Before explaining what mitral regurgitation is, we must know that the heart is an organ that is composed of four compartments (two atria and two ventricles), which contain blood at a specific moment of the heartbeat until it is expelled to the next cavity of the heart. heart and later, towards the rest of the organism.
The left atrium sends blood to the left ventricle. Between both chambers is the mitral valve, which works like a gate, which closes preventing blood from returning to the left atrium at the moment in which the left ventricle drives blood from the heart to the rest of the body (moment known as ventricular systole).
What is mitral regurgitation?
When the mitral valve loses its ability to function and does not close properly, then unexpected regurgitation (returns) of blood flow to the left atrium, known as mitral regurgitation (or mitral incompetence).
Why does mitral regurgitation occur?
There are many causes that affect mitral valve function and promote mitral regurgitation. Among these causes are: ischemic heart disease (after a myocardial infarction), valve prolapse, infective endocarditis that has affected the mitral valve, rheumatic disease, calcification of the valve and cardiomyopathies (associated with different causes such as viruses, steroid use, alcohol abuse, Chagas disease, among others).
These disorders cause the valve to not close properly, allowing the bloodstream to leak into the right atrium.
What are the symptoms of mitral regurgitation?
The symptoms of mitral regurgitation occur because when the blood returns to the right atrium, the pressure in the blood vessels that go from the lungs to the heart increases, which is why:
· Difficulty breathing (dyspnea).
· Need to sleep sitting up because dyspnea appears at the moment of lying down completely (orthopnea)
· Feeling tired.
· Chronic cough.
· Palpitation sensation, when atrial fibrillation is generated associated with atrial dilation.
In the consultation, the doctor detects a characteristic mitral murmur, in addition, he can in some cases auscultate respiratory aggregates due to the presence of pulmonary edema.
Mitral regurgitation and everyday life
The symptoms of mitral regurgitation depend on the degree of severity in which this condition occurs. On occasion, mitral regurgitation can be mild and patients are completely asymptomatic.
In the case of moderate mitral regurgitation, the symptoms appear as the patient performs activities such as jogging, climbing stairs, climbing hills, and exercising, these types of actions being increasingly limited as the severity increases. In cases of mitral regurgitation severe, the patient can have difficulty breathing even at rest meeting, so that the tasks of everyday life are affected.
How is mitral regurgitation diagnosed?
When the doctor suspects that there is mitral regurgitation, he should request the evaluation of a cardiologist, who will indicate the performance of a transthoracic echocardiogram (ultrasound that allows evaluating the characteristics and functions of the cavities, large vessels and valves of the heart).
The echocardiogram can determine defects in some structures of the mitral valve and measure regurgitation of blood flow to the left atrium.
If the cardiologist estimates it, he can perform a more specific study called a transesophageal echocardiogram in which he can evaluate structures of the valve that he could not determine with the transthoracic measurement; generally in very severe cases that warrant surgical repair.
Other studies that are requested are chest x-ray, electrocardiogram, and cardiac catheterization. The latter only if ischemic heart disease (heart attack or angina) is suspected.
How is mitral regurgitation treated?
Treatment will depend on the condition that is causing the mitral regurgitation and its degree of severity, in addition to the other associated diseases that the patient presents.
When the patient presents signs of pulmonary congestion, diuretics should be used and in cases of atrial arrhythmia, antiarrhythmic drugs such as beta-blockers (such as carvedilol and bisoprolol) and digitalis (such as digoxin) should be used, adjusted to each patient.
For their part, some patients merit the placement of a resynchronizer to improve symptoms. Patients with high blood pressure should continue antihypertensive treatment, usually with calcium blockers (such as lecardipine or amlodipine).
In this sense, surgery is indicated in symptomatic patients with severe chronic mitral regurgitation accompanied by left ventricular dysfunction, and in symptomatic patients with acute mitral regurgitation.
Valve repair is also indicated in asymptomatic patients with preserved ventricular function but with acute atrial fibrillation or pulmonary hypertension. It is extremely important that if you have this condition, go to the cardiologist in order to define the treatment that best suits your situation.
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