blood pressure ), left ventricle enlargement, connective tissue disorders such as Marfan's syndrome , other congenital defects, endocarditis , cardiac tumors, untreated syphilis , and others. Acute mitral regurgitation may become chronic.
Risk factors include an individual or family history of the above disorders. Mitral regurgitation affects approximately 6% of women and 3% of men. Congenital mitral regurgitation is rare.
Prevention:
Treat strep infections promptly to prevent rheumatic fever . Treat other causative disorders.
Note any history of heart valve disease or congenital heart disease before treatment by a health care provider or dentist. Any dental work, including cleaning, and any invasive procedure can introduce bacteria into the bloodstream. This bacteria can infect a damaged mitral valve causing endocarditis . Preventive treatment with antibiotics given just before dental or other invasive procedures may decrease the risk of endocarditis.
Symptoms:
Additional symptoms that may be associated with this disease: Note: Often no symptoms are present. When symptoms occur they often develop gradually.
Signs and Tests:
Palpation may show thrill (vibration) over the heart. A stethoscope examination of the heart reveals a distinctive (holosystolic) murmur. Rales or other abnormal breath sounds may be heard on lung examination. Ankle edema , enlarged liver , distended neck veins, and other signs consistent with right-sided heart failure may be present.
An enlarged left atrium with thickened or deformed mitral valve, and regurgitation of blood may show on: A chest X-ray may show an enlarged left atrium. An ECG often shows atrial fibrillation with a peaked P-wave, suggestive of left atrial enlargement. Other tests may include chest MRI , radionucleotide scans, or a CT scan of the chest .
Treatment:
Hospitalization may be required for diagnosis and treatment of severe symptoms. Surgical repair or replacement of the valve is curative. It is recommended if heart function is poor, if symptoms are severe, or if condition deteriorates.
Antibiotics are prescribed if bacterial infection is present.
Antiarrhythmics may be needed to control irregular rhythms.
Vasodilators to reduce the workload of the heart. Digitalis may be used to strengthen the heartbeat, along with diuretics to remove excess fluid in the lungs. Anticoagulants or antiplatelet medications may be used to prevent clot formation if atrial fibrillation is present (atrial fibrillation increases the chances of clot formation). A low-sodium diet may be helpful.
Most individuals have no symptoms; but if a person develops symptoms activity may be restricted.
Prognosis:
The outcome varies and depends on the underlying conditions. Usually the condition is benign , so no therapy or restriction is necessary. Symptoms can usually be controlled with medication. In severe cases, surgical opening of the valve or valve replacement may be necessary.
Complications:
Call Your Healthcare Provider:
Call for an appointment with your health care provider if symptoms are suggestive of mitral valve regurgitation. Call for an appointment with your health care provider if symptoms worsen or do not improve with treatment. Call your health care provider if during treatment, signs of infection occur: fever , chills, muscle aches, headache, malaise (general ill feeling).
This is a cross-sectional view of the interior of the heart. The valves, chambers, and associated vessels are labeled.
This is an illustration of the exterior of the heart. The arteries are colored blue and represent blood that is flowing into the heart. The veins are red and indicate blood flow out from the heart. The chambers are also labeled.
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