Chronic and acute mitral valve regurgitation

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Chronic and acute mitral valve regurgitation

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Although mitral valve regurgitation (MR) has one definition, it really represents two distinct conditions: chronic and acute. These two types of MR differ in terms of onset, causes, and treatment. Most notably, acute MR usually requires immediate medical attention and surgery, whereas chronic MR may be managed over the course of many years.

Chronic mitral valve regurgitation

Chronic MR is a long-term condition that generally worsens over time. It is quite common to have no symptoms when you first develop it (the asymptomatic phase), because the heart compensates for the regurgitation. At this time, your condition may not be serious and you generally feel good. However, even during this time, MR is doing irreversible damage to your heart.

Because of this ongoing damage, your doctor may suggest surgery before you develop symptoms. Although it may be difficult to think about surgery when you feel well, not having surgery could lead to heart failure. On the other hand, surgery to correct MR is a major procedure that has its own risks and complications. Talk to your doctor about the benefits of surgery, along with your heart's condition, your age, and your overall health.

The symptomatic phase of chronic MR begins when your heart begins to weaken. A variety of medications is available to treat MR as it progresses and to prevent complications. In the advanced stages of the disease, surgery is generally necessary.

Acute mitral valve regurgitation

Acute MR occurs when the mitral valve or one of its supporting structures ruptures suddenly, creating an immediate overload of blood and pressure around the valve. Unlike chronic MR, your heart does not have time to compensate for the increased volume and pressure of blood. If left untreated, acute MR often is fatal. If you cannot have surgery immediately, you will be given medications.

Acute MR is accompanied by noticeable symptoms. As your heart tries to increase the volume of blood pumping, a rapid heartbeat (tachycardia) may result. Acute MR also can lead to other irregular beatings of your heart (arrhythmias), fluid buildup in your lungs (pulmonary edema), and critically low blood output by your heart (cardiogenic shock), all of which can cause death.

**Differences between chronic and acute mitral valve regurgitation**
Difference	Chronic MR	Acute MR
Onset	Gradual	Sudden
Needs immediate medical attention?	Rarely	Almost always
Explanation	The heart makes up for the gradual backward flow of blood through the mitral valve by pumping even more blood out of the left ventricle.	The mitral valve’s normal functioning is suddenly disrupted. The heart is unable to adjust to the regurgitation.
Common causes	Mitral valve disease that damages the mitral valve flaps over time. Rheumatic fever Coronary artery disease Connective tissue disorder Prosthetic valve	Rupture of the chordae tendineae, which support the mitral valve. This is most commonly seen in middle-aged and older men and can be caused by an infection in the heart (infective endocarditis) or trauma, often from a surgical procedure. Rupture of the muscle (papillary) surrounding the valve. This may be caused by a heart attack (myocardial infection) or trauma, often from surgical procedures. Problems with a prosthetic valve
Symptoms	No symptoms OR No symptoms, followed by gradual development of: Fatigue Shortness of breath Chest pain Syncope Palpitations	Symptoms come on suddenly. Presents many of the same symptoms as chronic MR Buildup of fluid in the lungs (pulmonary edema), which can cause difficulty breathing, restlessness, shortness of breath that is worse when lying down, rapid heart rate, and a cough that sometimes produces foamy pink fluid
Diagnostic clues	Mild murmur Echocardiogram shows enlarged left atrium and ventricle. Mildly abnormal mitral valve	A new murmur Echocardiogram shows no change in the left chambers of the heart. Ruptured chordae or papillary muscle on echocardiogram Fluid in the lungs (pulmonary edema)
Treatment	Vasodilators to help widen blood vessels and help the heart pump more efficiently Surgery to repair or replace the valve	Emergency surgery

Credits

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Author	Robin Parks, MS
Editor	Kathleen M. Ariss, MS
Associate Editor	Pat Truman, MATC
Primary Medical Reviewer	E. Gregory Thompson, MD - Internal Medicine
Specialist Medical Reviewer	Stephen Fort, MD, MRCP, FRCPC - Interventional Cardiology
Last Updated	March 27, 2008

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Last updated:	March 27, 2008
Author:	Robin Parks, MS
Reviewed By:	E. Gregory Thompson, MD - Internal Medicine, Stephen Fort, MD, MRCP, FRCPC - Interventional Cardiology
Editors:	Kathleen M. Ariss, MS, Pat Truman, MATC

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