The dynamic mitral valve is prone to three diseases, which are known as mitral stenosis (MS), mitral regurgitation (MR), and mitral valve prolapse (MVP). As a key anatomic and functional structure, advanced disease of this valve may lead to complications such as heart failure and death [1].

MS is commonly caused by rheumatic fever, which is rare in industrialized countries but still prevalent in developing regions. The disease presents in young adults usually in the third or fourth decade with symptoms such as fatigue, palpitations, chest pain, hemoptysis [2]. When MS progresses, the patient may experience dyspnea on exertion, orthopnea, as well as paroxysmal nocturnal dyspnea [3]. Among the clinical features are jugular vein distension and a displaced apical impulse. On auscultation, there is a loud S1 (first heart sound), split S2 (second heart sound), an opening snap, and a diastolic rumble.

MR typically develops as a consequence of aging mechanisms, ischemic disease, rheumatic fever, or prolapse [2] [4]. There are two forms of MR, which are acute (rare) and chronic. Often the result of valvular infection, the presentation of acute MR mimics that of acute heart failure. However, chronic MR evolves gradually and may be asymptomatic in the early stages. Features include fatigue, dyspnea, palpitations, and so forth. Auscultation findings include an apical holosystolic murmur with a soft S1, split S2, and possibly a third heart sound (S3).

MVP is found in up to 3% of the population [5] and is more predominant in young women [2]. While many individuals with prolapse do not exhibit symptoms, some will have fatigue, dizziness, dyspnea, palpitations, chest pain, anxiety, and presyncope. The palpitations may be triggered by emotional stress. The hallmark murmur is a mid-to-late systolic click.

• Fatigue

  The disease presents in young adults usually in the third or fourth decade with symptoms such as fatigue, palpitations, chest pain, hemoptysis. [symptoma.com]

  When symptoms do happen, they may include Shortness of breath, especially when lying down Chest pain Extreme fatigue Heart palpitations Coughing Trouble breathing after exercise Rapid heartbeat or tachycardia (this is rare) Most of the time, MVP is not [texasheart.org]

  This can cause symptoms such as fatigue and shortness of breath. However, many people with mitral valve disease experience no symptoms. [healthline.com]

• Pain

  A 45-year-old man previously diagnosed with myxomatous mitral valve disease was admitted to our hospital with chest pain at rest and on effort. [ncbi.nlm.nih.gov]

  Some patients say they feel palpitations (like their heart is skipping a beat) or sharp chest pain. [texasheart.org]

  Most people with mitral valve disease have no symptoms, but those who do complain of fatigue, palpitations, chest pain and anxiety. [sharp.com]

  The disease presents in young adults usually in the third or fourth decade with symptoms such as fatigue, palpitations, chest pain, hemoptysis. [symptoma.com]

• Swelling

  […] to a build up of tissue in the valve flaps A mitral valve lesion following an infarct A dilatation of the mitral valve opening associated with dilated cardiomyopathy Symptoms Shortness of breath upon exertion or when lying down Fatigue Palpitations Swelling [icm-mhi.org]

  As a result, people can experience fatigue, shortness of breath, swelling in the ankles and feet, and irregular heartbeat. Two of the main types of mitral valve disease are mitral valve regurgitation and mitral valve stenosis. [nyulangone.org]

  When regurgitation or stenosis is more severe, the following symptoms may occur: Palpitations (sensation of feeling your heartbeat) Shortness of breath during activity Coughing Weakness or fatigue Dizziness Swelling of the legs, ankles or feet Chest pain [houstonmethodist.org]

  They may include: Shortness of breath with exertion Shortness of breath when lying flat Tiredness (fatigue) Reduced ability to exercise Unpleasant awareness of your heartbeat Palpitations Swelling in your legs, abdomen, and the veins in your neck Chest [cedars-sinai.org]

• Inflammation

  Various parts of the heart can become inflamed and lead to these potentially serious heart conditions, including: endocarditis: inflammation of the lining of the heart myocarditis: inflammation of the heart muscle pericarditis: inflammation of the membrane [healthline.com]

• Disability

  Please enable JS and disable any ad blocker [veterinarynews.dvm360.com]

  The joints can become inflamed, which can lead to temporary and sometimes chronic disability. [healthline.com]

• Cough

  When symptoms do happen, they may include Shortness of breath, especially when lying down Chest pain Extreme fatigue Heart palpitations Coughing Trouble breathing after exercise Rapid heartbeat or tachycardia (this is rare) Most of the time, MVP is not [texasheart.org]

  Over time, patients will notice common symptoms such as shortness of breath, lightheadedness, fatigue, racing or irregular heartbeat (arrhythmia), and a dry cough. [inovaheart.org]

  Someone with mitral valve disease will experience shortness of breath, particularly during exertion, and heart palpitations, weakness and fatigue, chest pain (angina), frequent respiratory infections or coughing sometimes with blood-tinged sputum. [columbiasurgery.org]

  When symptoms do occur, they can include: cough, shortness of breath when lying down or exercising, fatigue, lightheadedness. Some individuals may also feel pain or tightness in the chest. [eu.courierpostonline.com]

  When regurgitation or stenosis is more severe, the following symptoms may occur: Palpitations (sensation of feeling your heartbeat) Shortness of breath during activity Coughing Weakness or fatigue Dizziness Swelling of the legs, ankles or feet Chest pain [houstonmethodist.org]

• Heart Disease

  KEYWORDS: IL-10; IL-4; Rheumatic heart disease; mitral valve disease; polymerase chain reaction [ncbi.nlm.nih.gov]

  Top Rated Valvular Heart Disease Program The Nancy & Bill Thompson Heart Valve Center is one of a handful of clinics nationwide dedicated to state-of-the-art screening, diagnosis and treatment of valvular heart disease. [hoag.org]

  Heart valve disease occurs when one or more of the heart valves do not open or close properly. When it affects more than one heart valve, it is called multiple valvular heart disease. [heartandstroke.ca]

  In other patients with rheumatic heart disease, lesser degrees of MS may accompany mitral regurgitation (MR) and aortic valve disease. [accessmedicine.mhmedical.com]

• Mitral Valve Prolapse

  Patients with this condition are acutely ill and usually require emergency replacement of the heart valve. Mitral Valve Prolapse Mitral valve prolapse (Figure 2B) is a common condition, occurring most frequently in women; some types are hereditary. [ahajournals.org]

  What is mitral valve prolapse (MVP)? Mitral valve prolapse is a condition in which the two valve flaps of the mitral valve do not close smoothly or evenly, but instead bulge (prolapse) upward into the left atrium. [heart.org]

• Heart Murmur

  If you have a heart murmur, your doctor may recommend that you visit a cardiologist. [mayoclinic.org]

  Mitral valve regurgitation also produces a distinct sound (heart murmur) that a doctor may hear through a stethoscope. To continue reading this article, you must login. [health.harvard.edu]

  The main sign of heart valve disease is an unusual heartbeat sound called a heart murmur. Your doctor can hear a heart murmur with a stethoscope. But many people have heart murmurs without having a problem. [medlineplus.gov]

  Your doctor may listen to your heart with a stethoscope to determine if you have a heart murmur that may indicate a mitral valve condition. [rwjbh.org]

• Late Systolic Murmur

  The syndrome of mid-systolic click accompanying a systolic murmur was first described in the late 1800s, but it was in the early 1960s that its association with mitral regurgitation was demonstrated by Barlow and colleagues using cine-ventriculography [mitralvalverepair.org]

  In the 1960s, Reid 7 and Barlow and colleagues 1 proposed that mid to late systolic clicks and apical late systolic murmurs were of mitral valvar origin. [heart.bmj.com]

  […] click of the mitral valve and a late systolic murmur Radiology description Echocardiography is the most useful method of diagnosing a prolapsed mitral valve Two and three dimensional echocardiography are particularly valuable as they allow visualization [pathologyoutlines.com]

• Diastolic Murmur

  Loud first heart sound with an opening snap in early diastole. A mid-late diastolic murmur, best heard, with the patient in the left lateral position, with the bell of the stethoscope (see separate Heart Auscultation article). Atrial fibrillation. [patient.info]

  […] diminished and delayed; S 3 or S 4 may be present Murmur softer with Valsalva maneuver Mitral stenosis Diastolic rumble Loud Normal Opening snap may be present Murmur increased with brief exercise Aortic regurgitation Blowing diastolic Soft Normal Wide [aafp.org]

  The indicative low rumbling diastolic murmur is best heard in expiration at the apex, with the bell of the stethoscope. Ongoing elevated pulmonary artery (PA) pressures put strain on the right ventricle, and will eventually cause this to fail. [academic.oup.com]

• Dizziness

  MVP is usually asymptomatic in the absence of significant regurgitation, although there are reports that some patients experience chest pain, dyspnea, dizziness, and palpitations. [merckmanuals.com]

  When regurgitation or stenosis is more severe, the following symptoms may occur: Palpitations (sensation of feeling your heartbeat) Shortness of breath during activity Coughing Weakness or fatigue Dizziness Swelling of the legs, ankles or feet Chest pain [houstonmethodist.org]

  While many individuals with prolapse do not exhibit symptoms, some will have fatigue, dizziness, dyspnea, palpitations, chest pain, anxiety, and presyncope. The palpitations may be triggered by emotional stress. [symptoma.com]

  Mitral valve prolapse can sometimes cause: dizziness breathlessness tiredness an irregular heartbeat (arrhythmia) or noticeable heartbeats (palpitations) mitral regurgitation Treatments You probably won't need treatment if you don't have any symptoms. [nhs.uk]

Individuals with a clinical presentation suggestive of mitral valve disease warrant a thorough workup consisting of the patient and family history, physical exam including auscultation [2], and the appropriate studies.

Laboratory tests

The workup should include a complete blood count (CBC) a complete metabolic panel (CMP).

Imaging

Echocardiography is a critical component of the assessment since it is noninvasive, accessible, and provides information for diagnosis and monitoring of the disease [6]. This modality is sensitive and specific for identifying MS [7] and is the key for diagnosing MR and MVP [8]. This study also allows the clinician to determine the etiology and stage of the valvular abnormality and functionality and size of the atria.

Transthoracic echocardiogram (TTE) reveals mobility, calcification, and thickening of the valve [9]. Moreover, real-time 3-dimensional transesophageal echocardiography (TEE), which is superior to TTE, offers excellent images of the mitral valve [10]. Very importantly, TEE is very beneficial in cases suggestive of endocarditis or presence of thrombi.

Chest radiography is another important investigative study. In patients with MS, a chest X-ray will likely display calcification of the mitral valve, left atrial enlargement, interstitial edema, and prominent pulmonary vasculature. In patients with chronic MR, chest X-ray findings may include left ventricular and left atrial enlargement, and evidence of heart failure such as pulmonary congestion. Similar observations are found in patients with MVP associated with MR.

Other imaging tests such as ventriculography and cardiac magnetic resonance imaging (MRI) may be utilized to measure the regurgitation.

Electrocardiography (EKG)

An EKG is obtained in all patients with cardiac complaints. A typical finding in patients with advanced MS is atrial fibrillation. Other remarkable features include prolonged P wave in lead II, which is indicative of left atrial hypertrophy. Features associated with chronic MR are left ventricular and left atrial hypertrophy, and ST segment changes in lateral leads. Additionally, there are P wave abnormalities in various leads. Occasionally, MVP is associated with benign arrhythmias.

Procedures

Cardiac catheterization is performed selectively prior to surgery. Also, stress EKG is used periodically to monitor MR.

• P Mitrale

  Electrocardiography[edit] P mitrale is broad, notched P waves in several or many leads with a prominent late negative comp[[mb b [[]]]]onent to the P wave in lead V1, and may be seen in MR, but also in mitral stenosis, and, potentially, any cause of overload [en.wikipedia.org]

  In asymptomatic patients, where the systolic PA pressure is <50 mm Hg, non-cardiac surgery is considered safe.7 ECG AF is common, although p-mitrale may be noted if still in sinus rhythm. [academic.oup.com]

• Left Ventricular Hypertrophy

  However, as mitral regurgitation worsens and the stress on the left ventricle increases, left ventricular hypertrophy develops in order to maintain normal left ventricular pressures. [healio.com]

  For instance, the electrocardiogram (ECG) in long-standing MR may show evidence of left atrial enlargement and left ventricular hypertrophy. Atrial fibrillation may also be noted on the ECG in individuals with chronic mitral regurgitation. [en.wikipedia.org]

• Left Atrial Hypertrophy

  A typical finding in patients with advanced MS is atrial fibrillation. Other remarkable features include prolonged P wave in lead II, which is indicative of left atrial hypertrophy. [symptoma.com]

Learn More About Mitral Valve Disease Treatment UPMC Heart and Vascular Institute Mitral Regurgitation Treatment Mitral Stenosis Treatment From our Health Library Mitral Valve Replacement Surgery Mitral Valve Regurgitation Mitral Valve Stenosis Heart [upmc.com]

We will review the etiology, anatomy, pathophysiology, presentation, and treatment of aortic and mitral valve disease. [ncbi.nlm.nih.gov]

Treatment Top 1. Pharmacologic treatment of heart failure. 2. Antithrombotic treatment in patients with atrial fibrillation. 3. Prevention of infective endocarditis and of recurrent rheumatic disease (see Acute Rheumatic Fever). 4. [empendium.com]

There are several reasons why left atrial size can have a significantly negative impact on prognosis. [ncbi.nlm.nih.gov]

Prognosis Prognosis for mitral valve regurgitation varies based on its severity. Medication can ease symptoms, but not reverse damage to a valve. Surgical treatments have greatly improved the prognosis for mitral valve regurgitation patients. [baptisthealth.com]

Last Updated: April 23, 2015 Last Reviewed: June 22, 2019 Chapter Information Definition, Etiology, Clinical FeaturesTop Mixed mitral valve disease refers to coexisting mitral stenosis (MS) and mitral regurgitation (MR). [empendium.com]

A brief summary of the literature on pulmonary varices associated with mitral valve disease is presented, with special reference to its etiology and surgical treatment. [ncbi.nlm.nih.gov]

Definition / general Degenerative valve disease occurs due to a pathological weakening / sclerosis of connective tissue Terminology Mitral valve prolapse (MVP), Floppy mitral valve, Flail leaflet, Calcific aortic valve disease Epidemiology Prevalence [pathologyoutlines.com]

PMID 11728952. ^ "Pectus Excavatum: Epidemiology". Medscape. Retrieved 14 April 2016. ^ a b c d e f g h Playford, David; Weyman, Arthur (2001). "Mitral valve prolapse: time for a fresh look". Reviews in Cardiovascular Medicine. 2 (2): 73–81. [en.wikipedia.org]

Epidemiology of valvular heart disease in the adult. Nat Rev Cardiol. 2011;8:162–72. [Most up-to-date report of the epidemiology of vavular heart disease in Europe.] [PubMed] [Google Scholar] 2•. O'Rourke RA, Bailey SR. [ncbi.nlm.nih.gov]

Epidemiology United States data Mitral valve prolapse (MVP) is thought to be inherited with increased expression of the gene in female individuals (2:1). [emedicine.medscape.com]

The aetiology and epidemiology of mitral valve disease have been discussed in recent articles in this series and will not be covered in detail here. [escardio.org]

We will review the etiology, anatomy, pathophysiology, presentation, and treatment of aortic and mitral valve disease. [ncbi.nlm.nih.gov]

LEARNING OBJECTIVES After reading the preceding article and taking this test, you should be able to: Identify pathophysiology associated with aortic and mitral valve disease. List clinical manifestations of aortic and mitral valve disease. [journals.lww.com]

[…] pathological weakening / sclerosis of connective tissue Terminology Mitral valve prolapse (MVP), Floppy mitral valve, Flail leaflet, Calcific aortic valve disease Epidemiology Prevalence of degenerative valve disease is estimated at 2 - 3% of the population Pathophysiology [pathologyoutlines.com]

The Current Status is organized into the following six sections: The first section is entitled Fundamentals and describes our understanding of mitral valve disease based on pathophysiological triad and Carpentier's approach of valve analysis using functional [themitralvalve.org]

To prevent dehiscence, we selected short bands and compared the echocardiographic changes between this method and the Cosgrove ring. METHODS: Three sutures are placed in the commissures using two bands, which shortens the annular length by 60%. [ncbi.nlm.nih.gov]

Today, thanks to improved quality of medical care and increased attention on prevention, people are living longer. [eu.courierpostonline.com]

Problems with the mitral valve may lead to irreversible changes that prevent the heart from pumping properly, which is why experts now recommend early surgery for mitral valve disease to prevent these irreversible changes. [hoag.org]

During the heart’s contraction, the mitral valve closes, preventing blood from flowing back to the left atrium. A diseased mitral valve no longer opens or closes properly. [virginiaheart.com]

The obstructed mitral valve acts like a dam, preventing the blood from emptying from the lungs and causing breathlessness (Figure 1B). [ahajournals.org]

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