What’s going on with your heart?
Lately, when you’ve been out for your daily run, you notice that you have been becoming short of breath. This hasn’t happened before, so you go to the doctor. When he listens to your chest, he tells you that you have a murmur. Based on your symptoms, the doctor suspects you have mitral valve regurgitation. What does this mean? How will it impact your life? Can it be corrected?
Definition
Mitral valve regurgitation is when the valve that separates the upper (atrium) and lower (ventricle) chambers on the left side of your heart doesn’t close as tight as it should, which allows blood to backflow and doesn’t move through your body. This is why it’s also called mitral regurgitation, mitral insufficiency, or mitral incompetence. Symptoms are palpitations, fatigue, swollen feet/ankles, or shortness of breath, especially when being active or lying down. Also, you might have a heart murmur, which is an abnormal sound heard with a stethoscope. For most people, their condition is mild and progresses slowly. There are two main types are primary and secondary. In primary, the problem is related to the mitral valve itself. In secondary, which is also called functional, it’s the result of diseases of the left ventricle.
There are several possible causes of mitral valve regurgitation. When the valve leaflets (flaps) bulge back into the atrium during the heart’s contraction, it’s called mitral valve prolapse. The bulging prevents the valve from closing tightly. Another issue with the valve structure is that the tissue cords that connect it to the heart wall can stretch or tear, which results in the valve not being able to close properly either. Other conditions can damage the mitral valve, such as rheumatic fever (a complication of untreated strep throat), endocarditis (infection of the lining of the heart), atrial fibrillation (irregular heart rhythm), or heart attack. Some conditions happen over time, like enlargement of the left ventricle from high blood pressure (hypertension). Congenital heart defects are those that individuals are born with, and some can damage heart valves. A sudden injury, like those that can occur in traumatic events, can also result in heart valve injury. Certain medications, such as prolonged use of ergotamine, or treatment therapies, like radiation, can also impact the mitral valve. All of these are risk factors for developing mitral valve regurgitation. One other risk is being middle-aged because heart valves naturally deteriorate over time.
If your mitral valve regurgitation is severe, it can trigger several complications. When your body can’t pump enough blood throughout your body because it’s backing up in your heart due to the mitral valve not functioning correctly, your left ventricle gets bigger and weaker, leading to it failing. This is known as left-sided heart failure. The same dysfunction leads to pressure building in your lungs, causing fluid accumulation, putting strain on the right side of the heart, and eventually failing. A secondary condition caused by this is increased pressure in the pulmonary arteries, known as pulmonary hypertension. Another complication is atrial fibrillation (yes, it can be a result, not just a cause, of mitral valve regurgitation). In this scenario, the enlargement of the left atrium, resulting from the poorly working mitral valve, causes it to beat irregularly. Instead of contracting and relaxing the way they’re supposed to, they beat rapidly and chaotically. This allows blood to pool in the atria. When blood isn’t moving, it starts to clot. The risk is a clot or portion of one could break off and travel through your bloodstream, causing severe problems, like a stroke.
Treatment
Mitral valve regurgitation treatment is dependent on how severe your condition is. The goal is to minimize symptoms while improving heart function to decrease the chances of future complications. For those with a mild form, it’s a wait-and-see approach. During this time, you’ll need to have regular evaluations by your doctor to keep track of any changes in your condition. Your doctor might prescribe medications to treat symptoms. Medicines won’t fix the valve but can make your quality of life better. Some that may help are diuretics (to remove excess fluid from your body), blood thinners (to prevent blood clots), and high blood pressure medications (to get it closer to normal limits, since when it’s high, it can make your condition worse).
Another option is mitral valve repair or replacement. Your doctor may suggest this even if your symptoms/condition isn’t severe because it can prevent future complications. In valve repair, they can reconnect valve leaflets, replace the tissue cords, or remove excess valve tissue so that the leaflets can close tightly. Another option is to tighten or reinforce the ring around a valve by implanting an artificial one. If your valve can’t be repaired, your surgeon can replace it with a mechanical valve or a valve made from cow, pig, or human heart tissue (biological tissue valve). There are some drawbacks to either kind. Mechanical valves require that you take blood-thinning medication for the rest of your life. Biological tissue valves wear out and will need to be replaced. Mitral valve repair or replacement can take place via open-heart surgery or minimally invasive surgery. Your doctor will help you decide which method is best for you.
Regardless of the approach your doctor recommends, you need to make sure you see your doctor regularly and take all medications as prescribed. It’s helpful to have a good support network of family and friends to aid in coping. If you’re a woman with mitral valve regurgitation, talk to your doctor before becoming pregnant since it naturally causes your heart to work harder.
Prevention
To lessen your chances of developing mitral valve regurgitation, your focus should be on lifestyle changes. Two key aspects are maintaining normal blood pressure and a healthy weight. This is best achieved by eating a diet low in saturated/trans fats, sugar, salt, and refined grains. Instead, your diet should include fruits, vegetables, whole grains, and proteins (ex. lean meats, fish, and nuts). The other essential factor is getting regular physical activity. Check with your doctor before starting any new exercise routine. It’s also a good idea to limit how much alcohol use consume and not smoke.
Mitral valve regurgitation can range from an annoyance to life-altering. However, with the proper treatment, you’ll be back to your old self in no time. If you have any questions or concerns about mitral valve regurgitation, please speak with your doctor. If you would like more information, please visit the American Heart Association’s Mitral Valve Regurgitation page at https://www.heart.org/en/health-topics/heart-valve-problems-and-disease/heart-valve-problems-and-causes/problem-mitral-valve-regurgitation