How to Diagnose Mitral Regurgitation

Mitral regurgitation is when blood flows backward from the left ventricle into the left atrium, due to problems with the mitral valve. To diagnose mitral regurgitation, it is important to tell your doctor about any signs or symptoms you are experiencing that may relate to the condition. If your doctor suspects that you may have mitral regurgitation, she will order a series of tests to investigate further. If your diagnosis of mitral regurgitation is confirmed, you will be given treatment as needed.

Part 1 - Assessing Signs and Symptoms

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→ Know who is at risk. Age-related wear on the heart puts older adults at risk for mitral regurgitation. Those with other heart conditions, such as congenital heart disease, or who have already experienced complications with the mitral valve are at higher risk. Other risk factors include high blood pressure, high cholesterol and use of intravenous drugs.

→ If you have any of these risk factors and experience signs and symptoms of mitral regurgitation, contact your doctor for evaluation.

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→ Watch for shortness of breath. If you have mitral valve regurgitation, the backflow of blood through your mitral valve will compromise effective circulation and oxygenation throughout your body. As a result of getting less oxygen with each heartbeat, you may feel short of breath. Your shortness of breath may worsen with exertion, such as when running, walking, or going up stairs.

→ Shortness of breath may worsen with time as mitral valve regurgitation progresses.

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→ Take note of your energy level. In addition to shortness of breath, the decreased effectiveness of circulation from mitral valve regurgitation can lead you feeling more tired than usual. Tell your doctor if you have been experiencing an unusual level of fatigue compared to what is normal for you. It may be a sign of a heart or lung problem such as mitral regurgitation.

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→ Tell your doctor if you are experiencing "palpitations" (unusual heartbeats). Palpitations are sometimes felt as unusually forceful heartbeats. Other times, you may have the sensation that your heart is "fluttering" in your chest. Palpitations may be a sign of mitral regurgitation, or of another heart problem. It is important to inform your doctor if you are experiencing heart palpitations so that appropriate investigative tests can be ordered.

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→ Look out for swelling of your lower legs, ankles, and/or feet. Another possible sign of mitral regurgitation is swelling of your lower extremities. This is because the backflow of blood through your mitral valve can lead to a pressure build-up of blood in your heart. This makes it more difficult for blood to return to your heart, thus leading to the pooling of blood in the veins of your lower legs and/or feet.

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→ Be aware that you may present with no signs or symptoms. Many cases of mitral regurgitation have no observable signs or symptoms. They can, however, be detected via tests that examine your heart, such as an echocardiogram.

Part 2 - Investigating Further

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→ Have your heart listened to with a stethoscope. If you have mitral regurgitation, your doctor may be able to hear a heart murmur (the sound of blood flowing backward through your mitral valve) when he listens with a stethoscope. Although this in itself is not diagnostic of mitral regurgitation, it is suspicious of a heart problem that may very well be related to your mitral valve.

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→ Opt for a chest x-ray. If you present to your doctor with symptoms related to your cardiovascular and/or respiratory systems, she will most likely order a chest x-ray. A chest x-ray provides a more detailed view of your heart and lungs. If you do in fact have mitral regurgitation, the chest x-ray may show an enlarged left atrium or left ventricle. It may also show signs of fluid in your lungs (called "pulmonary edema") which can be caused by the backflow of blood through your mitral valve and the subsequent buildup of pressure in your heart and lung area.

→ A chest x-ray can also be used to rule in or rule out other heart or lung conditions that may present similarly to mitral regurgitation.

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→ Receive an echocardiogram. The most accurate way to diagnose mitral regurgitation — as well as to assess the severity of the condition — is via an echocardiogram. (Note that an echocardiogram, also called an "echo," is different than an electrocardiogram, also called an ECG or EKG.) Initially, you will most likely receive a TTE ("transthoracic echocardiogram"), meaning that the ultrasound probe is placed on the outside of your chest and an image of your heart is projected in real time onto a screen. Doctors can usually tell if there is any problem with your mitral valve with a TTE. They can also assess the pattern and direction of blood flow through various chambers of your heart, helping to determine the extent of the regurgitation.

→ If a TTE is insufficient to make the diagnosis, you can receive a TEE ("transesophageal echocardiogram").

→ This is where, rather than having the ultrasound probe placed on the outside of your chest, a tube-like ultrasound probe is inserted into your esophagus.

→ Since your esophagus is located much closer to your heart, a TEE can provide an even more detailed view of your heart and mitral valve than a TTE can.

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→ Ask your doctor for other investigative tests as needed. An echocardiogram is usually sufficient to diagnose mitral regurgitation and to delineate the degree of regurgitation. It can also help doctors to decide if and when surgery is necessary. In some cases, other investigative tests are needed both to further assess the mitral valve, as well as diagnose any other issues with the heart including atherosclerosis in the cardiac blood vessels so a treatment plan can be formulated addressing all the cardiac issues. If this is the case, your doctor may consider the following:

→ A cardiac MRI

→ An exercise stress test

→ Cardiac catheterization

→ A CT angiogram

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→ Classify which type of mitral regurgitation you have. There are two types of mitral regurgitation: primary or secondary. If you suffer from primary mitral regurgitation, there is an issue with the mitral valve itself; if it is secondary mitral regurgitation, then the issue is with the surrounding structures and not the valve.

→ Primary mitral regurgitation may be caused by the following: ruptured chord, valve prolapse, endocarditis (infection), rheumatic fever, valve calcification, or certain drugs.

→ Secondary mitral regurgitation may be caused by the following: coronary artery disease, heart failure, complication of a heart attack, or hypertrophic cardiomyopathy (thickening of the heart muscle).

Part 3 - Treating Mitral Regurgitation

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→ Opt for "watchful waiting." Mild cases of mitral regurgitation do not need immediate surgical treatment. Instead, your doctor may advise "watchful waiting." In this approach, you may be given medications to help reduce your symptoms and/or your cardiovascular risk factors, and you will be asked to return for regular tests, including echocardiograms, on your mitral valve.

→ Note that, eventually, most cases of mitral regurgitation do need surgery.

→ It is just a question of when surgery is needed, which is usually not until further along in the course of the disease.

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→ Go for repeat echocardiograms to monitor the status of your mitral valve. The key part of "watchful waiting" is regular monitoring. This is ideally done via repeat echocardiograms to assess the function and integrity of your mitral valve. As previously mentioned, an echocardiogram allows for a structural view of your heart and valves, and it can also identify the direction of blood flow as the heart pumps to evaluate the extent of regurgitation.

→ The frequency with which you will need to receive echocardiograms for your mitral valve will depend upon the severity of your condition.

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→ Take medication to reduce symptoms and risk factors. While you are in the process of "waiting" (for if and when you will need mitral valve surgery down the road), your doctor will likely offer you some medications. These may include:

→ A diuretic ("water pill") such as Hydrochlorothiazide or furosemide to reduce leg swelling, if you have been experiencing this as a symptom of mitral regurgitation.

→ A blood thinning medication such as Warfarin (Coumadin) to prevent blood clots, particularly if you have concurrent atrial fibrillation.

→ A blood pressure medication such as Ramipril if your blood pressure is elevated, as high blood pressure tends to worsen the symptoms of mitral regurgitation.

→ Other medications such as statins (to lower cholesterol) to diminish any other cardiovascular risk factors that you may have.