Mitral Valve Disease and Diagnosis

In this two-part blog, we’ll provide what you need to know about mitral valve diseases and their latest treatments.

In this first article, you’ll learn about the types of mitral valve diseases, what causes them and what symptoms might indicate a trip to your doctor. In the second part, we’ll discuss living with the disease, treatment options and what to expect after surgery.

The Different Varieties of Mitral Valve Diseases

The main types of mitral valve diseases are mitral valve stenosis, mitral valve prolapse and mitral valve regurgitation. Each has its own set of symptoms, but they can appear quite similar to one another.

What is Mitral Valve Stenosis?

Having mitral valve stenosis means your mitral valve stiffens and doesn’t open all the way, forcing blood through a smaller opening. In severe cases, fluid can build up in the lungs, leading to coughing and breathing problems such as pneumonia. Problems with the mitral valve can also cause a fast or irregular heartbeat, called palpitations. Over time, mitral stenosis may slowly get worse.

Possible Causes of Mitral Valve Stenosis

Most cases of mitral valve stenosis are caused by rheumatic fever, which can lead to inflammation that damages the heart valves. Although pregnancy doesn’t cause mitral stenosis, a woman may first develop symptoms of mitral valve stenosis during pregnancy. This is because the amount of blood her heart has to move has increased.

Symptoms of Mitral Valve Stenosis

• Shortness of breath with exertion
• Shortness of breath when you lie down
• Fatigue, especially during increased physical activity
• Swollen feet or legs
• Heart palpitations
• Dizziness or fainting
• Coughing up blood
• Chest discomfort or chest pain

What is Mitral Valve Prolapse and Regurgitation?

Mitral valve prolapse (MVP) is the bulging, or prolapse, of one or both of the mitral valve flaps into the left atrium when the heart contracts. Normally the flaps are tightly closed by small cords, or tendons, that connect the flaps to the muscles of the heart. This closure prevents blood from flowing backwards.

In MVP, the flaps enlarge and stretch inward toward the left atrium, sometimes snapping together during heart contraction. When the flaps don't close properly, blood leaks backward and when this happens, it’s called mitral regurgitation or mitral insufficiency.

With mitral valve regurgitation, the blood doesn’t flow forward into the ventricle the way it should and because of this, the heart has to work harder than it should to get blood out to the body. If the regurgitation gets worse, some blood may start to back up into the lungs.

A very small amount of mitral regurgitation is common, but some people have severe mitral valve regurgitation. Mitral valve regurgitation can be acute or chronic.

In the chronic form, the valve gradually becomes leakier over time. This gives the heart time to adapt to the leak. With chronic mitral regurgitation, the symptoms may range from mild to severe. With the acute condition, the valve suddenly becomes leaky and the heart doesn’t have time to adapt to the leak in the valve. Symptoms with acute mitral regurgitation are often severe and require immediate medical attention.

Possible Causes of Mitral Valve Prolapse

The cause of MVP is unknown, but most cases are thought to be inherited. There are two forms of MVP, primary and secondary.

Primary MVP

Primary MVP means the mitral valve is abnormal because of one or more of these changes to it:

• One or both flaps are too large and thick
• The flap surfaces are scarred
• The tendon cords are thinner or longer than they should be
• Deposits on the flaps

Secondary MVP

In secondary MVP, another disease is linked to MVP. Often the valve flaps are not thickened and the prolapse occurs for other reasons. The prolapse may be from:

• Coronary artery disease
• Functional changes in the heart muscle
• Heart attack
• Rheumatic heart disease
• Valve infection
• Hypertrophic cardiomyopathy
• A tissue disorder, such as Marfan syndrome
• Thyroid gland conditions, such as Graves’ disease
• Scoliosis and other skeletal problems
• Some types of muscular dystrophy

Possible Causes of Mitral Valve Regurgitation

A range of conditions can cause mitral valve regurgitation. They include:

• Mitral valve prolapse
• Rheumatic heart disease
• Coronary artery disease or heart attack
• Certain autoimmune diseases such as rheumatoid arthritis
• Infection of the heart valves
• Support structures of the mitral valve break
• Certain medicines
• Abnormal function of the heart muscle
• Trauma
• IV drug use
• Untreated health conditions that can lead to the disorder
• A family history of the condition

Symptoms of MVP

MVP may not cause any symptoms, and symptoms that do arise may vary depending on the degree of prolapse present. The presence of symptoms doesn't necessarily match the severity of MVP. The most common symptoms of MVP are:

• Fast or irregular heartbeats, known as palpitations
• Chest pain
• Anxiety
• Hyperventilation
• Exercise intolerance
• Dizziness

You may have no noticeable symptoms, though your doctor may hear a click or murmur during a routine physical exam. The click sound is created by the stretched flaps snapping against each other during contraction, while the murmur is caused by the blood leaking back into the left atrium. This may be the only sign of MVP in many cases.

Symptoms of Mitral Valve Regurgitation

Most people with chronic mitral valve regurgitation don’t notice any symptoms for a long time. People with mild or moderate mitral regurgitation often don’t have any symptoms, but if your regurgitation progresses, symptoms can surface such as:

• Shortness of breath with exertion
• Shortness of breath when lying flat
• Fatigue
• Reduced ability to exercise
• Unpleasant awareness of your heartbeat
• Palpitations
• Swelling in your legs, abdomen, and veins in your neck
• Chest pain

Acute, severe mitral valve regurgitation is a medical emergency and you should seek medical attention immediately. It can cause serious symptoms such as:

• Symptoms of shock such as pale skin, loss of consciousness or rapid breathing
• Severe shortness of breath
• Abnormal heart rhythms that make the heart unable to pump well

The symptoms of mitral valve prolapse may look like other medical conditions, so always see a health care provider for an accurate diagnosis.

How Are Mitral Valve Disorders Diagnosed?

Along with a complete medical history and physical exam, your provider may order some or all of these tests to diagnose your mitral valve disorder and the level of its severity:

• Electrocardiogram (ECG)
• Chest X-ray
• Transthoracic echocardiogram (echo or TTE)
• Stress test
• Cardiac catheterization
• Cardiac MRI

Learn more about the award-winning cardiovascular care we provide by clicking here, or read the second half of this blog series that explains mitral valve disease treatment, recovery and survivorship.