Mitral Regurgitation

With mitral regurgitation (also known as mitral insufficiency), the heart’s mitral valve is leaky. The mitral valve is one of the heart's four valves. These valves help the blood flow through the heart's four chambers and out to the body.

The mitral valve lies between the left atrium and the left ventricle. Normally, the mitral valve prevents blood flowing back into the left atrium from the left ventricle. In mitral valve regurgitation, however, some blood leaks back through the valve. In other words, the blood isn’t going where it should.

Instead, some of it leaks backward instead of flowing out to the rest of your body. As a result, the heart has to work harder to get blood out to the body. If the regurgitation gets worse, some blood may start to back up into the lungs, causing shortness of breath.

Mitral regurgitation can be acute or chronic. With the acute condition, the valve suddenly becomes leaky. When this happens, the heart doesn't have time to adapt to the leaky valve. Acute mitral regurgitation symptoms can be very severe. In the chronic form, the valve gradually becomes leakier over time. With chronic mitral regurgitation, the symptoms may range from mild to severe.

Symptoms

Many people with only mild regurgitation won’t notice any symptoms. But if the condition worsens, you might have:

Palpitations (rapid, fluttering heartbeat). They may be more likely to happen when you’re lying on your left side.
Coughing
Fatigue
Shortness of breath when lying flat, or during physical activity
Rapid breathing
Chest pain (less common)
Reduced ability to exercise
Swelling in your legs, abdomen, and neck

Acute, severe mitral valve regurgitation is a medical emergency. It can cause serious symptoms such as:

Symptoms of shock, such as pale skin, loss of consciousness, or rapid breathing
Severe shortness of breath
Abnormal heart rhythms

Causes

Various conditions can cause mitral valve regurgitation. They include:

Floppy mitral valve (mitral valve prolapse)
Coronary artery disease or heart attack
A former bout of rheumatic fever
Certain autoimmune diseases such as rheumatoid arthritis
Endocarditis (infection of the heart valves)
Cardiomyopathy (abnormal function of the heart muscle)
Mitral valve problems present at birth (congenital)
Support structures of the mitral valve break (rupture)
Certain medications
IV drug use
Trauma
Acute mitral valve regurgitation is more likely to happen after a heart attack. It’s also more likely to happen after rupture of the tissue or muscle that supports the mitral valve. It can happen after an acute injury or heart valve infection.

Treatment

Mild cases of mitral valve regurgitation often require no treatment at all. But, your physician will still recommend regular checkups and monitoring. Treatment varies depending upon the cause, along with how severe the condition is. Treatment may include:

Medications. While certain drugs can’t fix a valve problem, they can target other conditions that make regurgitation worse. For example, water pills (also known as diuretics) can reduce fluid buildup. Blood thinners can help prevent clots. Blood pressure lowering medications, and medicines to reduce the risk of arrhythmias may also be prescribed.
A low salt, heart healthy diet (to decrease blood pressure and the stress on your heart)
To reduce risk of arrhythmias, limit caffeine and alcohol.
Surgery may be needed with severe mitral valve regurgitation.
Some of the patients may be candidates for a minimally invasive Mitral Clip procedure where a clip is placed on the valve with a catheter placed using an intravenous in your groin.

When to see a doctor

Visit your doctor for regular check-ups to monitor your condition. See your healthcare provider right away if:

Your symptoms get worse
You notice sudden new symptoms
You have severe shortness of breath or chest pain