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by Polsdorfer R

Mitral Regurgitation

(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 serious. The sooner it is treated, the better the outcome.
Mitral Valve Regurgitation
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Causes

Mitral regurgitation may be caused by:
  • Mitral valve prolapse—Abnormal closure of the valve with protrusion of a leaflet tip backward into the left atrium, causing it to leak.
  • Infections that cause scarring of the heart valve, such as rheumatic fever or bacterial endocarditis .
  • Damage from a heart attack .
  • Several different types of congenital heart defects , which can affect mitral valve function.
  • Cardiomyopathies—Diseases that weaken the heart muscle and stretch the mitral valve.

Risk Factors

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

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.
Mitral regurgitation may cause:
  • 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 a heart arrhythmia

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.
Imaging tests evaluate the heart and surrounding structures. These can be done with:
An electrocardiogram (EKG) can measure your heart's electrical activity.

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:
  • Prevent cardiovascular 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 , pharyngitis , and scarlet fever
  • Get prompt treatment for infections
  • 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://www.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.
Mitral regurgitation. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated April 2, 2014. Accessed August 20, 2014.
Shipton B and Wahba H. Valvular heart disease: review and update. Am Fam Physician. 2001;63:2201-2208.
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.

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