Definition:
Mitral regurgitation, also known as mitral insufficiency, is a valve condition where the structure of the mitral valve is altered in such as a way that blood is allowed to flow back into the left atrium from the left ventricle when the valve is "supposedly closed." This causes an pressure/volume overload in the left atrium, eventually causing lung vessel congestion. Causes include: mitral valve prolapse/click-murmur syndrome (mitral valve with extra cords), coronary artery disease (decreased heart oxygenation causing ischemia of valve), rheumatic heart disease (history of rheumatic fever), ruptured chordae tendinae (causing leaflet of valve to not move), and endocarditis (infection on the valve causing perforation/destruction).
Symptoms:
- Shortness of breath - on exertion, while lying flat, and sleeping [left-heart failure]
- Edema/ascites - fluid retention in the legs/abdomen if severe [right-sided failure]
Diagnosis:
- Physical exam - holosystolic blowing murmur on stethoscope
- EKG - to evaluate heart rhythm, may see evidence of left ventricle hypertrophy
- Chest X-Ray - to evaluate heart enlargement
- Echocardiography - to visualize mitral valve and determine cause for alteration
- Cardiac catheterization - to determine left ventricle function, degree of regurgitation, and lung vessel pressures
Treatment:
- Medications (symptomatic relief) - digitalis (for atrial fibrillation), diuretics (reduce congestion and volume overload), vasodilators (for acute symptoms), anticoagulants (for preventing thrombus/clot formation)
- Intra-aortic balloon pump in acute settings
- Surgery (for progressive heart failure, heart enlargement, >1 valve disease, or ruptured tendinae)
