When you have a leaky heart — understanding mitral valve disease

When the heart is functioning normally, the mitral valve opens up to allow blood to flow from the left atrium to the left ventricle. But what happens when the valve leaks?

That’s what’s known as mitral valve disease, which occurs when the valve doesn’t work properly. While there are different types of mitral valve disease, the bottom line is that blood doesn’t flow normally through the valve. This can lead to a variety of health issues, varying in severity.

Dr. Megan Coylewright, Director of Structural Heart with the Erlanger Heart and Lung Institute, shares some perspective on the disease.

Q: What are the types of mitral valve disease?

When a person has mitral valve disease, the leaflets (like flaps) of the mitral valve are behaving abnormally. How they’re malfunctioning depends on the specific type of disease.

There are two main types of mitral valve disease. The most common type is when the valve leaks, called mitral valve regurgitation. Sometimes, this is due to the valve itself not working, such as in mitral valve prolapse. Other times, mitral valve regurgitation is from the valve being pulled apart and not closing all the way, such as after a heart attack. A leaky valve can damage the heart muscle.

If a person has mitral valve stenosis, on the other hand, the leaflets of the mitral valve thicken and may fuse together. This results in the valve being too tight, and not allowing enough blood to move forwards.

Q: What causes mitral valve disease?

The causes of mitral valve disease also vary depending on the type of disease. Mitral valve disease may be related to valve problems people are born with, or things that happen in life such as infections, radiation to treat cancer, or heart attacks. For many patients, mitral valve disease is simply due to aging.

Mitral valve regurgitation can be caused by a number of different heart problems, including a heart attack, rheumatic fever and endocarditis, which is an inflammation of the heart’s lining and valves. Other conditions that people are born with, such as mitral valve prolapse, may lead to regurgitation later in life.

Mitral valve stenosis is usually the result of scarring caused by rheumatic fever. This condition, which primarily occurs in childhood, results from the body’s response to a strep infection. If the mitral valve becomes inflamed due to rheumatic fever, it’s known as rheumatic heart disease. As people age, the more common cause of mitral stenosis is calcium build up.

Q: What symptoms will mitral valve disease cause?

In some cases, a person with mitral valve disease might not experience symptoms for a long period of time, even years. But a person with some form of the disease may experience:

  • Fatigue
  • Shortness of breath, even when lying down
  • Irregular heartbeat
  • Heart murmur
  • Swelling of the lower extremities
  • Cough
  • Lightheadedness

Tightness or discomfort in the chest may also occur, and symptoms may worsen when your body is stressed.

If you’re experiencing any of these symptoms, talk with your doctor. To diagnose mitral valve disease, a doctor will listen to your heart and potentially order imaging tests such as an echocardiogram (ultrasound of the heart).

Q: How is mitral valve disease treated?

Treatment for your condition will depend on the type of mitral valve disease, as well as the severity of the condition. In some cases, treatment may not even be necessary.

If treatment is needed, there are three main options — medications, a transcatheter procedure, and surgery.

While no medications can correct structural issues impacting the mitral valve, they can help ease symptoms.

A transcatheter procedure may include techniques to repair the valve, or a new valve to replace the old valve. Transcatheter means that the procedure is done in a minimally-invasive way, most often through a small tube (or catheter) placed in a vein in the leg leading to the heart. This is similar to how stents are placed in blocked arteries. Sometimes, a surgical procedure is the best option, either through small incisions (openings) in the chest, or through open-chest surgery that allows additional procedures to be performed at the same time (like bypass surgery).

Dr. Megan Coylewright evaluates patients with mitral valve disease and works with her multi-disciplinary team to ensure all options are presented to patients, and that patients are well-informed and included in making decisions that reflect what is most important to them. Dr. Coylewright performs transcatheter treatments for mitral valve disease, which most often require an overnight stay with rapid recovery. She trained at Johns Hopkins and Mayo Clinic, and brings experience in mitral valve procedures and clinical trials to Erlanger.

Think your symptoms may be associated with mitral valve disease? Book an appointment with Erlanger Structural Cardiology or call the Erlanger Heart and Lung Institute today at 423-778-5661.