February 3, 2022

Understanding mitral valve regurgitation

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Here’s what causes this leaking in one of the heart’s valves.

The mitral valve is one of the heart’s four valves. Normally, these valves close tightly to help 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. A healthy mitral valve stops blood from flowing back into the left atrium from the left ventricle when the ventricle squeezes. This maximizes forward blood flow through the heart and out to the body. 

With mitral valve regurgitation, the valve doesn’t close tightly. It lets some blood flow backward into the left atrium when the ventricle squeezes.

This forces the heart to work harder to get blood pumped out to your body. When this blood is regurgitated backwards in the heart, it increases the pressure within the heart, which can lead to muscle damage as well as high blood pressure in the lungs. 

Mitral valve regurgitation can increase the chances that other heart rhythm problems develop. Potential problems include atrial fibrillation (AFib). This abnormal heart rhythm results in fast, irregular heartbeats, which can also lower the heart’s pumping ability and increases the risk for stroke. 

Mitral valve regurgitation can be acute or chronic. If it’s acute, the valve suddenly becomes leaky. In this case, the heart doesn’t have time to adapt to the leak in the valve. Symptoms are often severe. If you have severe mitral regurgitation, you may need a catheter procedure or surgery to repair or replace the leaking valve. 

If it’s chronic, the valve leaks more and more over time. The heart and the body have time to adapt to the leak. 

What causes mitral valve regurgitation?

Mitral valve regurgitation can be caused by various things, such as:

  • A heart attack or coronary artery disease.
  • Natural aging that can damage the mitral valve.
  • Tearing of the tissue or muscle that supports the mitral valve, such as what an injury can cause. 
  • A floppy mitral valve, called mitral valve prolapse. 
  • Rheumatic heart disease caused by untreated Streptococcus infection. Strep are the bacteria that cause strep throat. 
  • Certain autoimmune diseases, such as rheumatoid arthritis.
  • Infection of the heart valves (endocarditis).
  • Problems with the mitral valve that are present at birth.
  • Certain medicines, such as weight loss medicines that were used to treat obesity (Fen-phen). 

You can reduce some risk factors for mitral valve regurgitation. For example:

  • Use antibiotics as directed to treat a strep infection and prevent rheumatic heart disease. 
  • Reduce the risk for heart valve infection by not injecting illegal drugs.
  • Manage risk factors that can lead to a heart attack or chronic heart artery disease.

There are other risk factors that you can’t change. For example, some conditions that can lead to mitral valve regurgitation are partly genetic. 

Symptoms of mitral valve regurgitation

Chronic mitral valve regurgitation often doesn’t cause symptoms for a long time. Mild or moderate mitral regurgitation often doesn’t cause any symptoms. If the condition becomes more severe, you may feel symptoms. They may get worse and happen more often over time. Symptoms may include: 

  • Shortness of breath with physical activity. 
  • Shortness of breath when lying flat.
  • Feeling tired.
  • Less ability to exercise.
  • Awareness of your heartbeat. This might be feeling a pounding in your chest (palpitations) or racing and irregular heartbeats that accompany atrial fibrillation. 
  • Swelling in your legs, abdomen and the veins in your neck.
  • Chest pain (less common than other symptoms).

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

  • Symptoms of shock (pale skin, loss of consciousness, rapid breathing).
  • Severe shortness of breath.
  • Arrhythmias that make the heart unable to pump blood well.

How is mitral valve regurgitation diagnosed?

To determine if this is what’s happening in your heart, your health care provider will ask about your health history. You’ll have a physical exam. Using a stethoscope, your health care provider will listen to your heart. This is to check for sounds called heart murmurs and other signs that the heart isn’t pumping normally. You may also have tests such as: 

  • An echocardiogram, to look at the structure of the heart using sound waves.
  • Stress echocardiogram, to see how well the heart does during exercise.
  • Electrocardiogram (ECG), to check the heart’s rhythm.
  • Cardiac MRI, trans esophageal echocardiogram or cardiac catheterization, if more information is needed.
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Vanderbilt University Medical Center is a leader in treating heart valve disease with the newest transcatheter techniques. Vanderbilt’s team includes general cardiologists, interventional cardiologists and cardiac surgeons, all with advanced training and expertise in structural heart and valve disease. They treat patients with diseases of the aortic, mitral or tricuspid valve, from the routine to the complex.

Download a free treatment guide