Moderate Mitral Regurgitation

Introduction

Mitral regurgitation (MR) is a condition where the mitral valve—located between the left atrium and left ventricle of the heart—fails to close properly. This causes blood to flow backward into the left atrium instead of moving forward into the body.

Degrees of Mitral Regurgitation

MR is classified into four grades: 1. Mild – Small amount of regurgitation, often without symptoms. 2. Moderate – More significant leakage, which may lead to symptoms over time. 3. Severe – Large volume of blood regurgitating, leading to heart failure and other complications. 4. Critical – Requires urgent treatment.

Causes of Moderate Mitral Regurgitation

MR can be caused by several conditions, including: - Degenerative valve disease (e.g., mitral valve prolapse) - Rheumatic fever (past infection affecting the valve) - Endocarditis (infection of the heart valves) - Ischemic heart disease (damage due to heart attacks) - Cardiomyopathy (weakening of the heart muscle)

Symptoms of Moderate Mitral Regurgitation

Some people may not notice symptoms, but possible signs include: - Shortness of breath, especially on exertion - Fatigue - Heart palpitations - Swelling in the legs

Diagnosis

Moderate MR is often detected through: - Echocardiography (ultrasound of the heart) – The primary diagnostic tool. - Electrocardiogram (ECG) – Checks for irregular heart rhythms. - Chest X-ray – Helps assess the size of the heart. - Cardiac MRI – In some cases, for detailed imaging.

Treatment Strategies

Management of moderate MR depends on symptoms and overall heart function:

1. Monitoring & Lifestyle Changes

• Regular echocardiograms to track progression.
• Manage blood pressure.
• Avoid excessive salt intake to reduce fluid overload.
• Maintain an active lifestyle without overexertion.

2. Medications (if needed)

While no drug can directly fix a leaky valve, medications may be prescribed to manage symptoms: - Diuretics – Help reduce fluid overload in the lungs. - Beta-blockers – Control heart rate and reduce strain. - ACE inhibitors – Help lower blood pressure and stress on the heart.

3. Surgical & Interventional Options

Surgery is usually reserved for severe cases but may be considered if moderate MR worsens. Options include: - Mitral valve repair – Preserves the native valve. - Mitral valve replacement – Necessary in cases where repair is not feasible. - Transcatheter mitral valve procedures – A minimally invasive approach for certain patients.

Prognosis

Many patients with moderate MR can live normal lives with proper management. However, regular follow-ups with a cardiologist are important to monitor disease progression and prevent complications.

Source recommendations

1. American Heart Association (AHA) Guidelines on Valvular Heart Disease

1. https://www.ahajournals.org/doi/10.1161/CIR.0000000000000923
2. https://professional.heart.org/en/guidelines-and-statements
3. https://www.ahajournals.org/doi/10.1161/CIR.0000000000000932
4. https://www.heart.org/en/health-topics/heart-valve-problems-and-disease/heart-valve-disease-resources
5. https://pubmed.ncbi.nlm.nih.gov/33332149/

2. European Society of Cardiology (ESC) Guidelines on Management of Valvular Heart Disease

1. https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Valvular-Heart-Disease-Guidelines
2. https://academic.oup.com/eurheartj/article/43/7/561/6358470
3. https://pubmed.ncbi.nlm.nih.gov/34453165/
4. https://academic.oup.com/eurheartj/article/38/36/2739/4095039
5. https://www.jacc.org/doi/10.1016/j.jacc.2023.05.061