MITRAL REGURGITATION
As opposed to mitral stenosis, regurgitation is more common in males, and is often noted more rapidly after the rheumatic fever episode. In this disorder, the valve opening is unable to be closed fully by the leaflets of the valve, and when the ventricle (lower chamber) contracts, the blood flows right back into the atrium from where it came, instead of into the aorta, where it belongs. This is a partial phenomenon, and symptoms are related to its severity. The ventricle must work overtime to compensate, and often hypertrophies or enlarges to impressive proportions in the process.
Symptoms
Fatigue is often the earliest symptom, but later shortness of breath occur. Fluid accumulation, sometimes noted as ankle swelling or edema may occur. Arrhythmias such as atrial fibrillation are sometimes noted. Finally, heart failure, shock and death may occur. It is noteable that many cases progress very slowly and never require intensive treatment. Survivals which are normal or near normal are commonplace.
Diagnosis
First suspected by its murmur on exam, mitral regurgitation is evaluated much like mitral stenosis, as described above.
Treatment
No treatment is necessary in many cases. The careful addition of appropriate drugs such as digoxin may be useful to control rhythm irregularities. Although restraint is indicated, in some cases the extent of symptoms warrants surgical valve replacement as discussed above. This is best done when symptoms are severe, but not so severe that the heart muscle is permanently damaged, as assessed by the cardiologist.
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