Mitral Valve Disease: Types, Causes & Symptoms

Mitral valve disease covers conditions that impair the function of the mitral valve, a critical component for directing blood flow between the heart’s chambers- the left atrium and left ventricle. This dysfunction disrupts normal blood circulation and compromises heart efficiency, potentially leading to serious cardiovascular complications.

This disease can affect individuals and profoundly impact their physical health, emotional well-being, and quality of life. While it is generally not considered a medical emergency in its chronic forms, acute occurrences require immediate medical attention.

Understanding the symptoms, causes, and treatment options for mitral valve disease is essential for effective management. If you experience symptoms that may suggest mitral valve disease, seeking medical attention is crucial for accurate diagnosis and proper treatment.

Understanding the Mitral Valve

The mitral valve is one of the four primary heart valves. It is between the left atrium and the left ventricle and comprises two leaflets, also known as cusps, which play a crucial role in its function.

During diastole (when the heart relaxes), the leaflets open to allow blood to flow from the left atrium into the left ventricle. During systole (when the heart contracts), the leaflets close to prevent blood backflow. This ensures blood pressure in the ventricle is maintained for ejection towards the aorta. 

This action is essential for efficient blood circulation, maintaining stable blood pressure in the heart chambers, and ensuring adequate oxygenation. However, if the mitral valve malfunctions and permits blood to flow backward, the left atrium may experience increased volume. This backflow can overload the heart, potentially leading to serious complications.

Types of Mitral Valve Disease

Understanding the different types of mitral valve disease and their specific causes equips one with knowledge regarding the nature of the condition. This awareness can encourage individuals to seek prompt medical evaluation, leading to timely treatment and improving quality of life.

Mitral Valve Prolapse

Mitral valve prolapse often occurs without a clear cause but is primarily linked to changes in the connective tissue of the valve. This condition makes the valve’s leaflets too floppy, causing them to bulge into the left atrium during the heart’s contraction and potentially leading to mitral regurgitation.

Genetics and structural abnormalities can influence the condition. The risk also increases with age, especially in people over 50. Furthermore, connective tissue disorders such as Marfan syndrome or other collagen vascular diseases exacerbate these changes by the long-term weakening of the valve tissue.

Mitral Valve Regurgitation

Mitral valve regurgitation happens when the valve fails to close fully, causing blood to flow back into the left atrium as the left ventricle contracts. Common causes include mitral valve prolapse and damage from a heart attack that affects the valve’s supporting structures.

Infections such as endocarditis and complications of untreated strep throat, including rheumatic fever and scarlet fever, can lead to mitral valve scarring or damage. Age-related degenerative changes can weaken the valve, particularly in individuals over 60. Additionally, cardiomyopathy, Marfan syndrome, and autoimmune diseases like lupus can also cause this condition.

Mitral Valve Stenosis

Mitral valve stenosis is characterized by the narrowing of the mitral valve, restricting blood flow from the left atrium to the left ventricle. Rheumatic fever is a primary cause of mitral valve damage and often develops as a complication of streptococcal infections, such as strep throat or scarlet fever.

It leads to inflammation and scarring of the valve leaflets, causing them to thicken and fuse, impairing their ability to open and close properly. Although rheumatic fever typically begins in childhood or adolescence, mitral valve stenosis can manifest later in life.

Other rare causes include abnormally formed valves present from birth, age-related calcium deposits that stiffen the leaflets in individuals over 60, and previous radiation treatments to the chest area, which can unintentionally damage the valve, leading to its narrowing and reduced flexibility.

Symptoms of Mitral Valve Disease

The indicators and manifestations of mitral valve disease vary according to the specific type of valve dysfunction. Symptoms often develop slowly and may only become noticeable when one encounters stressful situations or life events. Recognizing these symptoms is crucial for obtaining appropriate medical care and avoiding severe complications.

Shortness of Breath

Shortness of breath, medically known as dyspnea, is a hallmark of mitral valve disease. This issue occurs when the mitral valve fails to close properly, allowing blood to return to the lungs. As a result, the lungs become congested with excess blood, increasing pressure in the pulmonary vessels.

This can make it difficult for oxygen to move from the lungs to the bloodstream, leading to breathing difficulties. This symptom is particularly noticeable when lying flat or during physical activities that require exertion, such as walking, climbing stairs, or exercising.

Heavy Coughing

Heavy coughing is a significant symptom of mitral valve disease, often worsening at night or lying flat. This occurs due to increased blood pressure in the lungs from the malfunctioning valve, causing fluid to accumulate and irritate the airways.

Coughing may be a reflex to clear the airways, resolve breathing difficulties, or calm heart palpitations. Such persistent and severe coughing can disrupt sleep and daily routines, affecting the overall quality of life for those affected.

Pounding Heart Beat

Heart palpitations are commonly associated with mitral valve disease. This symptom occurs as the heart works harder to compensate for the lack of oxygen due to inefficient blood flow. Patients may experience these palpitations as fluttering, pounding, or a racing heart, which can be alarming and uncomfortable.

These episodes can happen anytime, whether during rest or physical activity, and might be accompanied by other symptoms, including chest pain, dizziness, or shortness of breath. While occasional palpitations might be harmless and triggered by anxiety, frequent or severe episodes can indicate a more serious issue.

Chest Pain and Tightness

Chest pain in mitral valve disease arises as the heart strains to pump blood through a compromised valve. The severity of the valve dysfunction can lead to sensations ranging from mild discomfort to intense pain. The pain can be stabbing, sharp, or a continuous feeling of pressure or chest tightness.

This discomfort often extends beyond the chest, radiating to the neck, arms, or back. Such widespread pain occurs because the stressed heart muscle requires more oxygen than the compromised circulation can supply, particularly during increased activity or stress periods.

Dizziness

When the mitral valve malfunctions, the heart pumps blood inefficiently, reducing the amount of oxygen-rich blood delivered to the brain. This can cause dizziness or lightheadedness, especially during physical exertion, activities requiring endurance, or sudden changes in position, such as quickly standing up.

Patients may experience a sudden sensation of spinning or losing balance. These episodes are often associated with other symptoms of mitral valve disease, such as fatigue, shortness of breath, and palpitations.

Fatigue

Fatigue is a common symptom of mitral valve disease, which arises when the condition disrupts the normal flow of oxygen-rich blood. This reduced oxygen supply to the body’s organs and tissues causes tiredness and weakness as the body’s cells lack the energy to function properly.

Lack of sleep due to symptoms like heavy coughing and breathing difficulties further contributes to fatigue. Persistent tiredness can make even routine tasks notably challenging for individuals. Additionally, fatigue in the context of mitral valve disease may indicate worsening cardiac function.

Swollen Feet

Swollen feet or ankles are common symptoms of mitral valve disease, where diminished cardiac function leads to fluid retention in the body. This condition, known medically as edema, is characterized by an accumulation of fluid in the tissues of the lower extremities.

This causes shoes to feel tighter and legs to feel unusually heavy. The swelling usually worsens by the end of the day or after long periods of standing or sitting due to gravity pulling blood and other fluids toward the lower parts of the body.

Bluish or Purple Skin Color

Skin can turn bluish or purplish, a condition known as cyanosis, due to reduced oxygen levels in the blood. It is often a sign of severe mitral valve disease, indicating poor blood flow and oxygenation to the body’s tissues.

Patients with this condition may exhibit skin discoloration around the lips, fingertips, and toes. This symptom reflects the heart’s reduced ability to efficiently circulate oxygen-rich blood, potentially leading to complications if not promptly addressed.

Complications from a Mitral Valve Disease

Mitral valve disease can lead to severe complications affecting heart and lung function. Understanding these risks is vital for managing symptoms and preventing further health deterioration.

Heart Failure

Heart failure is a critical outcome of mitral valve disease. It results from the heart’s progressive strain due to mitral valve malfunction. The backflow of blood through the defective valve forces the heart to work harder to meet the body’s demands.

This chronic overload can cause changes in the heart muscle, particularly in the left ventricle, which may enlarge and weaken—a condition known as left ventricular dysfunction.  If this condition deteriorates, it may result in heart failure, marked by a reduced ability of the heart to function effectively.

Irregular Heartbeat

Mitral valve disease can lead to structural changes in the heart, particularly stretching and enlargement of the left atrium. This occurs because the valve fails to prevent blood from flowing back, leading to increased pressure in the atrium and disrupting normal electrical signals.

This disruption in electrical pathways often triggers arrhythmias like atrial fibrillation, where the heart beats rapidly and irregularly. Additionally, the altered atrial conditions can result in poor blood flow, elevating the risk of stroke and other complications.

Elevated Lung Blood Pressure

Pulmonary hypertension frequently develops as a complication of mitral valve disease. It occurs when the defective mitral valve restricts the blood flow from the lungs to the heart, causing increased pressure within the pulmonary arteries.

This sustained high pressure significantly strains the right side of the heart, which must work harder to pump blood through the lungs. If this condition is not managed effectively, it can lead to heart failure, where the right ventricle weakens and loses the ability to pump efficiently.

Fluid in the Lungs

Pulmonary edema is a severe complication of mitral valve disease. It occurs when increased pressure in the left atrium extends backward into the pulmonary veins and lung capillaries, causing fluid to leak from the blood vessels into the lung tissue and air spaces.

This fluid accumulation in the lungs makes breathing difficult and significantly impairs oxygen exchange. The combination of pulmonary edema and mitral valve disease symptoms exacerbates the stress that the individual experiences.

Blood Clot Formation

Mitral valve disease can lead to blood clots because the abnormal valve function disrupts normal blood flow through the heart. Turbulent or stagnant blood flow increases the likelihood of clot formation within the ridges and folds of the heart chambers.

These clots can circulate through the bloodstream and become lodged in the blood vessels of the brain, causing a stroke and severe neurological damage. This risk is particularly heightened in individuals with atrial fibrillation, which further contributes to blood stasis and clot formation.

Diagnosis of Mitral Valve Disease

Healthcare professionals use various tests to assess the heart’s structure and function in diagnosing mitral valve disease. These procedures provide insights into mitral valve abnormalities and their severity.

Medical History

Medical history is pivotal in diagnosing mitral valve disease. By discussing symptoms such as breathlessness or palpitations, healthcare providers can help in identifying valve issues. Information on past heart conditions or surgeries adds crucial context, indicating potential valve dysfunction origins.

Family health history and lifestyle factors are also reviewed to detect genetic predispositions and risk factors, such as hypertension. This comprehensive evaluation guides the direction of further diagnostic tests necessary to confirm the diagnosis and plan treatment.

Physical Examination

During a physical examination for mitral valve disease, the doctor checks for heart sounds using a stethoscope. A key indicator of valve issues is a heart murmur, characterized by its distinctive sound, timing, and duration throughout the heartbeat cycle.

For instance, a swishing or whooshing sound might indicate either a narrowing of the mitral valve or a backflow, with mitral regurgitation typically heard as a systolic murmur and stenosis as a diastolic murmur. Additionally, the doctor will check for physical signs typical of heart disorders, including a rapid heartbeat.

They will also look for swelling and fluid retention, especially in the lower extremities. These symptoms help assess the severity and impact of the valve dysfunction on overall heart function.

Electrocardiogram (ECG/ EKG Test)

An electrocardiogram (EKG) tracks the electrical activity of your heart using small electrode patches placed on predetermined locations in your chest, arms, and legs to receive specific electrical signals. This test is beneficial for detecting irregular heart rhythms (arrhythmias), which are common among individuals with mitral valve disease.

While an EKG cannot directly visualize the mitral valve or evaluate its structural condition, it offers valuable insights into how valve issues affect overall heart function. Additionally, an EKG can help identify other heart conditions, such as reduced blood flow or previous heart attacks, which may complicate mitral valve disease.

Chest X-ray

A chest X-ray is typically used as an initial assessment to examine the heart’s structure. It can reveal enlargement of the heart or changes in its shape that suggest mitral valve disease.

In addition, this procedure can reveal signs of lung congestion, like pulmonary edema. While it is useful for monitoring the impact of altered heart function, it cannot directly evaluate the mitral valve’s functionality or detailed structure.

Heart Scans

An echocardiogram is a key diagnostic tool for confirming mitral valve disease. This non-invasive test utilizes ultrasound waves to produce detailed heart images, allowing doctors to assess valve structure and function accurately.

It can also visually estimate the heart’s size, pumping strength, and pressure within the heart chambers. It helps identify issues like valve thickening, leaflet prolapse, and calcification. Transthoracic echocardiography (TTE) is a common type of echocardiography where an ultrasound probe is placed on the chest to obtain heart images.

It is typically the first test performed to confirm mitral valve disease by identifying issues like regurgitation or stenosis. Transesophageal echocardiography (TEE) provides high-resolution images due to its proximity to the heart by placing a small transducer down the throat into the esophagus.

It is used when more detailed images are needed or when TTE results are inconclusive. Additionally, TEE also guides surgical procedures such as transcatheter mitral valve repair (TMVR). This comprehensive evaluation aids in diagnosing the condition and planning appropriate treatment strategies.

Stress Tests

A stress test evaluates heart function under physical stress by monitoring your heart’s activity while you exercise on a treadmill or stationary bike. This helps detect abnormalities in blood flow and valve function that may not be apparent during rest or normal ECG sessions.

These tests help determine the severity of symptoms and the impact of a possible mitral valve disease on your daily activities by observing the heart’s response to increased physical demand, including abnormal heart rhythms or worsening symptoms.

24-hour Heart Monitoring

Holter monitoring tracks heart activity continuously for 24 to 48 hours, capturing arrhythmias that intermittent tests might miss. While it records electrical patterns, it does not directly indicate mitral valve disease but suggests related cardiac dysfunctions.

This tool is crucial for detecting irregular heart rhythms possibly caused by mitral valve issues. It helps correlate symptoms like palpitations with specific heart activity patterns, which is essential for comprehensive cardiac assessment and management.

Heart Catheterization

Cardiac catheterization involves advancing a thin, flexible tube (catheter) through a blood vessel in your groin or arm and guiding it to your heart. This procedure enables measurement of the pressure inside your heart chambers and evaluates the mitral valve’s performance.

While it offers crucial insights that non-invasive tests may overlook, the procedure is invasive and carries risks like bleeding and infection. This is particularly crucial in assessing the severity of mitral valve regurgitation and plays a key role in planning surgical interventions.

Treatments for Mitral Valve Disease

The main objectives in managing mitral valve disease are to relieve symptoms, improve heart function, and prevent complications. Treatment might not be necessary for mild cases; however, severe cases often require a combination of treatments to effectively manage the condition.

Medications

Medications are often the first line of treatment for managing symptoms associated with mitral valve disease. They also play a crucial role in stabilizing the condition in preparation for medical procedures on the affected individual.

For example, diuretics help decrease fluid buildup in the lungs and other areas, while beta-blockers and calcium channel blockers manage heart rate and improve blood circulation.

Doctors may prescribe anticoagulants to help prevent blood clots. Additionally, they could recommend angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs) to decrease blood pressure and reduce the strain on your heart.

Non-surgical Valve Repair

Transcatheter Mitral Valve Repair (TMVR) is a minimally invasive option for individuals with severe valve regurgitation who are at a higher risk of complications from conventional surgery.  During the procedure, a catheter is introduced through a small incision, usually in the groin, and then guided to the heart.

A device is deployed to the mitral valve through the catheter, usually grasping or clipping the valve’s leaflets together to reduce regurgitation. Compared to traditional open-heart surgery, patients generally experience quicker recovery with TMVR, benefiting from shorter hospital stays and reduced postoperative pain.

This procedure significantly relieves symptoms and allows many patients to experience improved heart function and perform daily activities. However, it still comes with potential risks, including bleeding, infection, and device-related complications. TMVR may not be suitable for all patients, especially those with complex mitral valve anatomy or severe calcification.

Balloon Valve Repair

Valvuloplasty is a minimally invasive procedure used primarily for mitral valve stenosis. In this procedure, a catheter with a balloon is inserted through your blood vessels and guided to your heart. The balloon is expanded to open the narrowed valve flaps to improve blood flow.

This procedure is suitable for patients who are not immediate candidates for surgery but need intervention to alleviate symptoms. Risks are similar to TMVR, and related to the route of the procedure. The improvement following valvuloplasty can vary depending on your condition and how well the valve responds to the procedure.

Heart Surgery

Open-heart or thoracoscopic surgical options like mitral valve repair or replacement may be necessary when medications and less invasive procedures are insufficient. Mitral valve repair focuses on fixing the existing valve for better functionality, including reshaping valve parts or removing excess tissue to ensure a proper seal.

Mitral valve replacement involves replacing the damaged valve with a mechanical or biological valve. Mechanical valves are durable but require lifelong anticoagulant therapy. In contrast, biological valves, sourced from animal or human donors, often do not require long-term medication but may need replacement over time.

Most patients find significant relief from symptoms and an improved quality of life after recovery from surgery. Regular follow-ups with a cardiologist are crucial to monitor heart function and address long-term health concerns.

Prevention Strategies

There are no definitive methods to prevent mitral valve disease, particularly when caused by congenital conditions or age-related degeneration. However, managing risk factors can minimize the strain on the heart and potentially delay complications.

Healthy Lifestyle Choices

Maintaining a balanced diet rich in fruits, whole grains, and vegetables can help prevent hypertension and reduce stress on the mitral valve. Avoid excessive salt and cholesterol, quit smoking, and limit alcohol intake to manage blood pressure effectively.

Managing stress with meditation, yoga, or relaxation techniques reduces the heart’s workload and helps prevent arrhythmias. Regular moderate-intensity physical activities, like walking or swimming, for at least 150 minutes each week can strengthen heart muscles and boost cardiovascular health.

Managing Medical Conditions

Effectively managing chronic conditions like diabetes and hypertension is critical in preventing complications of mitral valve disease. Regular monitoring and medication adherence help control these risk factors, reducing heart strain.

Consulting healthcare providers for routine check-ups ensure early detection and management of symptoms related to mitral valve stress. Staying vigilant about heart health can minimize the risk of developing heart issues and enhance quality of life.

Immediately Addressing Infections

Addressing infections, particularly in the upper respiratory tract, is crucial in preventing the exacerbation of mitral valve disease. Bacterial infections can lead to rheumatic fever, which may cause or worsen damage to the mitral valve. Timely treatment of strep throat and other infections is essential to reduce the risk.

Regular dental hygiene and prophylactic antibiotics before certain dental procedures can also prevent bacterial endocarditis, an infection of the heart valves. This preventive measure is especially important for those with existing valve damage or replacements, as it significantly reduces the risk of serious complications.

Frequently Asked Questions

What are the different types of mitral valve disease and their causes?

Mitral valve disease manifests in various forms, each linked to specific causes. Mitral valve prolapse is usually due to alterations in the connective tissue, making the valve leaflets excessively floppy, possibly leading to regurgitation.

Mitral regurgitation, for example, arises when the valve doesn’t close appropriately, allowing blood to leak backward. This often stems from conditions like mitral valve prolapse or damage from a heart attack.

Mitral valve stenosis is a constricted valve opening that limits blood flow between the heart’s chambers. This condition is primarily caused by rheumatic fever, which thickens the valve leaflets as a complication of the infection.

What are the common symptoms associated with mitral valve disease?

Mitral valve disease typically manifests with symptoms indicating the heart’s diminished functionality. Shortness of breath is common, arising from blood accumulating in the lungs, causing congestion and breathing difficulties.

Heavy coughing often exacerbates this, especially at night or when lying down. Heart palpitations, characterized by a racing or pounding sensation, result from the heart struggling to pump efficiently. Other symptoms, such as chest pain, swollen feet, fatigue, dizziness, lightheadedness, and cyanosis, further signal the mitral valve’s impaired function.

How is mitral valve disease diagnosed?

Diagnosing mitral valve disease begins with a thorough medical history to understand symptoms and potential causes, followed by a physical examination where doctors listen for heart murmurs indicative of valve issues.

Common initial tests include a chest X-ray and an electrocardiogram (EKG) to assess the heart’s size, shape, and electrical activity. An echocardiogram, including TEE and TTE, confirms mitral valve disease by providing clear images of the mitral valve to identify specific abnormalities.

Stress tests further assess the heart’s functions under physical exertion, highlighting issues not apparent at rest. Cardiac catheterization is also employed, primarily to determine the severity of valve damage and plan surgical interventions.

What are the available treatment methods for mitral valve disease?

Treatment for mitral valve disease aims to alleviate symptoms, improve heart function, and prevent complications. Medications such as diuretics, beta-blockers, and anticoagulants are commonly prescribed to manage symptoms and are often used to stabilize the condition before any procedure.

For patients with significant mitral valve regurgitation at high risk for surgery, Transcatheter Mitral Valve Repair (TMVR) offers a minimally invasive option to reduce regurgitation.  Valvuloplasty is used for mitral valve stenosis to separate the valve flaps and improve blood flow.

Surgical options like mitral valve repair or replacement are considered when less invasive treatments are insufficient. Mitral valve repair focuses on restoring the valve’s functionality, whereas replacement involves substituting the damaged valve with either a mechanical or biological option, each offering distinct advantages and considerations.