Mitral Valve Regurgitation: Exams And Tests

Content provided by Healthwise

Exams and Tests

Chronic mitral valve regurgitation (MR) can be difficult to diagnose. It is a "quiet" condition and often has no symptoms, or your symptoms may be confused with other heart-related conditions.

Chronic MR is often diagnosed during a routine checkup or a visit to the doctor for another condition. A heart murmur may be the first sign leading your doctor to the diagnosis, especially if you have no other symptoms.

Acute MR causes sudden symptoms and is much less common than chronic mitral valve regurgitation. It is usually diagnosed while you are already hospitalized or in the emergency room.

When your doctor suspects you have MR, he or she will discuss your medical history, do a physical examination, and likely order tests to determine the severity of the regurgitation.

Medical history and physical examination

To determine the severity of your MR, your doctor will ask you to describe any symptoms you are experiencing, such as shortness of breath, fatigue, or chest pain.

During the physical exam, the doctor will take your blood pressure, check your pulse, listen to your heart and lungs, look at the veins in your neck (jugular veins), and check your legs and feet for fluid buildup (edema).

After the medical history and physical examination, your doctor may order a variety of tests, such as an echocardiogram or chest X-ray. Your doctor will want to know:

• The size of your left ventricle as your heart finishes contracting (end systolic dimension, or ESD). In chronic MR, the left ventricle expands as it tries to accommodate the larger amount of blood that flows back into the chamber. The larger the left ventricle, the more advanced the MR. This applies only to the chronic form of the disease because the left ventricle does not expand in acute MR. MR may also develop in response to dilation of the left ventricle that occurs for some other reason.
• Your heart's ejection fraction. This shows the efficiency of your heart. Ejection fraction is the amount (percentage) of blood pumped out of the ventricle compared to the total amount of blood in the left ventricle at rest. The smaller the ejection fraction, the harder your heart must work to pump a sufficient volume of blood.

Echocardiogram

Echocardiogram (sometimes called an echo or echocardiography) is a type of ultrasound examination. It is the best noninvasive method of determining the severity of MR. Also, echocardiography can help determine whether the heart's main pumping chamber (left ventricle) is functioning properly, whether any structural problems exist that may affect the mitral valve, and whether the chambers of the heart are enlarged.

Another form of ultrasound called Doppler echocardiogram (Doppler ultrasound) may be done to evaluate the severity of MR.

If you have severe MR or symptoms, your doctor may recommend an echocardiogram every 6 to 12 months. Your doctor will use the echocardiogram to see if your MR has gotten worse.

Electrocardiogram

An electrocardiogram (EKG, ECG) is a test that measures the electrical signals that control the rhythm of your heartbeat. It may be used to:

• Evaluate abnormal heart rhythms.
• Determine whether there may be enlargement of the heart's chambers.
• Look for signs of a possible previous heart attack.

Although the EKG may reveal abnormal electrical activity in the heart, further testing is often still needed to determine the severity of MR and to confirm whether MR is causing enlargement of the left ventricle. The result of an EKG is often normal in people with mild MR.

Chest X-ray

A chest X-ray may be done to evaluate heart size and to assess symptoms of MR, such as shortness of breath. Calcium deposits on the heart valves may occasionally be seen on a chest X-ray.

Cardiac catheterization

Cardiac catheterization (also called coronary angiogram), a test that evaluates your heart and heart (coronary) arteries, may be done to:

• Confirm the severity of mitral valve leakage seen on an echocardiogram.
• Check for coronary artery disease before valve repair or replacement surgery. If severe blockage is seen in the coronary arteries, the blockage may be corrected during the same open-heart surgery to correct the damaged valve.

Tests for acute mitral valve regurgitation may include one or more of the tests used for chronic MR as well as a transesophageal echocardiogram. In this test, a device that sends sound waves is passed down the esophagus to take clearer pictures of the heart.

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