Mitral Regurgitation

GENERAL INFORMATION:

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.

• 12-lead ECG: This test, also called an EKG, helps caregivers look for damage or problems in different areas of the heart. Caregivers may need to prepare your skin by shaving off some hair, or cleaning it with a gritty lotion. Sticky pads are placed on your chest, arms, and legs. Each sticky pad has a wire that is hooked to a machine or TV-type screen. A short period of electrical activity in your heart muscle is recorded. Caregivers will look closely for certain problems or changes in how your heart is working. This test takes about 5 to 10 minutes. It is important that you lie as still as possible during the test. You may need this test more than once.
  
  
• 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 also called an echo. It is a type of ultrasound, using sound waves to show pictures of the size and shape of your heart. An echo also looks at how your heart moves when it is beating. These pictures are seen on a TV-like screen.
    
    
  • This test is done while lying down on your back. Clear jelly will be squirted on your chest to help the ultrasound sensor slide easily. The sensor will be rubbed across your chest to see your heart from different angles. You may hear a barking or whooshing noise, which is the sound of your blood flow. Caregivers may ask you to pedal a bike during the test (exercise echo) or you may get medicine before the test to increase blood flow to your heart muscle (stress echo). This test can tell how well your heart is pumping. An echo can also find problems, such as fluid around the heart or problems with your heart valves.
  
  
• 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 test to see how well your heart is working. Your arteries (blood vessels) may also be checked to see if they are blocked. A special tube is threaded into your heart through a blood vessel in your leg or arm. Dye may be given so x-ray pictures of your arteries show up better on a TV-like screen.
  
  
• 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. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.

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