What is mitral valve regurgitation?
Do you have mitral valve regurgitation? What is mitral regurgitation? It is a heart valve disorder and malfunction that affects the mitral valve. The mitral valve (also known as the biscuspid valve) is one of four blood-regulating valves in the heart.
The most prevalent heart valve disease in developed countries, mitral regurgitation occurs when the mitral valve does not shut properly when the heart beats due to a physical abnormality. This allows blood to regurgitate into the left atrium.
Mitral regurgitation is sometimes described as mitral incompetence or mitral insufficiency because the mitral valve incompetently or insufficiently performs its primary functions in the heart. One can therefore also ask what is mitral valve incompetence or what is mitral valve insufficiency. People living with the heart valve regurgitation affliction are said to have a leaking or leaky heart valve.
What goes wrong in people with mitral regurgitation?
In people with mitral valve regurgitation, a component of the mitral apparatus is damaged or abnormal in some way. There may be a problem with the annulus, the papillary muscles, the tendineae chordae, or the leaflets of the mitral valve. Sometimes, more than one mitral component is irregular.
As a consequence of the damage or abnormality, when the heart beats and the mitral valve closes after blood has passed through it, the valve does not form a tight seal. Then, blood trickles back into the left atrial chamber to some degree. This can cause mitral regurgitation symptoms and complications.
Are there different types of mitral valve regurgitation?
There are. Mitral valve regurgitation is medically classified as either primary or secondary. Primary or organic mitral regurgitation is regurgitation that occurs due to a problem with the valve. Secondary (aka functional or ischemic) regurgitation occurs due to dysfunction of the left ventricle.
With secondary mitral valve regurgitation, the left ventricle dilates. This causes the mitral annulus to stretch and the papillary muscles to move out of place. The dilation of the ventricle may occur due aortic insufficiency/regurgitation and other causes of dilated cardiomyopathy.
Is mitral regurgitation a progressive disease?
Yes, it is a progressive heart valve disease. According to experts, there are three clinical phases of mitral valve regurgitation, namely acute, chronic compensated, and chronic decompensated.
Acute mitral regurgitation occurs suddenly. It is usually the result of one or more ruptured chordae tendinae or papillary muscles, which causes a volume/pressure overload in the left ventricle and atrium. This can hinder blood drainage from the lungs and cause pulmonary congestion.
If regurgitation develops slowly, or if acute regurgitation cannot be controlled with treatment, then the patient enters the chronic compensated phase. Here, the left ventricle and atrium enlarge as a compensation response, improving cardiac output and relieving lung congestion.
Though the compensated phase may persist, patients eventually enter the chronic decompensated phase, where the left ventricle and mitral annulus dilate and pulmonary congestion reoccurs. The degree of regurgitation worsens and the patient experiences heart failure symptoms.
What are the symptoms of mitral valve regurgitation?
Mitral valve regurgitation symptoms vary, depending on the phase of the disease process and the individual. Most times, a heart murmur can be heard if one has regurgitation.
Patients in the acute phase may experience symptoms such as heart palpitations, dyspnea (shortness of breath), paroxysmal nocturnal dyspnea (severe dyspnea attacks at night), and orthopnea (dyspnea when lying flat). Cardiogenic shock can occur if chordae or papillary muscles rupture.
Individuals in the chronic compensated phase of mitral valve regurgitation often do not experience any disturbing leaky heart valve symptoms. They are able to exercise normally and engage in physical activities as a heart-healthy person would, although that isn’t always the case.
In the chronic decompensated phase, which can take years to develop, one may experience atrial fibrillation and mitral regurgitation symptoms. These include exercise intolerance, dyspnea, and orthopnea, heart palpitations, angina, fatigue, and episodes of fainting (syncope).
What causes mitral regurgitation?
Other mitral regurgitation causes include ischemic heart disease, heart attacks, and rheumatic fever, as well as Marfan’s Syndrome. There also appears to be a connection between mitral valve regurgitation and diseases like Ehlers-Danlos Syndrome, Down Syndrome, and Osteogenesis Imperfecta.
Secondary mitral valve regurgitation can be caused by non-ischemic dilated cardiomyopathy, non-compaction cardiomyopathy, and regurgitation of the aortic heart valve. In individuals with acute cases of mitral regurgitation and insufficiency, infective endocarditis is often the cause.
Risk factors for the condition in general include inflammatory diseases like rheumatoid arthritis and lupus, radiation exposure, and old age. Malnutrition, alcoholism, and lithium, phenothiazine, sulphonamide, and chemotherapy drug usage also increase the risk of regurgitation.
How is mitral valve regurgitation diagnosed?
Mitral regurgitation can be diagnosed once a physician studies a patient’s medical history, performs a thorough physical examination, and listens for a heart murmur with a stethoscope. Other tests may also be performed to confirm the diagnosis and determine the degree of regurgitation.
Transthoracic echocardiography is the standard testing method for mitral valve regurgitation, although diagnostic tests may also include a transesophagealan echocardiogram, an electrocardiogram (EKG), and holter monitor testing, event monitor testing, exercise stress testing, and chest x-rays.
Magnetic resonance imaging (MRI), computed tomography (CT scans), and cardiac catheterization are other reliable testing methods for mitral regurgitation. In fact, healthcare professionals commonly perform these tests to detect and evaluate heart valve disease for treatment.
How is mitral regurgitation treated?
The two main mitral valve regurgitation treatment options are medication and surgery. Whether or not a person requires any treatment depends on the severity of the leaky heart valve symptoms and the cause/s of the regurgitation, as well as the presence of any underlying medical problems.
Medications that doctors use to treat mitral regurgitation include vasodilators such as ACE inhibitors and hydralazine, anticoagulants like aspirin or warfarin, and diuretics like furosemide and indapamide. Other drugs include digoxin, antiarrhythmics like beta blockers, and antibiotic prophylaxis.
Surgery, which is the preferred treatment for severe mitral valve regurgitation, involves repairing or replacing the mitral valve and its structures. Surgical treatment, unlike medication, is curative and can be invasive or minimally invasive. Not everyone is a suitable candidate for surgery, however.
Many times, both medication and surgery are required to treat the condition.
What is the prognosis for patients with mitral valve regurgitation?
The mitral regurgitation prognosis depends largely on the degree of displacement, the extent of the regurgitation (the regurgitant fraction), and how the disease progresses naturally. Underlying conditions and individual risk factors also determine the outcome and manageability.
Complications like edema, atrial fibrillation, heart failure, infective endocarditis, and blood clotting, as well as any troublesome symptoms, are more common with severe regurgitation. Nevertheless, asymptomatic patients with mild forms of the disease can deteriorate over time.
Medications can relieve symptoms and prevent complications, but only surgery can remedy the problem. While there are risks involved and not every patient can undergo surgery (for example, the elderly), surgical treatment for mitral regurgitation does have a high success rate.