From the Guidelines
Mitral regurgitation symptoms include shortness of breath, fatigue, heart palpitations, and swollen ankles, and treatment depends on severity and symptoms, with the most recent guidelines from 2023 1 emphasizing the importance of individualized treatment approaches.
Symptoms of Mitral Regurgitation
- Shortness of breath
- Fatigue
- Heart palpitations
- Swollen ankles Many patients remain asymptomatic until the condition progresses, highlighting the need for regular monitoring and early intervention.
Treatment Options
Treatment depends on the severity of mitral regurgitation and the presence of symptoms.
- For mild cases, regular monitoring with echocardiograms every 1-2 years is typically sufficient without specific medication.
- Moderate to severe symptomatic cases may require medications such as ACE inhibitors (like enalapril 2.5-20mg daily), beta-blockers (such as metoprolol 25-200mg daily), or diuretics (furosemide 20-80mg daily) to manage symptoms and reduce heart strain.
- Severe cases often require surgical intervention, either through mitral valve repair (preferred when possible) or replacement with mechanical or biological valves, as recommended by the 2023 guidelines 1.
- Minimally invasive options like MitraClip may be suitable for high-risk surgical patients, as noted in the 2021 study 1.
Importance of Regular Follow-Up
Regular follow-up with a cardiologist is essential, and patients should report worsening symptoms immediately as they may indicate disease progression requiring treatment adjustment. The condition results from the mitral valve not closing properly, allowing blood to flow backward into the left atrium during contraction, which can lead to left atrial enlargement, pulmonary hypertension, and eventually heart failure if untreated, as discussed in the 2022 systematic review 1.
From the Research
Mitral Regurgitation Symptoms
- Symptoms of mitral regurgitation may include shortness of breath, fatigue, and decreased exercise capacity 2
- The presence of symptoms plays a central role in determining the timing of surgery in primary mitral regurgitation 2
- However, studies have shown a disconnect between the severity of mitral regurgitation and symptoms 2
Treatment Options
- The first-line treatment of severe functional mitral regurgitation consists of guideline medical therapy (GMT) and resynchronization therapy when indicated 3
- Valvular intervention may be considered in symptomatic patients despite GMT, and can be performed surgically or percutaneously 3
- MitraClip is a safe percutaneous procedure associated with symptoms improvement 3
- The use of ACE inhibitors and angiotensin receptor blockers (ACE-I/ARB) in patients with moderate-to-severe mitral regurgitation and preserved to mildly reduced left-ventricular ejection fraction significantly associates with improved clinical outcome 4
- ACE inhibitors and ARBs each reduced the regurgitant fraction, regurgitant volume, and left ventricular size by a modest degree in chronic primary mitral regurgitation 5
Relationship Between Symptoms and Regurgitant Severity
- The prevalence of symptoms does not increase with worsening mitral regurgitation volume (MRV) severity 2
- There is a trend for an increase in the prevalence of symptoms in patients with severe mitral regurgitation fraction (MRF) 2
- Having a MRV < MRF is a risk factor for the presence of symptoms 2
- Risk factors for symptoms include age, female sex, MRF, and having a MRV < MRF 2