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A.D.A.M. Medical Encyclopedia [Internet]. Atlanta (GA): A.D.A.M.; 2013.

A.D.A.M. Medical Encyclopedia.

Mitral valve regurgitation

Mitral valve regurgitation; Mitral valve insufficiency

Last reviewed: June 4, 2012.

Mitral regurgitation is a disorder in which the heart valve that separates the upper and lower chambers on the left side of the heart does not close properly.

Regurgitation means leaking from a valve that does not close all the way.

Causes, incidence, and risk factors

Mitral regurgitation is the most common type of heart valve disorder.

Blood that flows between different chambers of your heart must flow through a valve. The valve between the two chambers on the left side of your heart is called the mitral valve.

Normal anatomy

When the mitral valve doesn't close all the way, blood flows backward into the upper heart chamber (atrium) from the lower chamber as it contracts. This leads to a decrease in blood flow to the rest of the body. As a result, the heart may try to pump harder. This may lead to congestive heart failure.

Mitral regurgitation may begin suddenly, most often after a heart attack. When the regurgitation does not go away, it becomes long-term (chronic).

Many other diseases or problems can weaken or damage the valve or the heart tissue around the valve and cause mitral regurgitation:

Risk factors include a personal or family history of any of the disorders mentioned above, and use of fenfluramine or dexfenfluramine (appetite suppressants banned by the FDA) for 4 or more months.

Symptoms

Symptoms may begin suddenly if:

There are often no symptoms. When symptoms occur, they often develop gradually, and may include:

Signs and tests

When listening to your heart and lungs, the health care provider may detect:

  • A thrill (vibration) over the heart when feeling the chest area
  • An extra heart sound (S4 gallop)
  • A distinctive heart murmur
  • Crackles in the lungs (if fluid backs up into the lungs)

The physical exam may also reveal ankle swelling, an enlarged liver, bulging neck veins, and other signs of right-sided heart failure.

The following tests may be done to examine the heart valve structure and function:

Cardiac catheterization may be done if heart function becomes worse.

Treatment

The choice of treatment depends on the symptoms, and the condition and function of the heart.

Patients with high blood pressure or a weakened heart muscle may be given medications to reduce the strain on the heart and help improve the condition.

The following drugs may be prescribed when mitral regurgitation symptoms get worse:

  • Beta-blockers or ACE inhibitors
  • Blood thinners (anticoagulants) to help prevent blood clots in people with atrial fibrillation
  • Drugs that help control uneven or abnormal heartbeats
  • Water pills (diuretics) to remove excess fluid in the lungs

A low-sodium diet may be helpful. If a person develops symptoms, activity may be restricted.

Once the diagnosis is made, you should make regular visits to your health care provider to follow your symptoms and heart function. Surgical repair or replacement of the valve is recommended if heart function is poor, the heart becomes larger (dilated), and symptoms become more severe.

People with abnormal or damaged heart valves are at risk for an infection called endocarditis. Anything that causes bacteria to get into your bloodstream can lead to this infection. Steps to avoid this problem include:

  • Avoid unclean injections
  • Treat strep infections quickly to prevent rheumatic fever
  • Always tell your health care provider and dentist if you have a history of heart valve disease or congenital heart disease before treatment. Guidelines recommend antibiotics for some patients, but only under certain conditions.

Expectations (prognosis)

The outcome varies. Usually the condition is mild, so no therapy or restriction is needed. Symptoms can usually be controlled with medication.

Complications

Problems that may develop include:

Calling your health care provider

Call your health care provider if symptoms get worse or do not improve with treatment.

Also call your health care provider if you are being treated for this condition and develop signs of infection, which include:

  • Chills
  • General ill feeling
  • Headache
  • Muscle aches

Prevention

Treat strep infections right away to prevent rheumatic fever. Prompt treatment of disorders that can cause mitral regurgitation reduces your risk.

References

  1. Otto CM, Bonow RO. Valvular heart disease. In: Bonow RO, Mann DL, Zipes DP, Libby P, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 66.
  2. Nishimura RA, Carabello BA, Faxon DP, et al. ACC/AHA 2008 Guideline update on valvular heart disease: focused update on infective endocarditis: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol. 2008;52:676-685. [PubMed: 18702976]

Review Date: 6/4/2012.

Reviewed by: Michael A. Chen, MD, PhD, Assistant Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, Washington. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.

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The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only — they do not constitute endorsementscof those other sites. © 1997–2011 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

Copyright © 2013, A.D.A.M., Inc.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial policy, editorial process and privacy policy. A.D.A.M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only — they do not constitute endorsementscof those other sites. © 1997–2011 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

Copyright © 2013, A.D.A.M., Inc.

Figures

  • Heart, section through the middle.
    Heart, front view.

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