Introduction:

Mitral valve regurgitation or Mitral regurgitation is a common type of heart valve disease in which the valve between the left heart chambers is unable to close appropriately; due to this issue, the blood leaks backward across the valve. Other names for this disease are Mitral incompetence and Mitral insufficiency. The heart has four valves that help keep proper blood flow; the mitral valve is one of them. These valves have flaps that once open and close during each heartbeat. If this valve does not open or close properly, the blood supply through the heart to the body gets disturbed. The valve flaps do not close appropriately in mitral regurgitation. So, blood leaks backward if the valve is closed, making it difficult for the heart to work properly. Due to the shortage of blood supply to the heart or other body parts, the patients feel fatigued and have shortness of breath. If Mitral valve regurgitation is not appropriately treated on time, it may cause heart rhythm problems or heart failure. 

Stages:

Two stages of Mitral valve regurgitation are the following:

  • Primary mitral valve regurgitation: If the mitral valve regurgitation is in its initial stage and the disease is due to a problematic mitral valve, this condition is known as primary mitral valve regurgitation.
  • Secondary mitral valve regurgitation: If the disease of the mitral valve gets worse and starts affecting other areas of the heart due to leakage, this condition is known as functional or secondary mitral valve regurgitation.

Causes:

A wide range of diseases or problems can cause mitral valve regurgitation. Some of the leading causes of Mitral valve regurgitation are the following:

  • Infection in the heart valves (endocarditis
  • Congenital heart defects
  • Rheumatic heart disease
  • Mitral valve prolapses
  • Breakage or rupture in the structure of the mitral valve
  • Trauma
  • Heart attack
  • Thickening of heart muscles(cardiomyopathy)
  • Coronary artery disease
  • Radiation therapies and Certain medications

Symptoms:

Mitral valve regurgitation disease is often mild and slowly develops in the body. Many people do not have any symptoms in the initial stage. When the Mitral valve regurgitation develops gradually over time, signs and symptoms appear in the body. Some of the common signs and symptoms of Mitral valve regurgitation are the following:

  • Fatigue is the most common symptom of mitral valve regulation
  • Palpitation (rapid or fluttering heartbeat)
  • Irregular heartbeat
  • Pain in chest
  • Cough
  • Swollen feet and ankles
  • Murmuring of heart
  • Shortness of breath while lying flat or excretion
  • Reduced ability for any physical activity
  • Loss of consciousness
  • Pale skin

When to see a doctor:

Contact the doctor immediately if you feel chest pain or suffer from severe shortness of breath. Your symptoms may worsen over time, so contact an expert cardiologist for the appropriate diagnosis and treatment of your heart disease. 

Diagnosis:

During diagnosis, your cardiologist asks you about your medical history and performs a physical exam. With the help of the stethoscope, he checks your heartbeat and notices the murmuring and other symptoms of mitral valve regurgitation. He may recommend the following tests after your physical exam for a proper diagnosis:

  • Echocardiogram to detect the severity of the disease
  • Cardiac MRI
  • Cardiac Catheterization
  • Transesophageal echocardiogram
  • Electrocardiogram (ECG) to check the heart rate
  • Stress echocardiogram to notice the exercise tolerance

Treatment:

The treatment of Mitral valve regurgitation usually depends on the causes and severity and the patient’s overall health. If the patient suffers from a mild or moderate mitral valve regurgitation, he might not need any treatment. This disease can also increase the risk of other heart problems such as atrial fibrillation. Your cardiologist may recommend you therapy after correctly diagnosing your heart condition. Even if you suffer moderate mitral valve regurgitation, you may need regular echocardiograms. 

Medications:

Your doctor may prescribe the following medication for mitral valve regurgitation:

  • Medicines that reduce the heart rate if you develop atrial fibrillation
  • Blood thinners to prevent blood clots
  • Water pills(diuretics) which improve the swelling and symptoms
  • Beta-blockers and Angiotensin-converting enzymes (ACE) inhibitors control the blood pressure and help to reduce the heart’s workload when the heart is unable to pump blood properly.

Surgery:

In severe conditions, surgery is the last option prescribed by the doctor. During surgery, the surgeon repairs the mitral valve or replaces it according to the patient’s condition. Your surgeon may suggest open surgery or a minimally invasive repair according to the patient’s condition. During surgery, your surgeon uses a valve of donor heart tissues, and these donors may be a cow, pig, or human. If the doctor does not get a donor valve, an artificial mechanical valve is another option for the patient. The surgeon may perform a maze procedure if the patient suffers atrial fibrillation. This kind of heart surgery can also reduce the future risk of atrial fibrillation. Clips are also used in some cases that help to reduce the amount of mitral regurgitation and delay or eliminate the need of r surgery for the patients. 

Lifestyle changes:

Your doctor may suggest the following lifestyle changes to treat mitral valve regurgitation disease:

  • A heart-healthy diet, which is low in salt decrease the stress, and blood pressure in your heart
  • Use medicines that reduce the risk of arrhythmias
  • Use medications that lower the blood pressure
  • Limit the use of Alcohol and caffeine

Risk factors:

Factors that increase the risk of Mitral valve regurgitation disease are the following:

  • Old age
  • Heart attack
  • Infection in heart
  • Use of IV drugs
  • Congenital heart diseases (Heart problems from birth)
  • Radiations to the chest
  • History of heart valve disease

Complications:

The complication of mitral valve regurgitation usually depends on the severity of the disease. Mild mitral valve regurgitation disease does not create any problem in the body of the patients. When this disease gets worse, it causes certain complications in the heart and other body parts: 

  • Blood clots in the lungs or brain
  • High blood pressure in the lungs (pulmonary hypertension)
  • Congestive heart failure
  • Irregular and often rapid heart rate
  • Heart Dilation 

References:

  • https://www.cedars-sinai.org/health-library/diseases-and-conditions/m/mitral-valve-regurgitation.html
  • https://www.mayoclinic.org/diseases-conditions/mitral-valve-regurgitation/symptoms-causes/syc-20350178
  • https://www.webmd.com/heart-disease/what-is-mitral-valve-regurgitation
  • https://medlineplus.gov/ency/article/000176.htm
  • https://www.thekeyholeheartclinic.com/services/valve-disorders/mitral-valve2/mitral-regurgitation/