Mitral Valve Regurgitation

Mitral valve regurgitation is also called mitral insufficiency, or incompetence. Normally, the valve only allows blood to flow from the upper to lower heart chamber. If new symptoms develop or preexisting symptoms become worse, call your doctor. Heart valves work like one-way gates, helping blood flow in one direction between heart chambers or in and out of the heart. But today, rheumatic fever is rare in North America, Australasia, Western Europe, and other regions where antibiotics are widely used to prevent infections such as strep throat. In these regions, rheumatic fever is a common cause of mitral regurgitation only among older people who did not have the benefit of antibiotics during their youthThis uncirculated blood causes the heart to work harder to pump the extra regurgitated blood (volume overload).

The condition can leave you fatigued and short of breath. This uncirculated blood causes the heart to work harder to pump the extra regurgitated blood (volume overload). Heart valves work like one-way gates, helping blood flow in one direction between heart chambers or in and out of the heart. Increased left ventricular filling pressures, combined with the transfer of blood from the left ventricle to the left atrium during systole, results in elevated left atrial pressures. The condition is progressive, which means it gradually gets worse. You may need heart surgery to repair or replace the valve. Talk with your doctor to determine a safe level of activity.

Myxomatous mitral valve ("floppy" or "billowing" mitral valve, or mitral valve prolapse) is usually asymptomatic but may be associated with nonspecific chest pain, dyspnea, fatigue, or palpitations. Most patients are female, many are thin, and some have minor chest wall deformities. There are characteristic midsystolic clicks, which may be multiple, often but not always followed by a late systolic murmur. These findings are accentuated in the standing position. The diagnosis is primarily clinical but can be confirmed echocardiographically. Its significance is in dispute because of the frequency with which it is diagnosed in healthy young women (up to 10%), but in occasional patients this lesion is not benign.

Patients who have only a midsystolic click usually have no sequelae, but patients with a late or pansystolic murmur may develop significant mitral regurgitation, often due to rupture of chordae tendineae. The need for valve replacement is commonest in men and increases with aging, so that approximately 2% of patients with clinically significant regurgitation over age 60 years will require surgery. Infective endocarditis may occur, chiefly in patients with murmurs; such patients should have antibiotic prophylaxis prior to dental work and surgical procedures. -Adrenergic blocking agents are often effective for supraventricular arrhythmias. Sudden death is rare in mitral prolapse, but when symptomatic ventricular tachycardia is present, aggressive management with an implantable cardioverter-defibrillator is usually indicated. An association between mitral prolapse and embolic cerebrovascular events has also been reported but not confirmed in subsequent studies. Echocardiographic evidence of marked thickening or redundancy of the valve is associated with a higher incidence of most complications.

Papillary muscle dysfunction or infarction following acute myocardial infarction is less common. When mitral regurgitation is due to papillary dysfunction, it may subside as the infarction heals or left ventricular dilation diminishes. If severe regurgitation persists, these patients have a poor prognosis with or without surgery. Transient—but sometimes severe—mitral regurgitation may occur during episodes of myocardial ischemia. Patients with dilated cardiomyopathies of any origin may have secondary mitral regurgitation due to papillary muscle dysfunction or dilation of the mitral annulus. In these, mitral valve replacement has been considered contraindicated because of the poor risk:benefit ratio and deterioration of left ventricular function postoperatively. However, several groups have reported good results with mitral valve repair in patients with left ventricular ejection fractions greater than 30% and secondary mitral insufficiency.

Cause of Mitral Valve Regurgitation

Hera are the list of the possible cause of Mitral Valve Regurgitation:

• Chronic mitral valve regurgitation , the most common type, develops slowly. Many people with this problem may have a valve that is prone to wear and tear.
• Mitral regurgitation becomes chronic when the condition persists rather than occurring for only a short time period.
• Myxomatous degeneration is usually a slow process, with a major complication being the rupture of the chordae tendineae.
• Mitral annular calcification can contribute to regurgitation.
• Ehlers-Danlos syndrome
• An infection of the lining of the heart and heart valves ( endocarditis ), which can cause scarring on the mitral valve.
• Autoimmune diseases that can damage the mitral valves, such as rheumatoid arthritis , lupus , and Marfan's syndrome .

Symptomsof Mitral Valve Regurgitation

Some sign and symptoms related to Mitral Valve Regurgitation:

• Shortness of breath, especially with physical exertion or when the person lies down
• Chest pain (not caused by coronary artery disease or a heart attack)
• Cough, especially at night or when lying down
• Symptoms include shortness of breath with exertion, which later develops into shortness of breath at rest and at night; fatigue and weakness; and fluid buildup (edema) in the legs and feet.
• Shortness of breath when lying flat ( orthopnea )
• The resultant decrease in diastolic filling time.
• Symptoms come on rapidly and include severe shortness of breath at rest, coughing, and fast heartbeat.
• This feeling is called palpitations.

Treatment & Prognosis of Mitral Valve Regurgitation

Acute mitral regurgitation due to endocarditis, myocardial infarction, and ruptured chordae tendineae often requires emergency surgery. Some patients can be stabilized with vasodilators or intra-aortic balloon counterpulsation, which reduces the amount of regurgitant flow by lowering systemic vascular resistance. Patients with chronic lesions may remain asymptomatic for many years. Operation is usually necessary when patients develop symptoms. However, because progressive and irreversible deterioration of left ventricular function may occur prior to the onset of symptoms, early operation is indicated even in asymptomatic patients with a declining ejection fraction (< 55–60%) or marked left ventricular dilation (end-systolic dimension > 4.5–5 cm on echocardiography).

There has been growing success with valve repair in nonrheumatic lesions, which avoids the complications of prosthetic valves described earlier. In addition, left ventricular function is better preserved when the subvalvular structures can be maintained intact by valve repair. Selected patients with poor left ventricular function and severe mitral regurgitation may benefit from this intervention. Mitral valve surgery is increasingly being performed using the appreciably less invasive thoracoscopic approach.

• Anti-hypertensive drugs and vasodilators may be given to reduce the strain on the heart and may help improve the condition.
• The mainstay of medical treatment in most other cases of mitral regurgitation is afterload reduction
• Anticoagulants , such as warfarin (Coumadin), to prevent blood clots if you also have atrial fibrillation .
• The physician should consider cardioversion in refractory or unstable patients.
• Anticoagulants , such as warfarin (Coumadin), to prevent blood clots if you also have atrial fibrillation .
• Propranolol is given for palpitations or chest pain.
• Anticoagulants (blood thinners) help prevent blood clots in persons who also have atrial fibrillation.
• Hyperthyroidism , a disease of the thyroid gland. 

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