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Mitral Valve Insufficiency
Mitral Regurgitation
Mitral valve insufficiency (regurgitation) is the condition characterized by backflow of the blood from the left ventricle to the left atrium during systole, due to mitral valve prolapse, rheumatic or ischemic heart disease, infective endocarditis, cardiomyopathy or mitral apparatus calcification. Depending primarily on the onset of the disease, acute or chronic, mitral valve insufficiency leads to various clinical pictures.
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Presentation
Patients may be asymptomatic or may have manifestations like fatigue caused by reduced cardiac output, tachypnea or dyspnea, orthopnea, paroxysmal nocturnal dyspnea and hemoptysis due to pulmonary hypertension [1]. When atrial fibrillation due to left atrium dilatation occurs, most patients experience palpitations. In children, failure to thrive is an important hallmark of almost all serious heart conditions.
When mitral regurgitation happens abruptly, being caused by an acute accident like chordal or papillary muscle rupture due to myocardial infarction, compensatory mechanisms do not have time to install and symptoms are dramatic, as patients present with pulmonary edema or cardiogenic shock. In chronic severe mitral regurgitation, patients slowly progress to congestive heart failure and pulmonary edema [2].
Hematological
Prolonged Bleeding
- Two siblings exhibited a hemorrhagic disorder characterized by moderate thrombocytopenia, giant platelets, and markedly prolonged bleeding time. The parents had no discernible platelet defect.[ncbi.nlm.nih.gov]
Entire Body System
Fatigue
- They include: A racing or irregular heartbeat (arrhythmia) Dizziness or feeling lightheaded Shortness of breath Fatigue Chest pain Mitral valve stenosis For some, the primary and often only symptom of mitral stenosis is shortness of breath.[heartvalvedisease.nm.org]
- We ask about general symptoms (anxious mood, depressed mood, fatigue, pain, and stress) regardless of condition. Last updated: January 31, 2019[patientslikeme.com]
- Patients may be asymptomatic or may have manifestations like fatigue caused by reduced cardiac output, tachypnea or dyspnea, orthopnea, paroxysmal nocturnal dyspnea and hemoptysis due to pulmonary hypertension.[symptoma.com]
- This leads to congestive heart failure, which causes fatigue, fluid retention and shortness of breath. Additionally, the leakiness of the valve burdens the heart and causes it to work harder. Eventually the heart becomes weakened and enlarged.[beaumont.org]
Congestive Heart Failure
- If the condition persists, the patient can also develop atrial fibrillation and potentially congestive heart failure, leading to shortness of breadth, dizziness, chest pain, and fatigue.[myocor.com]
- In chronic severe mitral regurgitation, patients slowly progress to congestive heart failure and pulmonary edema. A clinical examination reveals a left atrial lift caused by the left atrium filling with blood during systole.[symptoma.com]
- Complications congestive heart failure pulmonary hypertension mass-effect from left atrial enlargement (e.g.[radiopaedia.org]
Weakness
- The valve or its supporting structures can be damaged by a heart attack, coronary artery disease, or weakness in the tissues of these structures (myxomatous degeneration).[merckmanuals.com]
- The valve or its supporting structures can be damaged by a heart attack , coronary artery disease , or weakness in the tissues of these structures (myxomatous degeneration).[merckmanuals.com]
- As the child gets older, the valve gets weak and no longer closes tightly. Other causes include heart failure, rheumatic fever, congenital heart disease, a calcium buildup in the valve, and other heart problems.[stlouischildrens.org]
- Some surgeons might not be comfortable operating on weak hearts because they feel they might not recover well after surgery.[heartsurgeryinfo.com]
- As the damage progresses, the symptoms can appear suddenly, including: chest pain or tightness that increases with exercise and subsides when you’re at rest fatigue heart palpitations shortness of breath difficulty breathing when lying down weakness fainting[healthline.com]
Wound Infection
- infection, mechanical ventilation for more than 48 hours, gastrointestinal complication requiring surgery, new-onset permanent atrial fibrillation, septicemia, and transfusion of 2 units or more of blood.[doi.org]
Respiratoric
Cough
- Symptoms of mitral valve stenosis may include: Shortness of breath Cough due to fluid on the lungs (pulmonary edema) A rapid, fluttering heartbeat (palpitations) Dizziness or lightheadedness Swollen feet or legs Blood clots Chest pain[heartvalvedisease.nm.org]
- […] stethoscope, it is a blowing, whooshing or grating sound that the blood makes as it moves through the heart) Chest pain Heart palpitations (irregular, pounding or skipped heartbeats) Shortness of breath or rapid breathing Feeling exhausted or light-headed Coughing[rush.edu]
- Symptoms of mitral valve regurgitation Symptoms of mitral valve regurgitation can include: Fatigue, especially during times of increased activity Heart palpitations Shortness of breath Cough Swollen feet or ankles Symptoms may worsen with exertion.[wexnermedical.osu.edu]
- When symptoms occur, they often develop gradually, and may include: Cough Fatigue, exhaustion, and lightheadedness Rapid breathing Sensation of feeling the heart beat ( palpitations ) or a rapid heartbeat Shortness of breath that increases with activity[mountsinai.org]
Dyspnea
- The patients were referred to our cardiovascular department because of exertional dyspnea. Echocardiography showed severe mitral valve insufficiency resulting from leaflet flail or prolapse and normal left ventricular function.[ncbi.nlm.nih.gov]
- Patients may be asymptomatic or may have manifestations like fatigue caused by reduced cardiac output, tachypnea or dyspnea, orthopnea, paroxysmal nocturnal dyspnea and hemoptysis due to pulmonary hypertension.[symptoma.com]
- A 44-year-old man presents with dyspnea and new atrial fibrillation. He received a diagnosis of mild mitral regurgitation at 28 years of age but has not seen a physician in many years.[nejm.org]
- The predominant clinical symptoms in chronic mitral regurgitation of dyspnea and fatigue result from pulmonary venous hypertension and low cardiac output. The cardinal physical finding is a mitral systolic murmur.[ncbi.nlm.nih.gov]
- Marked dyspnea from pulmonary edema may be present.[healio.com]
Orthopnea
- Patients may be asymptomatic or may have manifestations like fatigue caused by reduced cardiac output, tachypnea or dyspnea, orthopnea, paroxysmal nocturnal dyspnea and hemoptysis due to pulmonary hypertension.[symptoma.com]
- Individuals with acute MR are typically severely symptomatic and will have the signs and symptoms of acute decompensated congestive heart failure (i.e. shortness of breath, pulmonary edema, orthopnea, and paroxysmal nocturnal dyspnea), as well as symptoms[en.wikipedia.org]
- […] coronary artery disease and acute myocardial infarction (typically, inferior myocardial infarction, which may lead to papillary muscle dysfunction), significant acute MR is accompanied by symptoms of impaired LV function, such as dyspnea, fatigue, and orthopnea[emedicine.medscape.com]
- Individuals with acute mitral regurgitation will have the signs and symptoms of decompensated congestive heart failure (i.e. shortness of breath, pulmonary edema, orthopnea, and paroxysmal nocturnal dyspnea), as well as symptoms suggestive of a low cardiac[slideshare.net]
- When the legs are elevated at night, the fluid redistributes centrally, causing pulmonary edema and resulting in orthopnea (dyspnea while lying flat) or paroxysmal nocturnal dyspnea (PND).[healio.com]
Hemoptysis
- Patients may be asymptomatic or may have manifestations like fatigue caused by reduced cardiac output, tachypnea or dyspnea, orthopnea, paroxysmal nocturnal dyspnea and hemoptysis due to pulmonary hypertension.[symptoma.com]
- Other less common symptoms include hemoptysis, thromboembolism or symptoms of infectious endocarditis. Acute mitral regurgitation presents with dramatic symptoms. Syncope can occur from sudden hypotension related to cardiogenic shock.[healio.com]
Dry Cough
- Symptoms Dry cough Difficulty breathing Stagnation of blood vessels in the lungs Heart palpitations Irregular heartbeat Upheavals in the left side of the chest Patients with insufficient mitral valve can also feel dizziness in the morning or before the[bookinghealth.com]
Gastrointestinal
Failure to Thrive
- In children, failure to thrive is an important hallmark of almost all serious heart conditions.[symptoma.com]
Failure to Thrive
- In children, failure to thrive is an important hallmark of almost all serious heart conditions.[symptoma.com]
Cardiovascular
Heart Disease
- You are at risk for mitral valve regurgitation if you have: Coronary heart disease and high blood pressure Infection of the heart valves Mitral valve prolapse (MVP) Rare conditions, such as untreated syphilis or Marfan syndrome Rheumatic heart disease[mountsinai.org]
- Valvular Heart Disease. Braunwald's Heart Disease. 8th ed. Philadelphia, PA: Saunders Elsevier; 2008. chap. 62. Thourani VH, Weintraub WS, Guyton RA, et al.[emedicine.medscape.com]
- Abstract Mitral valve insufficiency in rheumatic heart disease is often due to retracted posterior chordae and posterior leaflet thickening.[ncbi.nlm.nih.gov]
- International In areas other than the Western world, rheumatic heart disease remains the leading cause of mitral regurgitation.[emedicine.medscape.com]
Mitral Valve Prolapse
- Convert to ICD-10-CM : 394.1 converts directly to: 2015/16 ICD-10-CM I05.1 Rheumatic mitral insufficiency Approximate Synonyms Mitral regurgitation Mitral valve prolapse, rheumatic Mitral valve regurgitation, rheumatic Rheumatic mitral regurgitation Rheumatic[icd9data.com]
- Mitral valve prolapse is accompanied by an ejection systolic click. The murmur caused by mitral regurgitation is best heard at the apex and radiates towards the axilla and subscapular area.[symptoma.com]
- Symptoms of mitral valve prolapse Most patients with mitral valve prolapse have no symptoms. But some patients do have symptoms associated with mitral valve prolapse.[cormedicalgroup.com]
- valve prolapse Symptoms of mitral valve prolapse can be mild or develop gradually.[heartvalvedisease.nm.org]
Palpitations
- Symptoms of mitral valve stenosis may include: Shortness of breath Cough due to fluid on the lungs (pulmonary edema) A rapid, fluttering heartbeat (palpitations) Dizziness or lightheadedness Swollen feet or legs Blood clots Chest pain[heartvalvedisease.nm.org]
- […] hypotension, dizziness, and lightheadedness bleeding precautions while receiving oral anticoagulants and the need to report evidence of bleeding such as in urine or stool, excess bruising, or epistaxis signs and symptoms to report, such as increased palpitations[quizlet.com]
- When atrial fibrillation due to left atrium dilatation occurs, most patients experience palpitations. In children, failure to thrive is an important hallmark of almost all serious heart conditions.[symptoma.com]
- Palpitations are sensations of fast or irregular heart beats. In most people with mitral valve prolapse, palpitations are harmless.[medicinenet.com]
- When regurgitation is more severe, a person may have palpitations, especially when lying on the left side.[heart.org]
Heart Murmur
- When to see a doctor If your doctor hears a heart murmur when listening to your heart with a stethoscope, he or she may recommend that you visit a cardiologist and get an echocardiogram.[mayoclinic.org]
- To ensure proper cardiac function, please remember to get regular, annual check-ups if you have been diagnosed with a heart murmur, a mitral valve prolapse or mitral valve regurgitation.[heart-valve-surgery.com]
- Doctors can pinpoint mitral valve regurgitation through hearing a certain type of heart murmur.[uabmedicine.org]
- A doctor may hear a heart murmur during a check-up and that may be the first sign something is wrong, says Dr. Milla. Chronic mitral valve regurgitation There are few treatment options for mitral valve regurgitation.[piedmont.org]
Systolic Murmur
- Forty-five patients had a pan-systolic murmur and 37 had a late-systolic murmur on auscultation that was verified by timing of onset of regurgitant turbulence by cine magnetic resonance imaging.[ncbi.nlm.nih.gov]
- Systolic Murmurs - Mitral Regurgitation You are listening to a typical example of a murmur caused by mitral valve regurgitation.[med.ucla.edu]
- The cardinal physical finding is a mitral systolic murmur. Since the murmur can assume various configurations, the most reliable way to establish its correct origin is by bedside physiologic maneuvers.[ncbi.nlm.nih.gov]
- A third heart sound is commonly heard.In acute cases, the murmur and tachycardia may be the only distinctive signs.Patients with mitral valve prolapse may have a holosystolic murmur or often a mid-to-late systolic click and a late systolic murmur.[en.wikipedia.org]
Neurologic
Dizziness
- Symptoms of mitral valve stenosis may include: Shortness of breath Cough due to fluid on the lungs (pulmonary edema) A rapid, fluttering heartbeat (palpitations) Dizziness or lightheadedness Swollen feet or legs Blood clots Chest pain[heartvalvedisease.nm.org]
- […] practitioner if the pulse rate is outside the parameters dietary restrictions, including the need to maintain low salt intake prescribed medications, such as diuretics and ACE inhibitors and potential adverse effects, such as orthostatic hypotension, dizziness[quizlet.com]
- Some people with this condition may not feel any symptoms while others may have chest pain , shortness of breath, an irregular heartbeat , or dizziness , among other things.[webmd.com]
- If the condition persists, the patient can also develop atrial fibrillation and potentially congestive heart failure, leading to shortness of breadth, dizziness, chest pain, and fatigue.[myocor.com]
- For example, if the patient is complaining of lightheadedness or dizziness, we look at the monitor and see that the blood pressure is dipping down, and we know that, dizziness is caused by the blood pressure dipping down.[chd-uk.co.uk]
Workup
A clinical examination reveals a left atrial lift caused by the left atrium filling with blood during systole. The first heart sound is normal or diminished, while the second heart sound is split into early stages of the disease because the aortic valve closes early. The splitting interval diminishes as pulmonary hypertension starts [1]. A third sound caused by increased ventricular filling may also appear, while the pulmonary component of the second heart sound is accentuated if pulmonary hypertension has begun. Mitral valve prolapse is accompanied by an ejection systolic click.
The murmur caused by mitral regurgitation is best heard at the apex and radiates towards the axilla and subscapular area. It is usually pansystolic, but may also be presystolic in acute settings or telesystolic in mitral valve prolapse or papillary muscle dysfunction. The intensity decreases as the left ventricle dysfunction advances [2].
Peripheral pulse is sharp but has a small volume; atrial fibrillation presents late in the course of the disease and the characteristic pulse abnormality is noted. The dilated left atrium may compress the left main bronchus, leading to wheezing and, rarely, lung atelectasis and hyperinflation.
The postero-anterior radiography may show a normal aspect of the heart or enlarged left atrium and left atrial appendage; if mitral regurgitation begins abruptly, the X-ray shows signs of pulmonary edema with normal sized left atrium. The pulmonary edema might be more prominent in the right upper lobe [3]. Cardiomegaly is present in chronic regurgitations.
Echocardiography is the most valuable tool in assessing mitral regurgitation. Two-dimensional (2D) echocardiography is useful in measuring heart dimensions and characterizing the mitral apparatus while trying to identify the cause of the disease and associated abnormalities. Color flow echocardiography describes the direction of the flow [4]. Quantitative and semi-quantitative measurement methods should be used in evaluating disease severity [5].
Spectral Doppler (pulse and continuous) is useful in calculating the severity of the regurgitation (by measuring parameters such as vena contracta, proximal isovelocity surface area, and regurgitant fraction) and evaluating a possible concomitant mitral stenosis [5]. If doubt about severity persists, stress echocardiography and exercise testing should be performed [2].
Transesophageal echocardiography and heart catheterization are indicated in cases where heart anatomy is uncertain [6], whereas cardiac magnetic resonance imaging (MRI) is more accurate in determining ventricular function and size. Catheterization is also useful in grading the regurgitation [7].
Electrocardiography shows rhythm and conduction abnormalities, left atrial enlargement and right ventricular hypertrophy if pulmonary hypertension is present.
Brain natriuretic peptide has prognostic value in severe mitral regurgitation and can be used in risk stratification [8].
P Wave
P Mitrale
- Retrieved 2010-06-30. a b medilexicon.com P mitrale Citing. Stedmans Medical Dictionary. Copyright 2006 Greenberg BH, Massie BM, Brundage BH, Botvinick EH, Parmley WW, Chatterjee K (1978).[slideshare.net]
- P mitrale is broad, notched P waves in several or many leads with a prominent late negative component to the P wave in lead V1, and may be seen in MR, but also in mitral stenosis, and, potentially, any cause of overload of the left atrium.[en.wikipedia.org]
Treatment
- We found that although percutaneous treatment was effective at reducing mitral regurgitation, surgical treatment was more effective, as graded by an echocardiographic core laboratory.[doi.org]
- Treatment Treatment will depend on what symptoms you have, what condition caused the mitral valve regurgitation, how well the heart is working, and if the heart has become enlarged.[mountsinai.org]
- Cost for treatment Mitral valve Insufficiency (prolapse) diagnosis Surgical treatment of mitral valve insufficiency with repair of mitral valve (minimally invasive) Treatment of mitral valve insufficiency with minimally invasive replacement of mitral[bookinghealth.com]
Prognosis
- The prognosis of these patients is good; however, sudden death, endocarditis, and progressive regurgitation occur rarely.[emedicine.com]
- Determination of Operability and Prognosis Originally published 18 Mar 2018 Circulation. 2018;39:307-316 Abstract Twenty patients with mitral insufficiency (MI) due to ruptured chordae tendineae, papillary muscle infarction, or left ventricular enlargement[ahajournals.org]
Etiology
- Mitral regurgitation can be divided into acute and chronic forms, which have differing etiologies and imaging features 1,2 .[radiopaedia.org]
- Mitral regurgitation can be divided into acute and chronic forms, which have differing etiologies and imaging features 1,2.[radiopaedia.org]
- — Adult — Cardiac Surgical Procedures/methods — Child — Child Preschool — Chordae Tendineae/surgery — Cohort Studies — Echocardiography Transesophageal — Female — Follow-Up Studies — Humans — Male — Mitral Valve/surgery — Mitral Valve Insufficiency/etiology[archive-ouverte.unige.ch]
- An understanding of the underlying etiologies and pathophysiology of the condition is critical to direct appropriate treatment.[emedicine.medscape.com]
Epidemiology
- Working Group on Epidemiology and Prevention of Cardiovascular Diseases: Meeting of the Working Group of the European Society of Cardiology on Epidemiology and Prevention of Cardiovascular Diseases 9,Suppl. 1 von: Weltgesundheitsorganisation.[zdb-katalog.de]
- Epidemiology Frequency United States Previously, chronic rheumatic heart disease was the most common cause of acquired mitral valve disease in the Western world.[emedicine.com]
Sex distribution
Age distribution
Pathophysiology
- The pathophysiology and operative strategy for these patients are discussed.[ncbi.nlm.nih.gov]
- PATHOPHYSIOLOGY Echocardiographic studies of functional MR have shown that regurgitant flow varies during systole: there is an early systolic peak, a midsystolic decrease, and a late, smaller late systolic peak [ 4,5 ].[web.archive.org]
- An understanding of the underlying etiologies and pathophysiology of the condition is critical to direct appropriate treatment.[emedicine.medscape.com]
Prevention
- After mitral valve repair, a single-chamber cardioverter-defibrillator was implanted for secondary prevention of sudden cardiac death.[ncbi.nlm.nih.gov]
- To prevent blood clots from forming, the patient will need to take drugs that prevent abnormal blood clotting (anticoagulants).[encyclopedia.com]
- Treat strep infections quickly to prevent rheumatic fever. Always tell your provider and dentist if you have a history of heart valve disease or congenital heart disease before treatment.[mountsinai.org]
References
Article
- Nishimura RA, Otto CM, Benow RO, et al. 2014 AHA/ACC guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. JACC 2014;63(22):e60-e185
- Vahanian A, Alfieri O, Andreotti F, et al. Guidelines on the management of valvular heart disease (version 2012): The Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2012;33(19):2451-2496.
- Schnyder PA, Sarraj AM, Duvoisin BE, et al. Pulmonary edema associated with mitral regurgitation: prevalence of predominant involvement of the right upper lobe. AJR Am J Roentgenol. 1993;161(1): 33-36.
- Little SH, Pirat B, Kumar R, et al. Three-dimensional color Doppler echocardiography for direct measurement of vena contracta area in mitral regurgitation: in vitro validation and clinical experience. JACC Cardiovasc Imaging. 2008;1(6):695-704.
- Zoghbi WA, Enriquez-Sarano M, Foster E et al. Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography. J Am Soc Echocardiogr 2003;16(7):777-802.
- Calafiore AM, Gallina S, Iaco AL, et al. Mitral valve surgery for functional mitral regurgitation: should moderate-or-more tricuspid regurgitation be treated? a propensity score analysis. Ann Thorac Surg. 2009;87(3):698-703.
- Bonow RO, Carabello BA, Kanu C, et al. ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing committee to revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): developed in collaboration with the Society of Cardiovascular Anesthesiologists: endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons. Circulation. 2006;114(5):e84-231.
- Pizarro R, Bazzino OO, Oberti PF, et al. Prospective validation of the prognostic usefulness of brain natriuretic peptide in asymptomatic patients with chronic severe mitral regurgitation. J Am Coll Cardiol. 2009;54(12):1099-1106.