STENOSIS KATUP MITRALDEFINISI stenosis katup mitral merupakan penyempitan pada lubang katup mitral yang akan menyebabkan meningkatnya tahanan aliran darah dari atrium kiri ke ventrikel kiri. Kelainan struktur mitral ini menyebabkan angguan pembukaan sehingga timbul gangguan pengisian ventrikel kiri saat diastol.Dibagi atas : Reumatik (> 90% ) dan non reumatik. Sebagian terjadi pada usia < 20 tahun yang disebut Juvenile Mitral Stenosis .PATOFISIOLOGI Stenosis mitral menghalangi aliran darah dari atrium kiri ke ventrikel kiri selama fase diastolik ventrikel untuk mempertahankan curah jantung, atrium kiriharus menghasilkan tekanan yang lebih besar untuk mendorong darah melewati katup yang sempit sehingga terjadi :Hipertrofi atrium kiri untuk meningkatkan kekuatan memompa darahDilatasi atrium kiri terjadi karena volume atrium kiri meningkat karena ketidakmampuan atrium untuk mengosongkan diri secara normal.Kongesti ventrikel pulmonalis akibat dari peningkatan tekanan dan volume atrium kiri yang dipantulkan kebelakang pembuluh paru-paru sehingga tekanan dalam katup pulmonalis dan kapiler meningkat, kongesti paru-paru tekanan dan atrium pulmonalis meningkat sebagai akibat dari resistensi ventrikel pulmonalis yang meningkat. Hipertensi pulmonalis meningkat resistensi ejeksi ventrikel kanan menuju arteria pulmonalis ventrikel kanan memberi respon dengan hipertrofi.Curah jantung yang menetap.Pada keadaan normal area katup mitral mempunyai ukuran 4-6 cm. Bila area orifisium katup ini berkurang sampai 2 cm, maka diperlukan upaya aktif atrium kiri berupa peningkatan tekanan atrium kiriagar aliran transmitral yang normal tetap terjadi. Stenosis mitral yang kritis terjadi bila pembukaan katup berkurang hingga mencapai 1 cm. Pada tahap ini dibutuhkan suatu tekanan atrium kiri sebesar 25 mmHg untuk mempertahankan curah jantung yang normal (swain,2005).Derajat berat ringannya stenosis mitral, selain berdasarkan gradien transmitral, dapat juga ditentukan oleh luasnya area katup mitral, serta hubungan antara lamanya waktu antara penutupan katup aorta dan opening snap. Berdasarkan luasnya area katup mitral derajat stenosis mitral sebagai berikut :1. Minimal : bila area > 25 cm2. Ringan : Bila area 1,4 2,5 cm3. Sedang : Bila area 1 1,4 cm4. Berat : Bila area < 1,0 cm5. Reaktif : Bila area < 1,0 cmKeluhan dan gejala stenosis mitral mulai akan muncul bila luas area katup mitral menurun sampai seperdua normal ( 20 mmHg3. Ekokardiografi :Pemeriksaan ekokardiografi M-mode dan 2D-Doppler sangat penting dalam penegakan diagnosis. Dapat digunakan untuk :- Menentukan derajat stenosis- Dimensi ruang untuk jantung- Ada tidaknya kelainan penyerta- Ada tidaknya trombus pada atrium kiri4. Kateterisasi jantung :Kadang perlu dilakukan kateterisasi jantung untuk menentukan luas dan jenispenyumbatannya. Walaupun demikian pada keadaan tertentu masih dikerjakan setelah suatu prosedur ekokardiografi yang lengkap. Saat ini kateterisasi dipergunakan secara primer untuk suatu prosedur pengobatan intervensi non bedah yaitu valvulotomi dengan balon5. Laboratorium :Pemeriksaan laboratorium tidak ada yang khas, ditujukan untuk penentuan adanya reaktivasi reuma.KOMPLIKASIHipertensi pulmonal merupakan komplikasi yang sering terjadi pada stenosis mitral, dengan patofisiologi yang komplek. Pada awalnya kenaikan tekanan atau hipertensi pulmonal terjadi secara pasif akibat kenaikan tekanan atrium kiri. Dengan meningkatnya hipertensi pulmonal ini akan menyebabkan kenaikan tekanan dan volume aakhir diastole, regurgitasi trikiuspid dan pulmonal sekunder, dan seterusnya sebagai gagal jantung kanan dan kongesti sistemik.Dapat pula terjadi perubahan pada vaskular paru berupa vasokonstriksi akibat bahan neurohumoral seperti endotelin atau perubahan anatomik yaitu remodel akibat hipertrofi tunika media dan penebalan tunika intima.Komplikasi lain dapat berupa tromboemboli, endokarditis infektif, fibrilasi atrial atau simptom karena kompresi akibat besarnya atrium kiri seperti disfagi dan suara serakPENGOBATANPrinsip dasar penatalaksanaan adalah melebarkan lubang katup mitral yang menyempit, tetapi indikasi ini hanya untuk pasien kelas fungsional III (NYHA) ke atas. Pengobatan farmakologis hanya diberikan bila ada tanda-tanda gagal jantung, aritmia ataupun reaktifasi reumaObat-obat seperti beta-blocker, digoxin dan verapamil dapat memperlambat denyut jantung dan membantu mengendalikan fibrilasi atrium.Jika terjadi gagal jantung, digoxin juga akan memperkuat denyut jantung.Pada keadaan fibrilasi atrium pemakaian digitalis merupakan indikasi, dapat dikombinasikan dengan penyekat beta atau antagonis kalsium.Diuretik dapat mengurangi tekanan darah dalam paru-paru dengan cara mengurangi volume sirkulasi darah dan untuk mengurangi kongesti.Antikoagulan Warfarin sebaiknya dipakai pada stenosis mitral dengan fibrilasi atrium atau irama sinus dengan kecenderungan pembentukan trombus untuk mencegah fenomena tromboemboli.Jika terapi obat tidak dapat mengurangi gejala secara memuaskan, mungkin perlu dilakukan perbaikan atau penggantian katup.Intervensi bedah, reparasi atau ganti katup :1. Closed Mitral Commisurotomy.2. Open Mitral Valvotomy.3. Mitral Valve Replacement.Pada prosedur valvuloplasti balon, lubang katup diregangkan. Kateter yang pada ujungnya terpasang balon, dimasukkan melalui vena menuju ke jantung. Ketika berada di dalam katup, balon digelembungkan dan akan memisahkan daun katup yang menyatu. Pemisahan daun katup yang menyatu juga bisa dilakukan melalui pembedahan. Jika kerusakan katupnya terlalu parah, bisa diganti dengan katup mekanik atau katup yang sebagian dibuat dari katup babi.Sebelum menjalani berbagai tindakan gigi atau pembedahan, kepada penderita diberikan antibiotik pencegahan untuk mengurangi resiko terjadinya infeksi katup jantung.PENCEGAHANStenosis katup mitral dapat dicegah hanya dengan mencegah terjadinya demam rematik, yaitu penyakit pada masa kanak-kanak yang kadang terjadi setelah strep throat (infeksi tenggorokan oleh streptokokus) yang tidak diobati. Pencegahan eksaserbasi demam rematik dapat dengan :1. Benzatin Penisilin G 1,2 juta IM setiap 4 minggu sampai umur 40 tahun2. Eritromisin 2250 mg/hariProfilaksis reuma harus diberikan sampai umur 25 tahun walupun sudah dilakukan intervensi. Bila sesudah umur 25 tahun masih terdapat tanda-tanda reaktivasi, maka profilaksis dilanjutkan 5 tahun lagi. Pencegahan terhadap endokarditis infektif diberikan pada setiap tindakan operasi misalnya pencabutan gigi, luka dan sebagainya.
Mitral stenosisEmail this page to a friend Share on facebook Share on twitter Bookmark & Share Printer-friendly versionThe mitral valve separates the upper and lower chambers on the left side of the heart. Stenosis is a condition in which the valve does not open fully, restricting blood flow. Mitral stenosis is a disorder in which the mitral valve does not open fully.CausesBlood that flows between different chambers of your heart must flow through a valve. The valve between the two chambers on the left side of your heart is called the mitral valve. It opens up enough so that blood can flow from the upper chamber of your heart (left atria) to thelower chamber (left ventricle). It then closes, keeping blood from flowing backwards.Mitral stenosis means that the valve cannot open enough. As a result, less blood flows to the body. The upper heart chamber swells as pressure builds up. Blood and fluid maythen collect in the lung tissue (pulmonary edema), making it hard to breathe. See also: heart failure.In adults, mitral stenosis occurs most often in those who have had rheumatic fever (a condition that may develop after untreated orpoorly treated strep throat or scarlet fever). The valve problems develop 5 - 10 years or more after the episode of rheumatic fever, and symptoms may not show up for even longer. Rheumatic fever is becoming rare in the United States due to treatment of strep infections, so mitral stenosis is also less common.Only rarely do other factors cause mitral stenosis in adults. These include: Calcium deposits forming around the mitral valve Radiation treatment to the chest Some medicationsChildren may be born with mitral stenosis (congenital) or other birth defects involving the heart that cause mitral stenosis. Often, there are other heart defects present with the mitral stenosis.Mitral stenosis may run in families.SymptomsIn adults there may be no symptoms. However, symptoms may appear or get worse with exercise or any activity that raises the heart rate. In adults, symptoms usually develop between ages 20and 50.Symptoms may begin with an episode of atrial fibrillation(especially if it causes a fast heart rate). They may also be triggered by pregnancy or other stress on the body, such as infection in the heart or lungs, or other heart disorders.Symptoms may include: Chest discomfort (rare) Increases with activity, decreases with rest Radiates to the arm, neck, jaw, or other areas Tight, crushing, pressure, squeezing, constricting Cough, possibly bloody (hemoptysis) Difficulty breathing during or after exercise or when lying flat; may wake up with difficulty breathing (most common symptom) Fatigue, becoming tired easily Frequent respiratory infections such as bronchitis Sensation of feeling the heart beat (palpitations) Swelling of feet or anklesIn infants and children, symptoms may be present from birth (congenital), and almost always develop within the first 2 years of life. Symptoms include: Cough Poor feeding or sweating when feeding Poor growth Shortness of breathExams and TestsThe health care provider will listen to the heart and lungs with a stethoscope. A distinctive murmur, snap, or other abnormal heart sound may be heard. The typical murmur is a rumbling sound that is heard over the heart during the resting phase of the heartbeat. The sound often gets louder just before the heart begins to contract.The exam may also reveal an irregular heartbeat or lung congestion. Blood pressure is usually normal.Narrowing orblockage of the valve or swelling of the upper heart chambers maybe seenon: Chest x-ray CT scan of the heart Echocardiogram ECG (electrocardiogram) MRI of the heart Transesophageal echocardiogram (TEE)TreatmentTreatment depends on the symptoms and condition of the heart and lungs. People with mild symptoms or none at all may not need treatment. For severe symptoms, you may need to go to the hospital for diagnosis and treatment.Medications are used to treat symptoms of heart failure or abnormal heart rhythms (most commonly atrial fibrillation) and high blood pressure, as well as to prevent blood clots. These include diuretics (water pills), nitrates, beta-blockers, calcium channel blockers, ACE inhibitors, angiotensin receptor blockers (ARBs), or digoxin. Anticoagulants (blood thinners) are used to prevent blood clots from forming and traveling to other parts of the body.Antibiotics may be used for some people with mitral stenosis: People who have had rheumatic fever may need long-term preventive treatment with penicillin. In the past, most patients with heart valve problems such as mitral stenosis were given antibiotics before dental work or invasive procedures, such as colonoscopy. The antibiotics were given to prevent an infection of the damaged heart valve. However, antibiotics are now used much less often before dental work and other procedures. Ask your doctor whether you need to use antibiotics.Some patients may need heartprocedures to treat mitral stenosis. Percutaneous mitral balloon valvotomy (also called valvuloplasty) may be tried instead of surgery in people with a less damaged mitral valve. During this procedure, atube (catheter) is inserted into a vein, usually in the leg. It is threaded up into the heart. A balloon on the tip of the catheter is inflated, widening the mitral valve and improving blood flow.Other people need to havethe mitral valve repaired or replaced. Replacement valves can be made from different materials. Some may last for decades and others can wear out and need to be replaced.For more information, see: Mitral valve surgery - minimally invasive Mitral valve surgery - openChildren oftenneed surgery to either repair or replace the mitral valve.Outlook (Prognosis)The outcome varies. The disorder may be mild, without symptoms, or may be more severe and eventually disabling. Complications may be severe or life threatening. Mitral stenosis is usually controllable with treatment and improved with valvuloplasty or surgery.Possible Complications Atrial fibrillation and atrial flutter Blood clots to the brain (stroke), intestines, kidneys, or other areas Congestive heart failure Pulmonary edema Pulmonary hypertensionWhen to Contact a Medical ProfessionalCall your health care provider if: You have symptoms of mitral stenosis You have mitral stenosis and symptoms do not improve with treatment, or new symptoms appearPreventionFollow your health care provider's recommended treatment for conditions that may cause valve disease. Treat strep infections promptly to prevent rheumatic fever. Tell your health care provider if you have a family history of congenital heart diseases.Mitral stenosis itself often cannot be prevented, but complications can be prevented.Tell your health care provider about your heart valve disease before you receive any medical treatment. Discuss whether you need preventive antibiotics.
Mitral stenosis (MS) is a relatively uncommon heart valve abnormality that can cause significant cardiac problems if it is not treated appropriately. The mitral valve separates the two left chambers of the heart -- the left atrium and the left ventricle. When the left atrium contracts, the mitral valve opens to allow blood to flow into the left ventricle. When the left ventricle subsequently contracts, the mitral valve closes to prevent a backflow of blood into the other chamber. (Video: How the Heart Functions)With mitral stenosis, the heart's mitral valve becomes thickened and immobile, and does not completely open as a result. When this occurs, the blood tends to back up in the left atrium, leading to increased pressure in the chamber. Over a long period of time, significant problems can result.What Are The Causes of Mitral Stenosis?Several cardiac conditions can produce MS: Rheumatic heart disease is the most common cause of MS. Because rheumatic heart disease is becoming uncommon in developed countries, MS is now seen much less frequently than it was in past decades. Some forms of congenital heart disease can include MS. In these cases, the mitral valve fails to develop normally. Mitral annular calcification (a condition in which calcium deposits form on the mitral valve, usually in association with with aging or kidney disease) can cause MS. While mitral annular calcification is a fairly common condition, it only rarely produces MS. Infectious endocarditis (infection of the heart valves) very rarely results in MS.What Problems Does Mitral Stenosis Cause?When MS is caused by rheumatic heart disease (the most common cause), the valve problem develops slowly, over a period of years, and symptoms appear gradually. In most cases, the MS is first diagnosed 15 to 20 years after rheumatic fever has occurred. During this time, the pressure within the left atrium gradually increases, and it eventually becomes enlarged. The increased pressure is transmitted to the blood vessels in the lungs, and eventually to the pulmonary artery. Pulmonary artery hypertension, high pressure in the pulmonary artery, eventually results.Pulmonary artery hypertension can eventually cause heart failure affecting the right side of the heart. Right-sided heart failure is commonly associated with extreme fatigue and massive fluid accumulation (edema) in the legs, and often in the belly.Atrial fibrillation, rapid and irregular heart arrhythmia caused by chaotic electrical impulses in the upper two chambers of the heart, is extremely common in MS. It is estimated that 30% to 70% of people with MS will eventually develop this problem.Thromboembolism (blood clots within blood vessels or the heart that break off and cause tissue damage, such as stroke) is a risk in anybody with atrial fibrillation, but that risk is especially high when the atrial fibrillation is associated with MS. In fact, because of the damming-up of the blood in the left atrium seen in MS, blood clots can develop in the atrium (a condition called left atrial thrombus) even without atrial fibrillation.What Are the Symptoms of Mitral Stenosis?The most common symptoms caused by MS are shortness of breath (possibly accompanied by cough) and fatigue. People with MS are most likely to experience these symptoms any time the workload of the heart is increased, such as during exertion of any type, emotional stress, fever or other illness, or pregnancy. Just as the MS develops very gradually, so does the shortness of breath. In many cases, people with MS avoid symptoms by subconsciously reducing their activity levels over a period of years, eventually becoming quite sedentary. Because they are so inactive, they often will not actually notice the breathing issue, and may not report this symptom to their doctors.When MS becomes severe, patients may develop persistent symptoms, even at rest, and may also develop severe edema and cough up blood.Arial fibrillation can produce palpitations and lightheadedness, and can make all the symptoms associated with MS much worse.How is Mitral Stenosis Diagnosed?The diagnosis is often first suspected after the doctor performs a physical examination and notices the soft, rumbling heart murmur characteristic of MS. Usually, MS can be easily confirmed or ruled out with an echocardiogram. Treating Mitral StenosisIf you have been diagnosed with MS, the most important things you and your doctor will have to consider are whether/when to perform a surgical intervention to relieve the MS, and what steps need to be taken to prevent thrombosis.
Mitral StenosisMitral stenosis is a narrowing of the mitral valve in the heart. This restricts the flow of blood through the valve. Back pressure which builds up behind the narrowed valve can cause various problems and symptoms. The more severe the narrowing, the more serious the problems. Medication can help to ease symptoms. Surgery to stretch, repair or replace the valve may be needed.On this page Understanding the heart What is the mitral valve? What is mitral stenosis? What are the causes of mitral stenosis? What effects does mitral stenosis have? What are the symptoms of mitral stenosis? What complications may occur with mitral stenosis? How is mitral stenosis diagnosed? What are the treatments for mitral stenosis? What is the prognosis (outlook) for people with mitral stenosis? Further help and information ReferencesUnderstanding the heartThe heart has four chambers - two atria and two ventricles. The walls of these chambers are mainly made of special heart muscle. During each heartbeat both of the atria contract first to pump blood into the ventricles. Then both ventricles contract to pump blood out of the heart into the arteries. There are one-way valves between the atria and ventricles, and between the ventricles and the large arteries coming from the heart. The valves make sure that when the atria or ventricles contract, the blood flows in the correct direction.
What is the mitral valve?The mitral valve lies between the left atrium and left ventricle. The valve has two flaps (cusps). The valve allows blood to flow into the left ventricle when the left atrium contracts. When the left ventricle contracts, the valve closes and the blood flows out through the aortic valve into the aorta. (The aorta is the main artery which takes blood to the body.)
The cusps are stopped from turning inside out by thin strands of tissue called chordae. The chordae (not shown in the diagram) anchor the cusps to the inside wall of the ventricle. The valve or chordae may get damaged or scarred which can prevent the valve from working properly. This can lead to disorders called mitral stenosis, mitral regurgitation, or both.What is mitral stenosis?Mitral stenosis means that when the mitral valve opens, it does not open fully. It is narrowed (stenosed) when it is open. So, there is some restriction of blood flow from the left atrium to the left ventricle. This in turn means there is a reduced amount of blood that is pumped out into the body from the left ventricle. In general, the more narrowed the valve, the less blood that can get through, the more severe the problem is likely to be.What are the causes of mitral stenosis?Rheumatic heart diseaseThis is the cause in most cases. Rheumatic heart disease is a general term which means any heart problem which develops after having an episode of rheumatic fever.
Rheumatic fever is a condition which sometimes follows an infection with a bacterium called the streptococcus. Your body makes antibodies to the bacterium to clear the infection. But, in some people, the antibodies also attack various parts of the body - in particular, the mitral valve. Inflammation of the valve develops which can cause permanent damage and lead to thickening and scarring years later.
Rheumatic fever used to be common in the UK in the era before antibiotics, but is now rare. It is still quite common in some developing countries.Other causesOther causes are rare and include: Deposits of calcium (calcification) in parts of the valve. This sometimes occurs in older people. Some congenital heart problems. It is then usually part of a complex heart deformity. Infection of the valve (endocarditis). A complication of various uncommon diseases.What effects does mitral stenosis have?If the valve is only mildly narrowed (stenosed) you may have no symptoms or problems. If the stenosis is more severe, it takes more effort for the left atrium to pump the blood through the narrowed valve to the left ventricle. This causes a rise in pressure in the left atrium. The walls of the left atrium then become thickened (hypertrophied) and the atrium enlarges (dilates).
A back pressure of blood may then cause congestion of blood in the blood vessels which bring blood to the left atrium (the pulmonary veins which bring blood from the lungs). In severe stenosis the back pressure can extend right back through all the blood vessels in the lungs to the right ventricle of the heart (pulmonary hypertension).What are the symptoms of mitral stenosis?Symptoms can include: Shortness of breath. This tends to occur on exercise at first, but occurs at rest if the stenosis becomes worse. This symptom is due to the congestion of blood and fluid in the lungs. Fainting, dizziness or tiredness. If the amount of blood getting through to the ventricle is reduced, the output of blood from the left ventricle to the body is then reduced. Chest pains (angina) may develop if there is a reduced blood flow to the coronary arteries (the arteries that take blood to the heart muscle). Chest infections are common. Coughing up blood-stained sputum may occur due to the congestion of blood and fluid in the lungs.If rheumatic fever is the cause then, typically, symptoms start between the ages of twenty and fifty. (That is, 10-20 years after having have had an episode of rheumatic fever as a child.)What complications may occur with mitral stenosis?The main possible complications that may develop include the following: Atrial fibrillation develops in about 4 in 10 cases. This is where the heart beats in a fast and irregular way. This occurs because the electrical signals in the enlarged atrium become faulty. The irregular heart rhythm can cause palpitations, and make you even more breathless. See separate leaflet called 'Atrial Fibrillation'. Heart failure may develop and gradually become more severe. This causes worsening shortness of breath, tiredness, and fluid retention in various tissues of the body. See separate leaflet called 'Heart Failure'. A blood clot may form within the enlarged left atrium, which does not fully empty into the ventricle with each heartbeat. A blood clot is more likely to occur if you also develop atrial fibrillation. A blood clot may travel through the heart, be carried in the bloodstream and get stuck and block a blood vessel in another part of the body. For example, it may get stuck in a blood vessel going to the brain and cause a stroke. Endocarditis sometimes develops. This is an infection of the valve. (Damaged valves are more prone to infection than normal valves.) Unless promptly treated, endocarditis can cause serious illness. See separate leaflet called 'Endocarditis - Infective'.How is mitral stenosis diagnosed? People with mitral stenosis may get flushed cheeks. A doctor may hear a heart murmur or other abnormal noises when listening with a stethoscope. The pressure in the jugular vein that runs along the side of the neck may be raised. A doctor may be able to detect that the level of blood in this vein is higher than normal. The tip of the heart lies next to the chest wall and can normally be felt beating against it (the apex beat). This can be found further to the left in mitral stenosis if the heart is larger than normal. The liver may be swollen and you may develop a swollen stomach due to fluid. Murmurs and noises are due to blood passing through abnormal valves, or to abnormal movement of valves. There are typical murmurs and noises which occur with mitral stenosis. A scan of the heart, called an echocardiogram (heart echo), can confirm the diagnosis. Detailed ultrasound scans of the heart, and other heart tests, can assess the severity of the condition.What are the treatments for mitral stenosis?MedicationMild cases may not require any regular medication. Although medicines cannot correct a stenosed mitral valve, some medicines may be prescribed to help ease symptoms, or to help prevent complications. For example: Angiotensin-converting enzyme (ACE) inhibitors are medicines which help to reduce the amount of work the heart does. One may be prescribed to ease symptoms of heart failure. Diuretics (water tablets) usually help if you are breathless. They make the kidneys produce more urine. This gets rid of excess blood and fluid which may build up in the lungs or other parts of the body with the back pressure from the heart. Anti-arrhythmic medication may be needed to control your heart rate if you develop atrial fibrillation. Warfarin (anticoagulation) is usually advised if you develop atrial fibrillation. This helps to prevent blood clots from forming.CardioversionShocking the heart with an electrical current - this is also an option in some people who develop atrial fibrillation as a complication (described earlier).Surgical treatmentsSurgical treatment is needed in more severe cases. There are various options, depending of the exact site and severity of the stenosis. Stretching the stenosed valve. This is a procedure that does not involve open heart surgery. It is called percutaneous balloon commissurotomy or balloon valvuloplasty. (It is called a commissurotomy as the area where the valve cusps come in contact with each other are known as the commissures.) This is possible in many cases. It is done by inserting a thin tube called a catheter through the skin (percutaneous) into the main blood vessel in the top of the leg. The catheter is passed up to the heart. The tip of the catheter is placed in the mitral valve opening. A balloon at the tip of the catheter is then inflated to stretch the narrowed valve. This is often successful in widening the narrowed valve. Valve repair is possible in some cases. This is called mitral commissurotomy or mitral valvotomy. This is usually done by open heart surgery. Basically, the edges (commissures) of valve cusps that have become scarred and fused are shaved back to widen the narrowed valve opening. Valve replacement is needed in some cases. This may be with a mechanical or a tissue valve. Mechanical valves are made of materials which are not likely to react with your body (for example, those made from titanium), although they can produce a noise which can be heard outside the body. Tissue valves are made from treated animal tissue (for example, valves from a pig).If you need surgery, a surgeon will advise on which is the best option for your situation.Antibiotics to prevent endocarditisPeople with mitral stenosis used to be given antibiotics before some dental treatments and some surgical operations. However, the National Institute for Health and Clinical Excellence (NICE) no longer recommends that they be taken routinely for any of these procedures. Antibiotics are now only offered to people who have an infection at the time of the operation.What is the prognosis (outlook) for people with mitral stenosis?In some cases the disorder is mild and causes no symptoms. If you develop symptoms they tend to become gradually worse over the years. However, the speed of decline can vary. It often takes years for symptoms to become serious. Medication can ease symptoms, but cannot reverse a narrowed valve. Surgical treatments have greatly improved the outlook for most people with more severe stenosis. Surgery has a very good success rate. However, as with all surgical procedures and operations, there is some risk involved when you have surgery. Complications due to surgery occur in a small number of cases.
Mitral valve stenosisBy Mayo Clinic staff
Original Article: http://www.mayoclinic.com/health/mitral-valve-stenosis/DS00420
DefinitionMitral valve stenosis or mitral stenosis is a condition in which the heart's mitral valve is narrowed (stenotic). This abnormal valve doesn't open properly, blocking blood flow coming into your left ventricle, the main pumping chamber of your heart. Mitral valve stenosis can make you tired and short of breath, among other problems. The main cause of mitral valve stenosis is an infection called rheumatic fever, which is related to strep infections. Rheumatic fever now rare in the United States, but still common in developing countries can scar the mitral valve. Left untreated, mitral valve stenosis can lead to serious heart complications. SymptomsYou can have mitral valve stenosis and feel fine, or you may have only minimal signs and symptoms for decades. However, mild problems can suddenly get worse. See your doctor if you develop these mitral valve stenosis symptoms: Fatigue, especially during times of increased physical activity Shortness of breath, especially with exertion or when you lie down Swollen feet or ankles Heart palpitations sensations of a rapid, fluttering heartbeat Frequent respiratory infections, such as bronchitis Heavy coughing, sometimes with blood-tinged sputum Rarely, chest discomfort or chest painMitral valve stenosis symptoms which may resemble those of other heart or heart valve conditions may appear or worsen anytime you increase your heart rate, such as during exercise. An episode of rapid heartbeats also may accompany these symptoms. Or they may also be triggered by pregnancy or other stress on your body, such as an infection. Mitral valve stenosis symptoms usually include those of heart failure. In mitral valve stenosis, pressure that builds up in the heart is then sent back to the lungs, resulting in fluid buildup (congestion) and shortness of breath. Symptoms of mitral valve stenosis most often appear in your 40s and 50s, but they can occur at any age even during infancy. Depending on the amount of narrowing, an infant or a child with mitral valve stenosis may have no symptoms, may tire easily or may have shortness of breath with vigorous physical activity. Mitral valve stenosis may also produce a number of signs that only your doctor will be able to find. These may include: Heart murmur Lung congestion Irregular heart rhythms (arrhythmias) Pulmonary hypertension Blood clotsWhen to see a doctorCall your doctor for an immediate appointment if you develop symptoms such as fatigue or shortness of breath during physical activity, heart palpitations, or chest pain. If you've been diagnosed with mitral valve stenosis but haven't had symptoms, talk to your doctor about recommended follow-up. CausesChambers and valves of the heart
The heart, the center of your circulatory system, consists of four chambers. The two upper chambers, the atria, receive blood. The two lower chambers, the ventricles, pump blood. Blood flows through your heart's chambers, aided by four heart valves. These valves open and close to let blood flow in only one direction through your heart. The mitral valve which lies between the two chambers on the left side of your heart consists of two triangular flaps of tissue called leaflets. Heart valves open like a trapdoor. The mitral valve is forced open when blood flows from the left atrium into the left ventricle. When the blood has gone through the valve, the leaflets swing closed to prevent the blood that has just passed into the left ventricle from flowing backward, in the wrong direction. A defective heart valve is one that fails to either open or close fully. When a valve becomes narrowed and blood flow through it is limited, the condition is called stenosis. Mitral valve stenosis is narrowing of the mitral valve, which obstructs blood flow into the heart's left ventricle. Causes of mitral valve stenosis include: Rheumatic fever. A complication of strep throat, rheumatic fever can damage the mitral valve, leading to mitral valve stenosis later in life. Rheumatic fever is the most common cause of mitral valve stenosis. It can damage the mitral valve in two main ways. The infection may cause the leaflets of the valve to thicken, limiting the valve's ability to open. Or the infection may cause the leaflets of the mitral valve to fuse somewhat together, preventing the valve from opening and closing properly. People with rheumatic fever may have both mitral valve stenosis and regurgitation. Congenital heart defect. In rare cases, babies are born with a narrowed mitral valve and develop mitral valve stenosis early in life. Babies born with this problem usually require heart surgery to fix the valve. Others are born with a damaged mitral valve that puts them at risk of developing mitral valve stenosis when they're older. In most cases, doctors don't know why a heart valve fails to develop properly in a newborn, infant or child, so it's not something that can be prevented. Other causes. Rarely, growths, blood clots or tumors can block the mitral valve, mimicking mitral valve stenosis. As you age, excessive calcium deposits can build up around the mitral valve, which sometimes causes significant mitral valve stenosis. Radiation treatment to the chest and some medications also may cause mitral valve stenosis.Risk factorsMitral valve stenosis is less common today than it was several decades ago because the most common cause, rheumatic fever, is rare in the United States. However, rheumatic fever remains a frequent problem in countries where antibiotic use isn't as common. Risk factors for mitral valve stenosis include a history of rheumatic fever and recurrent strep infections. Radiation treatment involving the chest can result in mitral valve stenosis. Other unusual causes of mitral valve stenosis include medications, such as ergot preparations used for migraines. ComplicationsLike other heart valve problems, mitral valve stenosis can weaken your heart and decrease how efficiently it pumps blood. Mitral valve stenosis reduces the amount of blood that flows forward through your heart and out to the rest of your body. Left untreated, mitral valve stenosis can lead to complications such as: Heart failure. Heart failure is a condition in which your heart can't pump enough blood to meet your body's needs. A narrowed mitral valve interferes with blood flow through your heart and from your heart out to the rest of your body. In addition, pressure builds up in your lungs, leading to fluid accumulation. Eventually, this places a strain on the right side of the heart, which leads to fluid buildup in either your ankles or abdomen or both areas (edema). Heart enlargement. The pressure buildup of mitral valve stenosis results in enlargement of your heart's upper left chamber (atrium). At first this change helps your heart pump more efficiently, but eventually, it damages your heart's overall health. Additionally, pressure can build up in your lungs and cause pulmonary congestion and hypertension. Atrial fibrillation. In mitral valve stenosis, the stretching and enlargement of your heart's left atrium may lead to a heart rhythm irregularity called atrial fibrillation. In atrial fibrillation, the upper chambers of your heart beat chaotically and too quickly. Blood clots. Left untreated, atrial fibrillation can put you at risk of blood clots forming in the upper left chamber of your heart, where blood pools in mitral valve stenosis. Blood clots from your heart may break loose and travel to other parts of your body, causing serious problems. For example, a blood clot that travels to your brain and blocks a blood vessel there could cause a stroke. Lung congestion. Another possible complication of mitral valve stenosis is pulmonary edema a condition in which blood and fluid back up into your lungs. This causes congestion of the lungs, leading to shortness of breath and, sometimes, coughing up of blood-tinged sputum.Preparing for your appointmentYour family doctor may be the first to suspect or diagnose mitral valve stenosis. After your initial appointment, your doctor may refer you to a doctor who specializes in the diagnosis and treatment of heart conditions (cardiologist). Here's some information to help you prepare for your appointment. What you can do Write down any symptoms you're experiencing, and for how long. Make a list of your key medical information, including other recent health problems you've had and the names of any prescription and over-the-counter medications you're taking. Find a family member or friend who can come with you to the appointment, if possible. Someone who accompanies you can help remember what the doctor says. Write down the questions you want to be sure to ask your doctor.Questions to ask your doctor at your initial appointment include: What is likely causing my symptoms? Are there any other possible causes for these symptoms? What tests do I need? Should I see a specialist? Should I follow any restrictions in the time leading up to my appointment with a cardiologist?Questions to ask if you are referred to a cardiologist include: What is my diagnosis? What treatment do you recommend? What are the possible side effects of the medications you're recommending? If you're recommending an invasive procedure, what will my recovery be like? How will you monitor my health over time? What is my risk of long-term complications from this condition? What restrictions do I need to follow? Will physical activity, including sexual activity, increase my risk of complications? What diet and lifestyle changes should I make? I have these other health problems. How can I best manage them together?In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment at any time that you don't understand something. What to expect from your doctorA doctor or cardiologist who sees you for possible mitral valve stenosis may ask: What are your symptoms? When did you first begin experiencing symptoms? Have your symptoms gotten worse over time? Do your symptoms include rapid, fluttering or pounding heartbeats? Have you ever coughed up blood? Does exercise or physical activity make your symptoms worse? Are you aware of any history of heart problems in your family? Have you ever knowingly had rheumatic fever? Are you being treated or have you recently been treated for any other health conditions? Do you or did you smoke? How much? Do you use alcohol or caffeine? How much? Are you planning to become pregnant in the future?What you can do in the meantimeWhile you wait for your appointment, check with your family members to find out if any close relatives have been diagnosed with cardiac disease. The symptoms of mitral valve stenosis are similar to a number of other heart conditions, including some that tend to run in families. Knowing as much as possible about your family's health history will help your doctor determine next steps for your diagnosis and treatment. If exercise makes your symptoms worse, avoid exerting yourself physically until you've been seen by your doctor. Tests and diagnosisIf you develop signs or symptoms of mitral valve stenosis for example, if you are suddenly breathless with mild exertion your doctor may ask you to undergo several types of diagnostic tests. But first your doctor will ask about your medical history and give you a physical examination. As part of your examination, he or she listens carefully to your heart through a stethoscope. Mitral valve stenosis causes an abnormal heart sound, called a heart murmur. A narrowed mitral valve can make a distinct snapping sound followed by a rumbling murmur. In addition to listening to your heart, your doctor listens to your lungs and the sounds of your breathing. Your doctor is checking for lung congestion the buildup of fluid in your lungs that can occur with mitral valve stenosis. From the initial results, your doctor decides which tests are needed to make a diagnosis. For testing, you may be referred to a cardiologist. Diagnostic testsCommon tests to diagnose mitral valve stenosis include: Echocardiogram. This test uses sound waves to produce an image of your heart. In an echocardiogram, sound waves are directed at your heart from a wand-like device (transducer) held on your chest. Sound waves bounce off your heart and are reflected back through the chest wall and processed electronically to provide video images of your heart in motion. An echocardiogram helps your doctor closely examine the mitral valve. The image shows the structure of the mitral valve and how it moves during the beating of your heart. Electrocardiogram (ECG). In this test, patches with wires (electrodes) are attached to your skin to measure the electrical impulses given off by your heart. Impulses are recorded as waves displayed on a monitor or printed on paper. An ECG can give information about your heart rhythm and, indirectly, heart size. With mitral valve stenosis, some parts of your heart may be enlarged and you may have atrial fibrillation, a heart rhythm irregularity. Your doctor may ask you to walk on a treadmill or pedal a stationary bike while undergoing an ECG, to see how your heart responds to exertion. Holter monitoring. A Holter monitor is a portable device that you wear to record a continuous ECG, usually for 24 to 72 hours. Holter monitoring is used to detect intermittent heart rhythm irregularities that may accompany mitral valve stenosis. Chest X-ray. An X-ray image of your chest allows your doctor to check the size and shape of your heart to determine whether the left atrium is enlarged - a possible indicator of mitral valve stenosis. A chest X-ray also helps your doctor check the condition of your lungs. Mitral valve stenosis may lead to blood backing up in your lungs, which causes congestion that's visible on an X-ray. Transesophageal echocardiogram. This type of echocardiogram allows an even closer look at the mitral valve. Your esophagus, the tube that runs from your throat to your stomach, lies closely behind your heart. In a traditional echocardiogram, a transducer is moved across your chest. In a transesophageal echocardiogram, a small transducer attached to the end of a tube is inserted down your esophagus. Because your esophagus lies close to your heart, having the transducer there provides a clearer picture of the mitral valve and blood flow through it. Cardiac catheterization. In this procedure, your doctor threads a thin tube (catheter) through a blood vessel in your arm or groin to an artery in your heart. A dye injected through the catheter fills your heart's arteries, and the arteries become visible on an X-ray. This test gives your doctor detailed information about the condition of your heart. Some catheters used in cardiac catheterization have miniature devices (sensors) at the tips that can measure pressure within heart chambers, such as the left atrium.Cardiac tests such as these help your doctor distinguish mitral valve stenosis from other heart conditions, including other problems of the mitral valve. Mitral regurgitation is a condition in which the mitral valve doesn't close tightly. Mitral valve prolapse is a disorder in which the mitral valve sags instead of closing tightly. These conditions may also require treatment. If you receive a diagnosis of mitral valve stenosis, these tests also help reveal the cause, determine how serious the problem is, and determine whether the mitral valve can be repaired or if replacement may be necessary. Treatments and drugsTreatments to prevent permanent damage to your heart from mitral valve stenosis include medications and invasive procedures. Invasive treatment for mitral valve stenosis isn't always needed right away. If tests reveal that you have mild to moderate mitral valve stenosis and you have no symptoms, there's generally no need for immediate valve repair or replacement. Instead, your doctor will schedule checkups to carefully monitor the valve so that surgery can be done if your condition becomes more severe. Some people never need anything done to the mitral valve because they never develop severe mitral valve stenosis. MedicationsNo medications can correct a defect in the mitral valve. However, certain drugs can reduce symptoms by easing your heart's workload and regulating your heart's rhythm. For example, your doctor may prescribe: Diuretics. These drugs can reduce fluid accumulation in your lungs or elsewhere. Blood thinners (anticoagulants). These medications help to prevent blood clots from forming. Beta blockers or calcium channel blockers. These medications may be used to slow your heart rate and allow your heart to fill more effectively. Anti-arrhythmic medications. These medications may be used to treat atrial fibrillation or other rhythm disturbances associated with mitral valve stenosis.ProceduresYou may need valve repair or replacement to treat mitral valve stenosis. Both surgical and nonsurgical options are available. Repair with balloon valvuloplasty (valvotomy)This nonsurgical procedure uses a soft, thin tube (catheter) tipped with a balloon. A doctor guides the catheter through a blood vessel in your arm or groin to your heart and into your narrowed mitral valve. Once in position, a balloon at the tip of the catheter is inflated. The balloon pushes open the mitral valve and stretches the valve opening, improving blood flow. The balloon is then deflated and the catheter with balloon is guided back out of your body. Balloon valvuloplasty can relieve mitral valve stenosis and its symptoms. But it may not be appropriate if the valve is both tight (stenotic) and leaky (regurgitant) or if your valve is too heavily calcified. It's also not performed if there's a blood clot in a chamber of your heart, because of the risk of dislodging it. You may need the procedure repeated. Mitral valve surgeryIf there is more than mild leakage (regurgitation) of your valve or if you have other valve problems in addition to mitral stenosis, surgery may be a better option than balloon valvuloplasty. Surgical options include: Valvuloplasty. Using traditional surgical tools, a cardiac surgeon may make repairs such as separating fused valve leaflets and removing obstructions on or near the mitral valve. This helps clear the valve passageway. You may need the procedure repeated if you develop mitral valve stenosis again in the years following surgery. Mitral valve replacement. Most people with mitral valve stenosis who need surgery will have mitral valve replacement. Your surgeon removes the narrowed mitral valve and replaces it with a mechanical valve or a tissue valve. Mechanical valves, made from metal, are durable, but they carry the risk of blood clots forming on or near the valve. If you receive a mechanical mitral valve, you'll need to take an anticoagulant medication, such as warfarin (Coumadin), for life to prevent blood clots. Tissue valves which may come from a pig, cow or human cadaver donor often eventually need to be replaced. Your doctor can discuss the risks and benefits of each type of heart valve with you.You may continue to be at risk of arrhythmias even after successful surgery for mitral valve stenosis. You may need to take medications to lower that risk or control your heart rate. Other proceduresIn some cases your surgeon may perform additional surgery at the time of your operation to try to keep your heart in normal rhythm, such as the maze procedure. This involves making a series of surgical incisions in the upper half of your heart (atria). These heal into carefully placed scars in the atria that form boundaries that force electrical impulses in your heart to travel properly to cause the heart to beat efficiently. Lifestyle and home remediesTo improve your quality of life if you have mitral valve stenosis, your doctor may recommend that you: See your dentist regularly. Receive regular dental care, following recommendations for the prevention of heart infections (endocarditis) for any dental procedure. Lower the salt in your diet. Food doesn't directly affect the degree of mitral valve stenosis. However, salt in food and drinks may increase the pressure on your heart. So don't add salt to your food, and avoid foods high in sodium. Read the labels on foods for sodium content and ask for low-salt foods when you eat out. Maintain a healthy weight. Excess weight may make you short of breath and may complicate heart surgery if you ever need it. Keep your weight within a range recommended by your doctor. Cut back on caffeine. Irregular heartbeats (arrhythmias) may occur in people with mitral valve stenosis. Arrhythmias may get worse if you have too much caffeine. Ask your doctor about drinking beverages with caffeine, such as coffee or soft drinks. Seek prompt medical attention. If you notice frequent palpitations or feel your heart racing, seek medical help. Fast heart rhythms that aren't treated can lead to rapid deterioration in people with mitral valve stenosis. Cut back on alcohol. Heavy alcohol use can cause arrhythmias and can make symptoms worse. If you have mitral valve stenosis, ask your doctor about the effects of drinking alcohol. Exercise. Physical activity may help to keep your body fit and may help you to recover faster if you ever need heart surgery. How long and hard you're able to exercise may depend on what level of activity triggers your symptoms, if any. Ask your doctor for guidance before starting any exercise program. See your doctor regularly. Establish a regular appointment schedule with your cardiologist or primary care provider.If you're a woman with mitral valve stenosis, discuss family planning with your doctor before you become pregnant, because your heart works harder during pregnancy. How a heart with mitral valve stenosis tolerates this extra work depends on the degree of stenosis and how well your heart pumps. If you become pregnant, your cardiologist and obstetrician should evaluate you throughout your pregnancy, labor and delivery, and after delivery. PreventionThe best way to prevent mitral valve stenosis is to prevent its most common cause, rheumatic fever. You can do this by making sure you and your children see your doctor when any of you have a sore throat. Untreated strep throat infections can develop into rheumatic fever. Fortunately, strep throat is usually easily treated with antibiotics.
Mitral valve regurgitationBy Mayo Clinic staff
Original Article: http://www.mayoclinic.com/health/mitral-valve-regurgitation/DS00421
DefinitionMitral valve regurgitation or mitral regurgitation happens when your heart's mitral valve doesn't close tightly, which allows blood to flow backward in your heart. When the mitral valve doesn't work properly, blood can't move through your heart or to the rest of your body as efficiently, making you feel tired or out of breath. Mitral valve regurgitation is also called mitral insufficiency or mitral incompetence. Treatment of mitral valve regurgitation depends on how severe your condition is, whether it's getting worse, and signs and symptoms. For mild cases, treatment may not be necessary. You may need heart surgery to repair or replace the valve for more-severe cases. Left untreated, severe mitral valve regurgitation can cause heart failure or serious heart rhythm problems (arrhythmias). SymptomsSigns and symptoms of mitral valve regurgitation depend on its severity and how quickly the condition develops. Mitral valve regurgitation signs and symptoms can include: Blood flowing turbulently through your heart (heart murmur) Shortness of breath, especially with exertion or when you lie down Fatigue, especially during times of increased activity Lightheadedness Cough, especially at night or when lying down Heart palpitations sensations of a rapid, fluttering heartbeat Swollen feet or ankles Excessive urinationMitral valve regurgitation is often mild and progresses slowly. You may have no symptoms for decades and be unaware that you have this condition. Mitral valve regurgitation is often first suspected when your doctor hears a heart murmur. Sometimes, however, the problem develops quickly, and you may experience a sudden onset of severe signs and symptoms. When to see a doctorIf you develop signs and symptoms that suggest mitral valve regurgitation or another problem with your heart, see your doctor right away. Sometimes the first signs of mitral valve regurgitation are actually those of its complications, including heart failure. Heart failure is a condition in which your heart can't pump enough blood to the rest of your body, causing shortness of breath, fluid buildup and fatigue. There are a number of causes of this, and mitral valve regurgitation is just one of them. However, mitral valve regurgitation is usually discovered earlier, during a routine examination when your doctor listens to your heart with a stethoscope. Mitral valve regurgitation can cause an abnormal heart sound (heart murmur). When mild, mitral valve regurgitation may not progress and may never pose a serious threat to your health. But when severe, mitral valve regurgitation may cause heart complications and may require surgery to correct. CausesChambers and valves of the heart
Your heart, which is the pump of your circulatory system, has four chambers. The two upper chambers, the atria, receive blood. The two lower chambers, the ventricles, pump blood. Blood flows through your heart's chambers, aided by four heart valves. These valves open and close, allowing blood to flow through your heart in only one direction. The mitral valve which lies between the two left chambers of your heart has two triangular-shaped flaps of tissue called leaflets. Heart valves open like a trapdoor. The leaflets of the mitral valve open when the left atrium contracts, forcing blood through the leaflets and into the left ventricle. When the left atrium relaxes between heart contractions, the flaps shut to prevent blood that has just passed into the left ventricle from flowing backward, in the wrong direction. When working properly, heart valves open and close fully. In mitral valve regurgitation, the mitral valve doesn't close tightly. So, with each heartbeat, some blood from the left ventricle flows backward into the left atrium, instead of forward into the aorta. Regurgitation refers to this backflow of blood through the heart valve. Causes of mitral valve regurgitationMitral valve regurgitation can be caused by many things, including: Mitral valve prolapse. Mitral valve prolapse is a condition in which the leaflets and tendon-like cords supporting the mitral valve weaken. The result is that with each contraction of the left ventricle, the valve leaflets bulge (prolapse) up into the left atrium. This common heart defect may prevent the mitral valve from closing tightly and lead to regurgitation. However, mitral valve prolapse is common and most people who have it never develop severe regurgitation. Damaged tissue cords. Mitral valve regurgitation may result from damage to the tissue cords that anchor the flaps of the mitral valve to the heart wall. Over time, these cords may stretch or suddenly tear, especially in people with mitral valve prolapse. A tear of these cords can cause substantial leakage through the mitral valve and may require repair by heart surgery. Rheumatic fever. Rheumatic fever a complication of untreated strep throat and once a common childhood illness in the United States can damage the mitral valve, leading to mitral valve regurgitation later in life. Rheumatic fever can damage the mitral valve in two main ways. The infection may cause the leaflets of the valve to thicken, limiting the valve's ability to open. This causes narrowing of the valve, a condition known as mitral valve stenosis. The infection may also cause scarring of the mitral leaflets, leading to regurgitation. People with rheumatic fever, which is still common in countries where antibiotic use isn't common, may have both mitral valve stenosis and mitral valve regurgitation. Endocarditis. The mitral valve may be damaged by endocarditis, an infection of the lining (endocardium) of the heart that can involve heart valves. Wear and tear on the valve. The mitral valve opens and shuts tens of thousands of times every day of your life. Sometimes age-related wear and tear on the valve causes mitral valve regurgitation. Prior heart attack. A heart attack can damage the area of the heart muscle that supports the mitral valve, affecting the function of the valve. In fact, if the damage is extensive enough, a heart attack may result in sudden and severe mitral valve regurgitation. This sudden onset of regurgitation is sometimes referred to as acute mitral valve regurgitation. Untreated high blood pressure. Over time, high blood pressure can cause your heart to work harder, and gradually your heart's left ventricle can enlarge. This can then stretch the tissue around your mitral valve, which can lead to leakage. Congenital heart defects. Some babies are born with defects in their hearts, including damaged heart valves.Severe mitral valve regurgitation regardless of its cause can weaken your heart. When the left ventricle contracts in a heart with mitral valve regurgitation, some blood flows backward into the left atrium instead of flowing forward into the aorta. As a result, blood flow to the rest of your body decreases. In response, the left ventricle may enlarge (dilate) so that it can pump more blood with each heartbeat. At first this adaptation helps your heart beat with more force. But eventually, the change weakens your heart and may cause heart failure and heart rhythm irregularities, such as atrial fibrillation. Risk factorsSeveral factors can increase your risk of mitral valve regurgitation, including: A history of mitral valve prolapse or mitral valve stenosis. However, having either condition doesn't necessarily mean you'll develop mitral valve regurgitation. In fact, most people with mitral valve prolapse never develop severe regurgitation. A past heart attack. A heart attack can damage your heart, affecting the function of the mitral valve. Use of certain medications. People who take ergotamine and similar medicines for migraines and those who took pergolide (now removed from the market) have an increased risk of mitral regurgitation. Similar problems were noted with the appetite suppressants fenfluramine and dexfenfluramine, which are no longer sold. Infections such as endocarditis or rheumatic fever. Infections can damage the mitral valve. Congenital heart disease. Some people are born with an abnormal mitral valve prone to regurgitation. Often babies born with heart defects may have more than one problem, such as a hole in the upper chambers of the heart (atrial septal defect) and an abnormal mitral valve. Age. By middle age, many people have some mitral valve regurgitation caused by natural deterioration of the valve. However, mitral valve regurgitation causes symptoms in only a small percentage of older adults.ComplicationsWhen it's mild, mitral valve regurgitation may never cause problems. But when it's severe, mitral valve regurgitation may lead to these complications: Heart failure. In heart failure, your heart is unable to pump enough blood to meet your body's needs. Severe mitral regurgitation places an extra strain on the heart due to the need to pump extra blood. The left ventricle gets bigger and, if untreated, weakens. This can cause heart failure. Fluid and pressure build up in your lungs as a result of mitral valve regurgitation and can eventually put a strain on the right side of your heart, leading to ankle swelling (edema). People with heart failure experience shortness of breath and fatigue and may wake up at night feeling short of breath. Atrial fibrillation. This is an irregular heart rhythm in which your heart's upper chambers (atria) beat chaotically and rapidly. Atrial fibrillation can cause blood clots. These blood clots may break loose from your heart and travel through your bloodstream, often to your brain, causing a stroke. Other irregular heartbeats (heart arrhythmias) also may occur in people with mitral valve regurgitation. Endocarditis. Endocarditis is an infection of the inner lining of your heart. Typically the infection involves one of the heart valves, especially if it's already damaged. If the mitral valve is damaged, it's more prone to infection than is a healthy valve. You can develop endocarditis when bacteria from another part of your body spread through the bloodstream and lodge in your heart. Doctors used to recommend that some people with mitral valve regurgitation take antibiotics before certain dental or medical procedures to prevent endocarditis, but antibiotics are no longer considered necessary in most cases for someone with mitral valve regurgitation or mitral valve prolapse. Pulmonary hypertension. If you have mitral regurgitation for many years and it's untreated, or treated improperly, you can develop pulmonary hypertension. Pulmonary hypertension is a type of high blood pressure that affects the arteries in the lungs. In mitral regurgitation, your leaky valve may cause increased pressure in the left atrium, which can eventually cause pulmonary hypertension. Pulmonary hypertension in turn causes increased pressure in your right ventricle and atrium, which can lead to heart failure.Preparing for your appointmentIf you think you have mitral valve regurgitation, make an appointment to see your doctor. Because appointments can be brief, and because there's often a lot of ground to cover, it's a good idea to be prepared for your appointment. Here's some information to help you get ready for your appointment, and what to expect from your doctor. What you can do Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance. Write down any symptoms you're experiencing, including any that may seem unrelated to mitral valve regurgitation. Write down key personal information, including a family history of heart disease, heart defects, genetic disorders, stroke, high blood pressure or diabetes, and any major stresses or recent life changes. Make a list of all medications, as well as any vitamins or supplements, that you're taking. Take a family member or friend along, if possible. Sometimes it can be difficult to soak up all the information provided to you during an appointment. Someone who accompanies you may remember something that you missed or forgot. Be prepared to discuss your diet and exercise habits. If you don't already follow a diet or exercise routine, be ready to talk to your doctor about any challenges you might face in getting started. Write down questions to ask your doctor.Your time with your doctor is limited, so preparing a list of questions will help you make the most of your time together. List your questions from most important to least important, in case time runs out. For mitral valve regurgitation, some basic questions to ask your doctor include: What is likely causing my symptoms or condition? What are other possible causes for my symptoms or condition? What kinds of tests will I need? What's the best treatment? What are the alternatives to the primary approach that you're suggesting? I have other health conditions. How can I best manage them together? Are there any restrictions that I need to follow? Should I see a specialist? If I need surgery, which surgeon do you recommend for mitral valve repair? Is there a generic alternative to the medicine you're prescribing for me? Are there any brochures or other printed material that I can take home with me? What websites do you recommend?In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment at any time that you don't understand something. What to expect from your doctorYour doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask: When did you first begin experiencing symptoms? Have your symptoms been continuous or occasional? How severe are your symptoms? What, if anything, seems to improve your symptoms? What, if anything, appears to worsen your symptoms?Tests and diagnosisIf you have signs and symptoms of mitral valve regurgitation, you may need several diagnostic tests. But first your doctor will ask you about your general health, including your symptoms, prior tests and history of heart disease in your family. Next, your doctor performs a physical examination. He or she listens to your heart sounds with a stethoscope. Mitral valve regurgitation usually produces a heart murmur. The murmur is the sound of blood leaking backward through the mitral valve. With this information, your doctor decides which tests to request so that he or she can make a diagnosis and develop a treatment plan. You may be referred to a cardiologist a doctor who specializes in the study of the heart and its function. Common tests used to diagnose heart valve problems include: Echocardiogram. This test uses sound waves to produce an image of your heart. In an echocardiogram, sound waves are directed at your heart from a wand-like device (transducer) held on your chest. An echocardiogram helps your doctor get a close look at the mitral valve and how well it is or isn't working. Chest X-ray. With an X-ray of your chest, your doctor can see the size and shape of your heart to determine whether the left ventricle is enlarged. A chest X-ray also allows your doctor to evaluate your lungs. Mitral valve regurgitation may result in blood backing up into your lungs, which causes congestion that's visible on an X-ray. Electrocardiogram (ECG). In this test, adhesive patches with wires (electrodes) are attached to your skin to measure the electrical impulses given off by your heart. Impulses are recorded as waves displayed on a monitor or printed on paper. An ECG gives information about heart rhythm and, indirectly, heart size. With mitral valve regurgitation, the left ventricle may be enlarged and you may have heart rhythm irregularities (arrhythmias). Holter monitor. A Holter monitor is a portable device that you wear to record a continuous ECG, usually for 24 to 72 hours. Holter monitoring is used to detect intermittent heart rhythm irregularities that may be associated with mitral valve regurgitation. Transesophageal echocardiogram. This type of echocardiogram allows an even closer look at the mitral valve. The esophagus, the tube that runs from your throat to your stomach, lies close to your heart. In a transesophageal echocardiogram, a small transducer attached to the end of a tube is inserted down the esophagus. Because the esophagus lies close to your mitral valve, having the transducer there provides a clearer picture of valve structure and blood flow through it. Exercise tests. Various exercise tests can help measure your tolerance for activity and check your heart's response to exertion (exercise). Cardiac catheterization. In this procedure, a doctor threads a thin tube (catheter) through a blood vessel in your arm or groin into your heart. The catheter is used to deliver dye into the heart chambers and the blood vessels of your heart. The dye, appearing on X-ray images as it moves through your heart, gives your doctors detailed information about your heart and heart valves. Some catheters used in cardiac catheterization have miniature devices (sensors) at the tips that can measure pressure within heart chambers, such as the left ventricle.Treatments and drugsMitral valve regurgitation treatment depends on how severe your condition is, and if it's getting worse. The goal of treatment is to improve your heart's function while minimizing your signs and symptoms and avoiding future complications. ObservationSome people, especially those with mild regurgitation, don't need to be treated. However, even if you don't have signs and symptoms with mitral valve regurgitation, the condition may require monitoring by your doctor. You may need regular evaluations, with the frequency depending on the amount of regurgitation. Observation isn't the same as ignoring the condition. Working with your doctor, you should keep a close eye on your symptoms in case you do end up needing treatment. MedicationsMedication can't correct a deformity of a mitral valve. But medications such as diuretics are available to relieve fluid accumulation in your lungs or legs, which can accompany mitral valve regurgitation. High blood pressure makes mitral valve regurgitation worse, so if you have high blood pressure, your doctor may prescribe medication to help lower it. Following a low-salt diet helps prevent fluid buildup and helps control blood pressure. SurgeryYour mitral valve may need to be surgically repaired or replaced. If you feel good, you may question the need for open-heart surgery. But you can have bad mitral valve regurgitation and yet feel good. This is because the heart is good at counteracting problems caused by a leaky mitral valve. However, if you wait too long to have surgery, your heart might become damaged beyond repair or become so weakened that surgery wouldn't help. That's why it's important to closely monitor mitral valve regurgitation and get surgery if your doctor feels it will help you avoid future problems. Discuss the risks and benefits of surgery with your doctor. Your surgery options include: Valve repair. Mitral valve repair is a surgery that preserves your own valve. For most people with mitral valve prolapse, this is the preferred surgical treatment to correct your condition. Your mitral valve consists of two triangular-shaped flaps of tissue called leaflets. The leaflets of the mitral valve connect to the heart muscle through a ring called the annulus. The surgeon can modify the original valve (valvuloplasty) to eliminate backward blood flow. Surgeons can also repair the valve by reconnecting valve leaflets or by removing excess valve tissue so that the leaflets can close tightly. Sometimes repairing the valve includes tightening or replacing the ring around the valve (annulus). This is called an annuloplasty. It's important to have an experienced surgeon perform mitral valve repair. Valve replacement. Valve replacement is done when valve repair isn't possible. In valve replacement surgery, the damaged mitral valve is replaced by an artificial (prosthetic) valve. The two types of artificial valves are mechanical and tissue. Mechanical valves, which are made of metal, may last a long time. However, if you have a mechanical valve, you must use an anticoagulant medication, such as warfarin (Coumadin), for the rest of your life to prevent blood clots from forming on the valve. If a blood clot forms on the valve and breaks free, it could travel to your brain and cause a stroke. Tissue valves are made from animal tissue such as a pig's heart valve. These kinds of valves are called bioprostheses. They may wear out over time and need replacement. However, an advantage of the tissue valve is that you don't have to use long-term anticoagulant medication. Mitral valve repair or replacement requires open-heart surgery under general anesthesia. With traditional open-heart surgery, a cut that's the length of your breastbone (sternum) is made and your heart is exposed and connected to a heart-lung machine that assumes your breathing and blood circulation functions during the procedure. Your surgeon then replaces or repairs the valve. After the operation, you'll spend one or more days in an intensive care unit, where your heart function and general recovery will be closely monitored. Mitral valve regurgitation can be eliminated with surgery, but some people may continue to have some leakage. How well you do depends on whether the valve was repaired or replaced, how much regurgitation is left, and your heart's pumping function. Talk to your doctor about what type of follow-up you need after surgery, and let your doctor know if you develop new or worsening signs and symptoms after treatment. Less invasive techniquesDoctors are developing less invasive techniques to treat valve disorders, such as repairing or replacing mitral valves using heart catheterization or robotic techniques. Some surgeons now repair the mitral valve through smaller cuts in your chest (minimally invasive cardiac surgery). People who have minimally invasive cardiac surgery usually have a shorter recovery time and leave the hospital sooner. These techniques are not for everyone, so talk to your surgeon to see if this type of surgery might be right for you. Lifestyle and home remediesTo improve your quality of life if you have mitral valve regurgitation, your doctor may recommend that you: Check your blood pressure regularly. Control of high blood pressure is important if you have mitral valve regurgitation. Eat a heart-healthy diet. Food doesn't directly affect mitral valve regurgitation. However, developing coronary artery disease blockages of arteries that feed your heart muscle may lead to heart attacks with further weakening of the heart muscle. To follow a heart-healthy diet, eat low-fat foods and check your cholesterol levels regularly. Also, your doctor may suggest that you limit your salt intake. If you have any questions about your diet, ask to talk to a dietitian. Maintain a healthy weight. Excess weight may make you short of breath and may complicate heart surgery if you ever need it. Keep your weight within a range recommended by your doctor. Cut back on caffeine. Irregular heartbeats (arrhythmias) may occur in people with mitral valve regurgitation. Arrhythmias may worsen if you have too much caffeine. Ask your doctor about drinking beverages with caffeine, such as coffee and soft drinks. Cut back on alcohol. Heavy alcohol use can cause arrhythmias and can make your symptoms worse. Excessive alcohol use can also cause cardiomyopathy, a condition of weakened heart muscle that often leads to mitral regurgitation. If you have mitral valve regurgitation, ask your doctor about the effects of drinking alcohol. Exercise. Physical activity helps to keep your body fit and may also help you to recover faster if you ever need heart surgery. Your doctor usually gives you guidelines for your exercise program. Don't stop exercising if you've received a diagnosis of mitral valve regurgitation. If you find that you're unable to do things because of mitral valve regurgitation, talk to your doctor. See your doctor regularly. Establish a regular evaluation schedule with your cardiologist or primary care provider.If you're a woman with mitral valve regurgitation, discuss family planning with your doctor before you become pregnant, because your heart works harder during pregnancy. How a heart with mitral valve regurgitation tolerates this extra work depends on the degree of regurgitation and how well your heart pumps. Should you become pregnant, your cardiologist and obstetrician need to evaluate you throughout your pregnancy, labor and delivery, and after delivery. PreventionBecause rheumatic fever is a risk factor for developing mitral valve regurgitation, if you have a severe sore throat you should see a doctor. Untreated strep throat can lead to rheumatic fever. Fortunately, strep throat is easily treated with antibiotics. If you have high blood pressure, it's important to make sure it's well controlled to prevent mitral regurgitation. If you have an abnormal valve, such as mitral valve prolapse, it's important to seek medical care if you develop a fever or signs or symptoms of an infection of your heart tissue (endocarditis). If you have mitral valve regurgitation, talk to your doctor about the frequency of follow-up examinations, and have your doctor regularly check the amount of regurgitation through regular physical examinations and follow-up echocardiograms when needed.
