Mitral Regurgitation, Acute

Alternate Names
acute mitral insufficiency
acute mitral incompetence

Definition of Mitral Regurgitation, Acute

Acute mitral regurgitation is a condition that affects the mitral valve in the heart. The mitral valve does not close completely, causing the blood to flow in the wrong direction. The mitral valve separates the heart's left atrium, or upper chamber, from the left ventricle, or lower chamber.

What is going on in the body?

The left side of the heart has two chambers:

• the left atrium
• the left ventricle

Between them lies the mitral valve, a one-way valve that allows blood to flow from the left atrium to the left ventricle, the main pumping chamber of the heart. The mitral valve opens to allow the ventricle to fill. It closes as the ventricle contracts and the ventricle ejects oxygen-rich blood into the aorta, the major artery in the body. This blood is then sent throughout the body

In a person who has acute mitral regurgitation, the mitral valve no longer closes properly. With every heartbeat, some blood is pumped back through the valve and into the upper part of the heart. The body is not able to pump enough blood to the rest of the body.

What are the signs and symptoms of the condition?

Symptoms of acute mitral regurgitation include:

• chest pain
• cough, which occurs especially at night during sleep
• fatigue
• palpitations (an unusual awareness of the heart beating in the chest)
• rapid breathing
• shortness of breath at rest or with minimal exertion

What are the causes and risks of the condition?

Mitral regurgitation is caused when the mitral valve fails to close properly. Some people are born with a defective mitral valve.

Diseases and conditions that can cause mitral regurgitation include the following:

• congestive heart failure, a condition in which a weakened heart fails to pump blood effectively
• endocarditis (an infection of the heart lining)
• infection of the mitral valve
• heart attacks
• mitral valve prolapse, a condition in which the valve thickens and weakens and may become too "floppy"
• old age
• rheumatic fever, which can cause scarring of the valve
• systemic lupus erythematosus, an autoimmune disorder that affects many body systems
• trauma to the heart, such as a crush injury of the chest

What can be done to prevent the condition?

Appropriate and timely treatment of diseases of the heart may help prevent some cases of mitral regurgitation. People with heart disease should ask their healthcare provider about taking antibiotics before dental work or surgery.

How is the condition diagnosed?

The diagnosis of acute mitral regurgitation begins with a medical history and physical exam. The healthcare provider can hear the sound of abnormal blood flow across the valve, which is called a heart murmur. Another sign is a vibration, called a thrill, felt on the chest.

Special tests can be done to identify the cause and severity of the regurgitation. Common tests (in approximate order from simplest to most expensive and invasive) nclude the following:

• electrocardiogram, or ECG, which measures electrical activity in the heart
• chest X-ray, to look for enlargement of the heart and fluid in the lungs
• electrocardiogram, which uses ultrasound waves to look at blood flow throughout the heart
• cardiac catheterization, which involves placing a wire into the heart to measure the amount of blood flowing in the wrong direction

What are the long-term effects of the condition?

Acute mitral regurgitation may have few long term effects in an otherwise healthy person. However, it may result in death if it is severe and accompanied by other medical problems. The outcome is often related to the underlying cause, such as a heart attack.

What are the risks to others?

Acute mitral regurgitation is not contagious and poses no risk to others.

What are the treatments for the condition?

Acute mitral regurgitation requires immediate medical care. Regardless of the cause, open heart surgery is often needed to replace or repair the damaged mitral valve. Medication and special devices may help before surgery.

What are the side effects of the treatments?

Surgery may be complicated by bleeding, infection, or an allergic reaction to the anesthetoc. Someone who has an artificial valve is at higher risk for blood clots. These small blood clots can travel in the blood and block blood flow to other organs.

What happens after treatment for the condition?

After recovering from surgery, a person:

• can usually return to a normal daily routine
• should see the provider regularly to help assure that the valve is working properly
• should follow any recommended diet, such as a low-sodium diet
• should slowly increase activity
• should tell the healthcare provider about any change in how he or she feels

A blood-thinning medicine is often prescribed after surgery to help prevent blood clots. A person should check with the healthcare provider before taking any over-the-counter medications or herbal remedies.

Some drugs, and foods containing vitamin K, can interfere with the blood-thinning medicine.

How is the condition monitored?

Mitral regurgitation is monitored through regular visits to the healthcare provider. Close followup is required if the valve has been repaired or replaced surgically. The provider may order regular tests, including an echocardiogram. Any new or unusual symptoms should be reported to the healthcare provider.