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Mitral regurgitation - chronic
Alternative namesChronic mitral valve regurgitation; Mitral valve insufficiency
DefinitionChronic mitral regurgitation is a progressive, long-term disorder in which the mitral valve, which separates the left upper chamber of the heart (atrium) from the left lower chamber (ventricle), does not close properly. This causes blood to leak (backflow or regurgitation) into the left atrium from the left ventricle during contraction of the heart (systole).
Causes, incidence, and risk factors
Mitral regurgitation is the most common type of heart valve insufficiency. Any disorder that weakens or damages this valve can prevent it from closuring properly, causing this type of leakage. Mitral regurgitation becomes chronic when the condition persists rather than occurring for only a short time period.
When the mitral valve fails to close properly, blood flows back to the left atrium from the left ventricle. The blood flow to the body (cardiac output) is decreased as a result, so the heart pumps harder to try to compensate.
Chronic mitral regurgitation affects approximately 6% of women and 3% of men, but after 55 years of age, some degree of mitral regurgitation is found in almost 20% of men and women who undergo echocardiograms. Congenital (present from birth) mitral regurgitation is rare if not part of a more complex heart defect or syndrome. Mitral valve prolapse , which involves weakening and ballooning out of the valve and affects about 5% of the population, is a relatively common cause of chronic mitral regurgitation.
Chronic mitral regurgitation can also be caused by disorders such as atherosclerosis , hypertension ( high blood pressure ), left ventricular enlargement, connective tissue disorders such as Marfan's syndrome , other congenital defects, endocarditis (infection of the heart valve), cardiac tumors, or untreated syphilis (rare). Acute mitral regurgitation may become chronic.
Additional symptoms that may be associated with this disease:
Note: Often no symptoms are present. When symptoms occur, they often develop gradually.
Signs and tests
Palpation may show thrill (vibration) over the heart. A stethoscope examination of the heart reveals a distinctive murmur. Rales (a crackly sound) or other abnormal breath sounds may be heard on lung examination. Ankle swelling, enlarged liver , distended neck veins, and other signs consistent with right-sided heart failure may be present.
Hospitalization may be required for diagnosis and treatment of severe symptoms. Surgical repair or replacement of the valve is recommended if heart function is poor, if symptoms are severe, or if the condition deteriorates. Once the diagnosis of mitral regurgitation is made, periodic follow-up by a specialist is needed to determine the appropriateness of surgery.
Expectations (prognosis)The outcome varies and depends on the underlying conditions. Usually the condition is benign , so no therapy or restriction is necessary. Symptoms can usually be controlled with medication. In severe cases, valve repair or valve replacement may be necessary.
Calling your health care providerCall your health care provider if symptoms suggest mitral regurgitation or if you have mitral regurgitation and your symptoms worsen or do not improve with treatment. Also call your health care provider if signs of infection occur during treatment: fever , chills, muscle aches, headache, malaise (general ill feeling).
Treat strep infections promptly to prevent rheumatic fever . Treat other causative disorders.
Update Date: 5/25/2002Seth Keller, M.D., Division of Cardiology, Yale New Haven Medical Center, New Haven, CT. Review provided by VeriMed Healthcare Network.
Last updated: Tue, 06 Jan 2009 00:20:03 GMT