Mitral Regurgitation

What is mitral regurgitation?

Mitral (MI-trull) valve regurgitation (ree-ger-jih-TA-shun) is also called "MR". MR happens when some of the blood in your heart leaks from the left ventricle into the left atrium (A-tree-um). This causes health problems because the blood flows backward through the mitral valve instead of forward.

Where is the mitral valve?

• The heart has 4 chambers (rooms). The two upper chambers are called atria (A-tree-ah) and the two lower chambers are called ventricles (VEN-trik-ulls). When the heart "beats", the atria push blood into the ventricles. The ventricles then push blood out of the heart. The right ventricle pushes blood into the pulmonary artery, then into the lungs to get oxygen. The left ventricle pushes blood with oxygen into the aorta and out to the body.
  
  
• There are valves (doors) between the chambers that open and close to direct blood flow through the heart. The mitral valve is made up of two leaflets that come from the front and back of the valve and meet in the middle. As your heart beats, the mitral valve opens to let blood go from the left atrium to the left ventricle. The mitral valve closes when your heart rests between beats. The closed mitral valve should prevent backflow of blood from the ventricle to the atrium.

What happens when you have mitral regurgitation?

• Most people who have mitral regurgitation will not have symptoms for a long time. At first, the heart beats a little harder to make up for the blood escaping back into the atrium. Some people may never have symptoms or may have only mild symptoms as long as they live. Some people have symptoms that begin suddenly. The difference in the length of time it takes for symptoms to begin, if they begin, depends on the cause of MR.
  
  
• It may slowly get harder for your heart to keep up as time passes. You may begin to have symptoms like being more tired, especially when you are adding a new activity. You may need more than one pillow when you sleep.You may also begin to get dizzy, cough, or be able to feel your heartbeat. Sometimes your heartbeat may not feel regular.

What causes mitral regurgitation?

Mitral regurgitation can be caused by many things. The following is a list of some causes of mitral regurgitation:

• Mitral valve prolapse.
  
  
• Damage to the cords that help to open and close the mitral valve.
  
  
• Rheumatic (rew-MAH-tik) fever.
  
  
• Bacterial (bak-TEER-e-uh) endocarditis (end-o-kar-DI-tis).
  
  
• Aging. Some people have a mitral valve that wears out earlier than other people.
  
  
• Heart attack. Usually, around two weeks after having a heart attack, your caregiver will hear a murmur. Your caregiver will find that you now have MR even though you did not before.
  
  
• Coronary artery (heart vessel) disease.
  
  
• Heart valve disease that you are born with.
  
  
• Other diseases.
  
  
• Injury to the heart possibly by an accident.
  
  
• Myxoma. This is a jelly-like growth on the leaflets in the mitral valve.
  
  
• Having taken certain diet medicines.

Signs and Symptoms:

You may have one or more of the following signs and symptoms:

• Fatigue (getting tired easily).
  
  
• Shortness of breath during exercise or activities like climbing stairs.
  
  
• Needing more than one pillow to sleep.
  
  
• Heart murmur (extra sounds).
  
  
• Dizziness.
  
  
• Cough.
  
  
• Feeling your heartbeat. Sometimes your heart may not feel regular.
  
  
• Feet and ankle swelling.

Care:

You may have some or all of the following tests to show how well your mitral valve is working. These tests may be done more than once as your mitral regurgitation is being treated.

• Heart monitor: This test is also called an EKG or ECG. Sticky pads are placed on your skin to record your heart's electrical activity. An EKG gives information about how your heart is working. Lie as still as possible during the test.
  
  
• Chest x-ray: This is a picture of your lungs and heart. Caregivers use it to see how your lungs and heart are doing. Caregivers may use the x-ray to look for signs of infection like pneumonia, or to look for collapsed lungs. Chest x-rays may show tumors, broken ribs, or fluid around the heart and lungs.
  
  
• Echocardiogram: This test is a type of ultrasound. Sound waves are used to show the structure, movement, and blood vessels of your heart.
  
  
• Transesophageal (trans-eh-sof-uh-G-ull) echocardiogram (TEE):
  
  
  • A transesophageal (trans-eh-sof-uh-G-ull) echocardiogram (eh-ko-KAR-d-o-gram) is a test to check for problems inside and around your heart. It can also check for problems in the veins and arteries near your heart. It is also called a "TEE" .
    
    
  • TEE sends harmless sound waves to the heart through a tube put down your throat. Parts of the heart, like the walls, valves, muscles, and blood vessels, send echoes back to the machine. The motion of the echoes is traced on a machine and recorded on film. This recording shows caregivers how your mitral valve looks and works.
  
  
• Ultrasound with Color Flow Doppler: This is a painless test using sound waves to look at your heart. Pictures show up on a TV-like screen. Doppler adds color and sound to show blood flow. You may need the ultrasound to help your caregiver decide on the best treatment for you.
  
  
• Cardiac blood pool imaging: This test shows how well your heart is pumping. It can also be called a "gated blood pool scan" or a MUGA scan. You are given a small, safe amount of radioactive dye in an IV. Caregivers then take pictures of your heart.
  
  
• Cardiac catheterization: This is a procedure done to find the cause of and treat a heart condition. A thin, bendable tube inserted into an arm, neck, or groin vein is moved into your heart. Your caregiver may use an x-ray to guide the tube to the right place. Dye (contrast) may be put into your vein so the pictures show up better on a monitor.
  
  
• MRI: This test is also called magnetic resonance (REH-zuh-nuns) imaging. MRI allows your caregivers to see inside your body. During the MRI pictures are taken of your heart. Caregivers use these pictures to measure the backflow in your heart.

Treatment:

Treatment of your mitral regurgitation depends on three things: Did the disease begin quickly or slowly? Are you having symptoms? What do the tests show about how well your mitral valve is working? Your caregiver may want you to follow a low sodium diet. You may need to have surgery to fix or replace your mitral valve. You may also need to take one or more of the following medicines:

• Antibiotics.
  
  
• Blood thinning medicine.
  
  
• Diuretic medicine (water pills).
  
  
• Heart medicine.

Surgery:

There are two types of surgery you may have to repair or replace your mitral valve:

• Mitral valve repair: There are several ways to repair mitral valve problems. Ask your caregiver for the CareNotes™ handout about mitral valve repair that applies to you.
  
  
• Mitral valve replacement: Ask your caregiver for the CareNotes™ handout about mitral valve replacement.

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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