Mitral Valve Regurgitation
A leaky mitral valve that lets blood flow backward in the heart
Quick Facts
- Type: Heart valve disease
- Valve affected: Mitral valve
- Problem: Backward leakage of blood
- Symptoms: Fatigue, breathlessness, palpitations
Overview
Mitral valve regurgitation, also called a leaky mitral valve, occurs when the mitral valve does not close completely. The mitral valve sits between the upper and lower chambers on the left side of the heart and should close tightly when the heart pumps. If it leaks, some blood flows backward into the upper chamber instead of moving forward to the body.
This backward leak means the heart has to work harder to pump enough blood, and over time it can enlarge and weaken. Mild regurgitation is common and often causes no problems, while more significant leakage may need monitoring or treatment. Many people live for years with the condition, especially when it is detected and followed.
Symptoms
Mitral regurgitation often develops gradually, and many people have no symptoms for a long time. When symptoms appear, they may include:
- Fatigue, especially with activity
- Shortness of breath, particularly with exertion or when lying flat
- Heart palpitations or a fluttering sensation
- Swelling in the feet, ankles, or legs
- A rapid or irregular heartbeat
- Lightheadedness
Symptoms can appear suddenly if the leak develops quickly, for example after a heart attack or infection. Seek emergency care for sudden severe shortness of breath, fainting, or chest pain.
Causes
Mitral regurgitation results from problems with the valve itself or with the heart muscle and structures that support it. Causes include:
- Mitral valve prolapse: When valve flaps bulge backward and do not seal properly, a common cause.
- Rheumatic heart disease: Valve damage from a past rheumatic fever.
- Heart attack or heart muscle disease: That weakens or stretches the heart and valve supports.
- Infective endocarditis: An infection of the heart valves.
- Age-related changes: Wear and calcium buildup on the valve.
- Congenital valve abnormalities.
Risk Factors
- Mitral valve prolapse
- A history of heart attack or heart failure
- Previous rheumatic fever
- A prior heart valve infection
- Older age
- Certain congenital heart conditions
Diagnosis
A leaky mitral valve is often first detected as a heart murmur during a routine examination.
- Echocardiogram: The main test, an ultrasound that shows the valve, measures the leak, and assesses heart function.
- Electrocardiogram (ECG): Checks the heart's rhythm.
- Chest X-ray: Can show heart enlargement or fluid in the lungs.
- Cardiac MRI or transesophageal echocardiogram: Provide detailed images when more information is needed.
These tests help determine how severe the leak is and how it affects the heart, which guides treatment.
Treatment
Treatment depends on the severity of the leak, symptoms, and the effect on the heart. Mild cases are often just monitored.
- Regular monitoring: Periodic echocardiograms to track the valve and heart over time.
- Medications: Drugs to control blood pressure, reduce fluid buildup, and manage symptoms or irregular rhythms. These help symptoms but do not repair the valve.
- Valve repair: Surgery to fix the existing valve, often preferred when feasible.
- Valve replacement: Replacing the valve when repair is not suitable.
- Catheter-based repair: A less invasive option for selected patients.
The timing of a procedure is carefully judged based on symptoms and heart function.
Prevention
- Treat strep throat promptly to help prevent rheumatic fever
- Manage high blood pressure and heart disease to protect the heart
- Maintain good dental and skin hygiene to reduce the risk of heart valve infection
- Attend regular check-ups if you have a murmur or known valve disease
- Follow your clinician's advice about activity and medications
When to See a Doctor
See a clinician if you have new or worsening fatigue, breathlessness, palpitations, or leg swelling, or if you have been told you have a heart murmur. Regular follow-up is important if you have known mitral regurgitation. Seek emergency care for sudden severe shortness of breath, fainting, or chest pain, which may indicate a rapidly worsening leak.
Frequently Asked Questions
What is mitral valve regurgitation?
It is a condition in which the mitral valve does not close tightly, so some blood leaks backward into the upper heart chamber when the heart pumps. This makes the heart work harder and, if significant, can lead to enlargement and symptoms over time.
Is a leaky mitral valve serious?
Mild leakage is common and often harmless, needing only occasional monitoring. More significant regurgitation can strain the heart and may eventually require valve repair or replacement, so it is important to have it evaluated and followed.
What are the symptoms of mitral regurgitation?
Many people have no symptoms for years. When symptoms develop, they include fatigue, shortness of breath with activity or lying down, palpitations, and swelling in the legs. Sudden severe symptoms can occur if the leak develops quickly.
How is mitral valve regurgitation treated?
Mild cases are monitored with periodic echocardiograms. Medications can ease symptoms and manage related problems but do not fix the valve. Significant leaks may be treated with valve repair, valve replacement, or a catheter-based procedure.
Can mitral regurgitation be cured with medication?
No. Medications can control symptoms, blood pressure, fluid, and rhythm problems, but they cannot repair a leaky valve. Fixing significant regurgitation requires a valve repair or replacement procedure when indicated.
References
- American Heart Association. Problem: Mitral Valve Regurgitation.
- MedlinePlus, U.S. National Library of Medicine. Mitral regurgitation.
- Mayo Clinic. Mitral valve regurgitation — Symptoms and causes.
- National Heart, Lung, and Blood Institute (NHLBI). Heart Valve Diseases.