What is mitral valve regurgitation?

Mitral valve regurgitation is a backward flow of blood in the heart through the mitral valve. The mitral valve is located between the upper and lower parts of your heart on the left side. Before each heart beat, the upper part of your heart fills with oxygen-rich blood that has passed through your lungs and the mitral valve opens. Then your heart muscle squeezes to push blood into the lower part. At the end of the squeeze, the valve normally closes tightly so that blood flows in just 1 direction through your heart.

When you have valve regurgitation, the valve does not close completely. This lets blood move backward into the upper left part of your heart. This means your heart must work harder to pump blood to the rest of your body. Over time, this extra work can cause can cause high blood pressure in the left upper left part of your heart and in your lungs. This can cause trouble breathing and damage your heart.

What is the cause?

Many things can cause mitral valve regurgitation:

• A problem that you are born with
• Scarring of the mitral valve by rheumatic fever or other diseases
• Mitral valve prolapse, which is when the mitral valve in your heart is floppy and does not close all the way
• Heart attacks, heart disease, or high blood pressure

What are the symptoms?

People who don’t have a lot of leaking may not have any symptoms. Over time, the added workload on your heart may cause symptoms during exercise and later with any activity or while you are resting. Symptoms may include:

• Abnormal heart rhythm that feels like your heart is pounding, racing, or skipping in your chest
• Shortness of breath or trouble breathing
• Feeling very tired
• Waking up at night or having a hard time lying flat in bed because of shortness of breath
• Swollen ankles and feet and weight gain due to too much fluid in the body
• Loss of appetite

How is it diagnosed?

Your healthcare provider will ask about your symptoms and medical history and examine you. Your provider will use a stethoscope to listen for the sound of a heart murmur caused by the mitral valve.

Tests may include:

• A chest X-ray
• An ECG (also called an EKG or electrocardiogram), which measures and records your heartbeat. You may have an ECG while you are resting or while you exercise on a treadmill.
• An echocardiogram, which uses sound waves (ultrasound) to see how well your heart is pumping
• A Doppler exam, which uses sound waves (ultrasound) to look at the blood flow in your blood vessels
• Heart catheterization, which uses a small tube called a catheter inserted into a blood vessel, dye, and X-rays to show blood flow through the mitral valve

How is it treated?

If you do not have any symptoms and your heart and lungs are not damaged, you may not need any treatment.

Medicines that expand blood vessels and lower blood pressure may help you feel better, but they will not correct the valve problem.

Most people with symptoms need surgery to repair the valve or replace it. If you wait too long to get treatment, your heart muscle may be damaged. The valve may be able to be repaired. Sometimes it is damaged so badly that it must be replaced. Two types of artificial heart valves are available:

• Mechanical valves are made completely from man-made materials. When you have a mechanical valve, you must take blood-thinning drugs for the rest of your life to reduce the risk of blood clots. The main advantage of mechanical valves is that they usually last 20 years or more.
• Biological valves are made from human or animal tissue The main advantage of a biological valve is that you do not need to take blood-thinning drugs for the rest of your life. These valves usually last up to 15 years.

How can I take care of myself?

Follow the full course of treatment prescribed by your healthcare provider. Ask your healthcare provider:

• How and when you will hear your test results
• How long it will take to recover
• What activities you should avoid and when you can return to your normal activities
• How to take care of yourself at home
• What symptoms or problems you should watch for and what to do if you have them

Make sure you know when you should come back for a checkup.

A healthy lifestyle may also help:

• Eat a healthy diet. Ask your provider about the benefits of talking to a dietician to learn what you need in a healthy diet.
• Try to keep a healthy weight. If you are overweight, lose weight.
• Stay fit with the right kind of exercise for you. Ask your healthcare provider about what types of activities or exercise you can do and what you should avoid.
• Limit caffeine.
• Learn to manage stress. Ask for help at home and work when the load is too great to handle. Find ways to relax, for example take up a hobby, listen to music, watch movies, or take walks. Try deep breathing exercises when you feel stressed.
• If you smoke, try to quit. Talk to your healthcare provider about ways to quit smoking.
• If you want to drink alcohol, ask your healthcare provider how much is safe for you to drink.
• Try to get at least 7 to 9 hours of sleep each night.
• Keep all appointments for provider visits or tests.
• Contact your healthcare provider if you have new or worsening symptoms.

Tell all healthcare providers you see that you have mitral valve regurgitation. Damaged, abnormal, or artificial heart valves are more likely to get infected by bacteria, which can cause severe problems. Ask your healthcare provider if you should take an antibiotic before any kind of dental work or surgery. This includes having your teeth cleaned or procedures involving the bladder, vagina, or rectum.

How can I help prevent mitral regurgitation?

Rarely, mitral regurgitation is caused by rheumatic fever. See your healthcare provider if you have a sore throat without other symptoms or if you have been exposed to strep throat. Treating strep throat infections with antibiotics can usually prevent rheumatic fever.

If you have high blood pressure, make sure your blood pressure is under control. Follow your healthcare provider’s instructions about exercise, diet, and medicines.