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Alternative Names Return to topMitral insufficiency; Acute mitral regurgitation
Definition Return to top
Acute mitral regurgitation is a disorder in which the heart's mitral valve suddenly does not close properly, causing blood to flow backward (leak) into the upper heart chamber when the left lower heart chamber contracts.
See also: Chronic mitral regurgitation
Causes Return to top
Regurgitation means leaking from a valve that doesn't close all the way. Diseases that weaken or damage the valve or its supporting structures cause mitral regurgitation.
When the mitral valve doesn't close all the way, blood flows backward into the left upper heart chamber (atrium). This leads to a decrease in blood flow to the rest of the body. As a result, the heart may try to pump harder.
Acute mitral regurgitation may be caused by dysfunction or injury to the valve following a heart attack or infection of the heart valve (infective endocarditis). These conditions may rupture the valve or surrounding structures, leaving an opening for blood to move backwards.
Symptoms Return to top
Note: Symptoms may start suddenly.
Exams and Tests Return to top
The doctor may detect a thrill (vibration) over the heart when feeling (palpating) the chest area. An extra heart sound (S4 gallop) and a distinctive heart murmur may be heard when listening to the chest with a stethoscope. However, some patients may not have this murmur. If fluid backs up into the lungs, there may be crackles heard in the lungs.
Blood pressure is usually normal.
The following tests may be performed:
Treatment Return to top
Patients with severe symptoms may need to be admitted to a hospital for diagnosis and treatment.
Emergency surgery may be necessary for severe leakages, usually resulting from infection, heart attack, or rupture of a valve structure.
Medications may include:
If blood pressure cannot be controlled, an intra-aortic balloon pump (IABP) may be used to help move blood forward into the aorta, the main artery from the heart.
Outlook (Prognosis) Return to top
How well a patient does depends on the cause and severity of the valve leakage. Milder forms may become a chronic condition.
Acute mitral regurgitation can rarely be controlled with medications. Surgery is usually needed to repair or replace the mitral valve. See: Valve replacement.
Abnormal heart rhythms associated with acute mitral regurgitation can sometimes be deadly.
Possible Complications Return to top
When to Contact a Medical Professional Return to top
Call your health care provider if you have symptoms of mitral valve regurgitation, or if symptoms worsen or do not improve with treatment.
Call your health care provider if you are being treated for this condition and develop signs of infection, which include:
Prevention Return to top
Prompt treatment of disorders that can cause mitral regurgitation reduces your risk.
Any invasive procedure, including dental work and cleaning, can introduce bacteria into your bloodstream. The bacteria can infect a damaged mitral valve, causing endocarditis. Always tell your health care provider and dentist if you have a history of heart valve disease or congenital heart disease before treatment. Taking antibiotics before dental or other invasive procedures may decrease your risk of endocarditis.
References Return to topKarchmer AW. Infectious Endocarditis. In: Libby P, Bonow RO, Mann DL, Zipes DP, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. St. Louis, Mo: WB Saunders; 2007: Chap. 63. Update Date: 5/12/2008 Updated by: Larry A. Weinrauch, MD, Assistant Professor of Medicine, Harvard Medical School, and Private practice specializing in Cardiovascular Disease, Watertown, MA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.