Is your heart valve leaking a little? Let's learn about Mitral Valve Regurgitation!

Do you sometimes suddenly find it difficult to breathe? Or do you feel something strange, heavy in your chest? Do you sometimes feel tired even after doing small tasks? One reason for such things could be a problem with a small door in your heart, that is, a valve. Today we are going to talk about Mitral Valve Regurgitation, which is such a condition. Don't worry, let's understand this simply.

What is this mitral valve in the heart? What happens when it doesn't work properly?

Simply put, the mitral valve is the door between the upper chamber (left atrium) and the lower chamber (left ventricle) on the left side of your heart. Think of it like a door in your house. This door has to open and close properly, allowing blood to flow from the upper chamber to the lower chamber. Then, this door has to be closed properly to send blood from the lower chamber to the rest of your body. Otherwise, the blood will start leaking back into the upper chamber.

But sometimes this door doesn't close properly. Just like the doors in our houses sometimes don't lock properly, leaving a little space. This can be due to a problem with the door itself, that is, the valve tissue. Or it can be due to a problem with the walls around the door, that is, the left chambers of the heart. However, when this door doesn't close properly, some blood leaks backward, that is, into the upper chamber. This is what we call mitral valve regurgitation or ``Mitral Regurgitation - MR''.

Think of it like a water tap. If the tap isn't closed properly, water will leak out, right? That's how it is with this one.

If this leak is small, meaning the space in the door is very small, it may not be a big problem. Your heart can handle it, so you may not feel any difference. However, if this leak is large, meaning the door is wide open, your heart feels a lot of strain. Because the heart has to work harder than usual to pump the amount of blood it needs to pump forward. Over time, the heart can no longer handle this, and you may experience symptoms and other complications.

This condition is also called:

• Mitral valve insufficiency (`(Mitral valve insufficiency)`)
• Mitral valve incompetence
• Leaky mitral valve (`(Leaky mitral valve)`)

In fact, mitral valve prolapse is the most common type of heart valve disease in countries like the United States. It is especially common in older people, especially those over the age of 65.

Are there any types of mitral valve leaks?

Yes, there are mainly two types:

1. Primary mitral regurgitation : In this case, the problem lies with the valve itself. It is caused by structural damage to one or more parts of the valve that prevents it from closing properly. For example, the valve leaflets may become too flexible and unable to seal properly, or they may become thickened and unable to close properly.

2. Secondary mitral regurgitation : This is caused by another heart condition that affects the chambers of the heart (left atrium or ventricle) that support the valve. For example, a heart muscle disease (cardiomyopathy) can cause the heart to become enlarged and weak. These changes can cause the valve to move around and not close properly.

No matter what type of leak it is, it can be severe all of a sudden (`(Acute)`), or it can develop gradually over time (`(Chronic)`).

What symptoms can occur if there is a leak in the mitral valve?

If the leak is small, you may not have any symptoms. But when the leak becomes large and begins to affect heart function, the most common symptom is shortness of breath (dyspnea) . You may feel like you can't get enough air into your lungs, or you may feel short of breath when you're just standing, lying down, trying to sleep, or even doing simple tasks.

There may also be other symptoms:

• Atypical chest pain.
• Cough.
• Swelling of the legs or feet (`(Edema)`).
• Feeling very tired (`(Fatigue)`).
• It feels like fainting, but it doesn't actually happen (`(Presyncope)`).
• Feeling like your heart rate is changing, like your chest is pounding (`(Heart palpitations)`).

These symptoms can come on gradually or start suddenly.

This is an emergency! If you experience these symptoms, go to the hospital immediately!

If your heart is working too hard, you may develop symptoms of acute heart failure. These can come on suddenly, so watch out for these symptoms:

• Breathing loudly.
• Feeling like you're suffocating.
• Difficulty breathing when lying down.
• Feeling of tightness in the chest.
• If a pulse oximeter at home shows that the oxygen level in the blood is low.

Acute heart failure is a medical emergency in which the heart suddenly stops working and can be life-threatening. Therefore, it is essential to seek treatment quickly.

Why doesn't this mitral valve close properly? What are the reasons?

As we've discussed before, this problem occurs when the mitral valve doesn't close properly. This valve has two flaps (leaflets). They open and close to allow blood to flow from the upper chamber to the lower chamber.

If these leaflets or other parts of the valve are damaged, or if various diseases cause the valve to not close properly, a little blood leaks backward every time the valve closes.

The reasons for this vary depending on the type of MR you have (primary or secondary).

Primary mitral valve regurgitation can be caused by:

• Mitral valve prolapse (MVP) : This is the most common cause in developed countries.
• Rheumatic heart disease : This is the leading cause worldwide.
• Connective tissue diseases (`(Connective tissue diseases)`).
• Cleft mitral valve is a congenital heart defect.
• Infection of the inner lining of the heart (endocarditis).
• Heart disease caused by radiation therapy (`(Radiation heart disease)`).
• Accidental injuries.

Secondary mitral valve regurgitation can be caused by:

• Ischemic cardiomyopathy (this is the most common) is caused by blockage of the blood vessels that supply the heart.
• Atrial fibrillation, an irregular heartbeat.
• Dilated cardiomyopathy (a disease of the heart muscle that causes the heart to enlarge for no known reason)
• A disease caused by thickening of the heart muscle (`(Hypertrophic obstructive cardiomyopathy)`).

What complications can occur if this condition becomes severe?

If left untreated, mitral valve prolapse can be life-threatening. Here are some of the complications that can occur:

• Your heart starts to beat irregularly (`(Atrial fibrillation)`), which can sometimes lead to a stroke.
• Your heart is unable to pump enough blood to the body (`(Heart failure)`).
• The pressure in the arteries that carry blood from the heart to the lungs increases (`(Pulmonary hypertension)`).
• The heart may suddenly stop beating (`(Sudden cardiac arrest)`).

How does a doctor accurately diagnose this disease?

The first thing a doctor does is examine you thoroughly. There:

• They ask about your symptoms and other illnesses you have.
• They will check your vital signs, such as your blood pressure and pulse rate.
• They check the body for swelling (edema).
• A stethoscope will listen to your heart and lungs. If you hear an abnormal heart sound (a ``heart murmur''), it could be a sign of valve disease.

Then the doctor will order several tests to find out more information.

What tests are done to diagnose this disease?

Doctors often do a test called a transthoracic echocardiogram (TTE) to look for a leak in your mitral valve. This is a painless, noninvasive scan. It can check for a leak in your valve and for other problems with the structure or function of your heart. If your doctor wants to get a closer look at your valve, they may also do a test called a transesophageal echocardiogram (TEE).

Your doctor may order additional tests to determine the severity of your condition and plan treatment. These include:

• A `(CT scan)` of the heart (`(Cardiac CT scan - computed tomography scan)`).
• An `(Echocardiogram)` performed while exercising (`(Exercise stress echocardiogram)`).
• A heart MRI (magnetic resonance imaging) test.
• Cardiac catheterization, also known as cardiac cath or coronary angiogram.

What are the treatments for mitral valve leakage?

There is no such thing as a "one-size-fits-all" treatment. Doctors will tailor treatment to your needs. They will consider the following:

• The type of mitral regurgitation you have (primary or secondary).
• The severity of your condition. It can be described as stage A, B, C, D. D is the most severe stage.
• The risk of complications from surgery.

Your doctor will explain your treatment options, including their pros and cons. Be sure to ask questions if there's anything you don't understand. That way, you can make an informed decision.

Mitral regurgitation is the second most common reason for heart valve surgery in Western countries (the first is aortic valve stenosis).

There are several treatment options:

Mitral valve repair (`(Mitral valve repair)`)

Options for this:

• Open-heart surgery.
• Heart surgery using small incisions (`(Minimally invasive heart surgery)`).
• Mitral transcatheter edge-to-edge repair (TEER): In this procedure, the doctor uses a long, thin tube (catheter) to attach a small clip to your valve leaflets. This clip helps the leaflets close properly.

Mitral valve replacement (`(Mitral valve replacement)`)

Options for this:

• You will be given an open-heart surgery (`(Open-heart surgery)`) and a new mitral valve will be inserted. This valve may be made of metal (`(mechanical)`) or made of animal tissue (`(bioprosthetic)`).
• Transcatheter mitral valve replacement (TMVR) is a minimally invasive procedure.

Treatment for heart failure

This may include:

• Medicines like diuretics .
• Implantation of a left ventricular assist device (LVAD).
• Palliative care.

Treatment for atrial fibrillation

This may include:

• Medicines.
• Procedures.
• Surgery.

What will my health be like if I develop this disease?

Many factors affect how your health will be. For example:

• your age.
• Do you have symptoms and how severe they are?
• The severity of the leak.
• Can your valve be repaired?
• The extent of the damage to your heart.

Because all of these factors affect your condition, your situation may be different from others. Your doctor is the best person to know exactly how your condition will progress. He or she knows you, your medical history, and the treatment options that can help you.

How quickly does this mitral valve leak increase?

For some people, this progresses slowly. For others, it may progress more quickly. Your doctor will tell you how your condition is, how often you should see a doctor for a check-up, and how this condition may affect your lifespan.

Are there ways to prevent this disease?

You may not always be able to prevent this. However, you can work with your doctor to reduce your risk of developing various heart diseases. Your doctor will review your medical history and risk factors and give you advice that is right for you. In general, you can do the following:

• Completely stop using tobacco products (like cigarettes, beedis).
• Exercise regularly.
• Eat heart-healthy foods.
• Maintain a healthy weight for you.
• See a doctor at least once a year for a checkup and identify any problems quickly.
• If you often have a sore throat along with a fever, or if you have had rheumatic fever in the past, see a doctor.

How do I take care of myself?

It's always good to control your blood pressure and eat plenty of fruits and vegetables.

Participating in a cardiac rehabilitation program (`(Cardiac rehab)`) after heart valve surgery can help you start exercising again.

If you have a new prosthetic valve, you will need to take medication afterward. You will need to take anticoagulants (blood thinners) for the rest of your life to prevent blood clots. You will also need to take antibiotics to prevent endocarditis (infection of the lining of the heart) before dental procedures and certain upper respiratory tests.

When should I see the doctor? What questions should I ask?

Your doctor will tell you how often you should see your doctor for check-ups. The more severe your condition is, the more often you will need to see your doctor and have imaging tests (such as scans). It is important to keep all your appointments . This will allow your doctor to monitor your condition and recommend appropriate treatment.

Here are some questions you can ask your doctor to learn more about your condition:

• How severe is my mitral valve leak?
• What treatment options do you recommend for me?
• What are the advantages and disadvantages of the treatments?
• What lifestyle changes do I need to make?
• How often do I need to see a doctor or have imaging tests?
• What will my future health be like?

Something to think about

It's normal to feel overwhelmed when you hear that you have heart disease. But as you learn more about your condition and get treatment, you'll be able to move forward again soon.

Mitral valve prolapse affects everyone differently, so your doctor will tailor your treatment to your needs. Don't hesitate to share your questions and concerns with your doctor. He or she will help you understand more about how your heart works. He or she will also recommend treatments and lifestyle changes that will help you stay healthy and live the best possible quality of life.

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