8 Common Symptoms of Mitral Valve Disease You Should Know

Mitral valve disease is a condition affecting the mitral valve, which controls blood flow between the left atrium and left ventricle of your heart. When this valve doesn’t function properly—either not opening fully (stenosis) or not closing completely (regurgitation)—it can lead to various symptoms that impact your daily life. Understanding these symptoms is crucial for early detection and management of the condition.

Many people with mitral valve disease may not experience symptoms initially, especially in mild cases. However, as the condition progresses, specific signs begin to emerge. Recognizing these symptoms early can help you seek timely medical attention and prevent complications such as heart failure, stroke, or atrial fibrillation.

1. Shortness of Breath (Dyspnea)

Shortness of breath is one of the most common and noticeable symptoms of mitral valve disease. This occurs because the faulty valve causes blood to back up into the lungs, leading to fluid accumulation in the lung tissue—a condition known as pulmonary congestion.

Initially, you may notice breathlessness only during physical activities such as climbing stairs, exercising, or carrying heavy objects. As the disease progresses, breathing difficulties may occur even during light activities like walking short distances or performing daily household tasks. In advanced cases, shortness of breath can happen even while resting or lying flat in bed, a condition called orthopnea that may force you to sleep propped up with multiple pillows.

Some patients also experience paroxysmal nocturnal dyspnea—sudden episodes of severe shortness of breath that wake them from sleep, typically occurring a few hours after lying down. This symptom requires immediate medical attention as it indicates significant fluid buildup in the lungs.

2. Fatigue and Weakness

Persistent fatigue is another hallmark symptom of mitral valve disease. When your mitral valve doesn’t work properly, your heart cannot pump blood efficiently throughout your body. This means your muscles and organs don’t receive adequate oxygen-rich blood to function optimally, resulting in constant tiredness and weakness.

This fatigue is different from normal tiredness after a busy day. Patients often describe feeling exhausted even after adequate rest or sleep. You may find it difficult to complete activities you previously handled with ease, such as walking to the mailbox, doing light housework, or engaging in conversations. This type of fatigue can significantly impact your quality of life, affecting your ability to work, socialize, and enjoy hobbies.

The weakness may be particularly noticeable in your arms and legs, making even simple tasks feel overwhelming. This symptom tends to worsen gradually over time as the valve dysfunction progresses and your heart works harder to compensate for the inefficient blood flow.

3. Heart Palpitations

Heart palpitations—the sensation of your heart racing, fluttering, pounding, or skipping beats—are frequently reported by people with mitral valve disease. These sensations occur because the abnormal valve function can trigger irregular heart rhythms, particularly atrial fibrillation, a common complication of mitral valve disease.

You might describe palpitations as feeling like your heart is:

• Beating too fast or too hard
• Flipping or flopping in your chest
• Skipping beats or pausing momentarily
• Fluttering rapidly like a bird’s wings

These episodes can last from a few seconds to several minutes or even hours. They may occur randomly or be triggered by physical exertion, stress, caffeine, or certain body positions. While palpitations can be alarming, they’re not always dangerous. However, if accompanied by chest pain, severe shortness of breath, or fainting, you should seek immediate medical care as these could indicate a more serious heart rhythm problem.

4. Swollen Feet and Ankles (Edema)

Swelling in the lower extremities, particularly the feet, ankles, and sometimes the legs, is a common symptom that develops as mitral valve disease progresses. This happens when the heart’s inability to pump blood effectively causes fluid to accumulate in the body’s tissues, a condition called peripheral edema.

The swelling typically develops gradually and tends to worsen as the day progresses, especially if you’ve been standing or sitting for extended periods. You may notice that your shoes feel tighter by evening, or that pressing your finger into the swollen area leaves an indentation that takes time to disappear—this is called pitting edema.

In more severe cases, the swelling may extend up to the calves and thighs, and you might also notice swelling in the abdomen (ascites). The skin over swollen areas may feel tight, stretched, or shiny. This symptom often indicates that your heart is struggling to maintain adequate circulation, and fluid retention is occurring because blood is backing up in the veins returning to the heart.

5. Chest Discomfort or Pain

While chest pain is more commonly associated with coronary artery disease, people with mitral valve disease can also experience chest discomfort. This symptom occurs because the heart muscle must work harder to pump blood through the faulty valve, and in some cases, the enlarged heart chambers may put pressure on surrounding structures.

The chest discomfort associated with mitral valve disease can manifest in different ways:

• A feeling of pressure, tightness, or heaviness in the chest
• Sharp or stabbing pains, particularly when taking deep breaths
• A dull ache that persists for extended periods
• Discomfort that worsens with physical activity or when lying flat

It’s important to note that chest pain should always be evaluated by a healthcare professional, especially if it’s severe, sudden, or accompanied by other symptoms like sweating, nausea, or pain radiating to the arms, jaw, or back. These could indicate a heart attack or other serious cardiac emergency requiring immediate attention.

6. Dizziness and Lightheadedness

Feeling dizzy, lightheaded, or experiencing episodes of near-fainting (presyncope) or actual fainting (syncope) can occur with mitral valve disease. These symptoms result from inadequate blood flow to the brain due to the heart’s reduced pumping efficiency.

Dizziness associated with mitral valve disease may occur when you:

• Stand up quickly from a sitting or lying position (orthostatic hypotension)
• Engage in physical exertion or exercise
• Experience irregular heart rhythms that temporarily reduce blood flow to the brain
• Have episodes of rapid heartbeat

You might feel unsteady on your feet, experience a spinning sensation (vertigo), or feel as though you might pass out. Some people describe a feeling of being disconnected or “spaced out.” These episodes can be dangerous if they occur while driving, climbing stairs, or operating machinery. If you experience frequent dizziness or have fainted, it’s essential to inform your doctor, as this may indicate that your mitral valve disease is significantly affecting your circulation.

7. Heart Murmur

A heart murmur is an abnormal sound heard during a heartbeat cycle, typically detected by a doctor using a stethoscope during a physical examination. While a heart murmur is not a symptom you would notice yourself, it’s often the first sign that alerts healthcare providers to the possibility of mitral valve disease.

In mitral valve disease, the murmur is caused by turbulent blood flow through the abnormal valve. In mitral regurgitation, blood leaks backward from the left ventricle into the left atrium, creating a characteristic whooshing or swishing sound. In mitral stenosis, the narrowed valve opening causes blood to rush through forcefully, also producing an abnormal sound.

The characteristics of the murmur can help doctors determine:

• The type of valve problem (stenosis or regurgitation)
• The severity of the condition
• Which valve is affected
• Whether further diagnostic testing is needed

Many people with mitral valve disease first learn about their condition when a heart murmur is detected during a routine physical examination, even before they experience any noticeable symptoms. This makes regular check-ups important for early detection.

8. Persistent Cough

A chronic cough, particularly one that produces white or pink blood-tinged mucus, can be a symptom of mitral valve disease. This occurs due to fluid accumulation in the lungs (pulmonary congestion) caused by blood backing up through the faulty mitral valve.

The cough associated with mitral valve disease has several distinctive characteristics:

• It tends to worsen when lying down flat, which is why it may be more troublesome at night
• It may be accompanied by wheezing or difficulty breathing
• It often doesn’t respond to typical cough medications
• It may produce frothy or blood-tinged sputum in severe cases
• It persists for weeks or months without signs of infection

This type of cough is sometimes mistaken for bronchitis, asthma, or other respiratory conditions, which can delay proper diagnosis. If you have a persistent cough that doesn’t improve with standard treatments, especially if accompanied by other symptoms like shortness of breath or fatigue, it’s important to have your heart evaluated.

Main Causes of Mitral Valve Disease

Understanding what causes mitral valve disease can help you recognize risk factors and take appropriate preventive measures. The condition can develop from various underlying causes:

Mitral Valve Prolapse: This is one of the most common causes, where the valve leaflets bulge back into the left atrium during heart contraction. While many people with mitral valve prolapse have no symptoms, it can progress to significant regurgitation over time.

Rheumatic Fever: Although less common in developed countries due to effective antibiotic treatment of strep throat, rheumatic fever remains a leading cause of mitral valve disease globally. This inflammatory condition can damage the valve, typically causing stenosis years or decades after the initial infection.

Degenerative Changes: As we age, the mitral valve can undergo degenerative changes. Calcium deposits may accumulate on the valve, causing it to stiffen and narrow (calcific mitral stenosis). The valve tissue may also weaken and stretch, leading to regurgitation.

Infective Endocarditis: This serious infection of the heart’s inner lining and valves can damage the mitral valve structure, causing perforations in the leaflets or damage to the supporting structures.

Congenital Heart Defects: Some people are born with abnormal mitral valve structure, such as a valve with malformed leaflets or abnormal supporting structures. These congenital defects may cause problems from birth or develop into significant disease over time.

Coronary Artery Disease and Heart Attack: A heart attack can damage the muscles and structures that support the mitral valve, particularly the papillary muscles and chordae tendineae, leading to regurgitation.

Cardiomyopathy: Diseases that affect the heart muscle can cause the left ventricle to enlarge, stretching the mitral valve ring and preventing the leaflets from closing properly.

Connective Tissue Disorders: Conditions such as Marfan syndrome or Ehlers-Danlos syndrome affect connective tissue throughout the body, including the heart valves, making them more prone to dysfunction.

Prevention of Mitral Valve Disease

While not all cases of mitral valve disease can be prevented—particularly those caused by congenital defects or genetic conditions—there are several steps you can take to reduce your risk or prevent the condition from worsening:

Prevent Rheumatic Fever: Promptly treat strep throat infections with appropriate antibiotics. Complete the full course of antibiotics as prescribed, even if you feel better before finishing the medication. This is especially important for children and adolescents.

Maintain Good Oral Hygiene: Practice regular dental care by brushing twice daily, flossing, and having routine dental check-ups. Poor oral health can lead to bacterial infections that may spread to the heart valves, causing endocarditis.

Practice Heart-Healthy Lifestyle Habits:

• Eat a balanced diet rich in fruits, vegetables, whole grains, and lean proteins
• Limit saturated fats, trans fats, sodium, and added sugars
• Maintain a healthy weight through proper diet and regular exercise
• Exercise regularly as recommended by your doctor (aim for at least 150 minutes of moderate activity weekly)
• Avoid smoking and limit alcohol consumption
• Manage stress through relaxation techniques, meditation, or counseling

Control Risk Factors: Keep conditions like high blood pressure, high cholesterol, and diabetes under control through lifestyle modifications and, if necessary, medication as prescribed by your doctor. These conditions can contribute to heart disease and valve problems.

Regular Medical Check-ups: If you have a heart murmur or risk factors for heart disease, have regular check-ups with your doctor. Early detection of valve problems allows for monitoring and timely intervention before complications develop.

Antibiotic Prophylaxis When Needed: If you have certain types of heart valve disease or have had previous valve surgery, your doctor may recommend taking antibiotics before certain dental or medical procedures to prevent infective endocarditis. Follow your doctor’s recommendations carefully.

Seek Prompt Treatment for Infections: Don’t ignore symptoms of infection, particularly strep throat. Early treatment can prevent complications that might affect your heart valves.

Frequently Asked Questions

Can mitral valve disease be cured?

Mitral valve disease cannot typically be cured with medication alone, but it can be effectively managed. Mild cases may require only monitoring, while more severe cases might need surgical valve repair or replacement. The prognosis is generally good with appropriate treatment and regular follow-up care.

How is mitral valve disease diagnosed?

Diagnosis typically begins with a physical examination where your doctor listens for a heart murmur. Confirmation usually involves an echocardiogram (ultrasound of the heart), which can visualize the valve structure and function. Additional tests may include chest X-rays, electrocardiogram (ECG), stress tests, or cardiac catheterization.

Is mitral valve disease serious?

The seriousness depends on the severity and type of valve dysfunction. Mild cases may cause no symptoms and require only monitoring. However, severe or progressive disease can lead to serious complications including heart failure, atrial fibrillation, stroke, or pulmonary hypertension if left untreated. Regular medical follow-up is essential.

Can I exercise with mitral valve disease?

Many people with mild mitral valve disease can exercise safely and should maintain physical activity. However, the type and intensity of exercise should be discussed with your doctor based on your specific condition. Those with severe disease may need to limit strenuous activities. Your cardiologist can provide personalized recommendations for safe exercise.

Is mitral valve disease hereditary?

Some forms of mitral valve disease have a genetic component, particularly mitral valve prolapse and conditions associated with connective tissue disorders. If you have a family history of valve disease, inform your doctor, as you may benefit from screening. However, many cases occur without any family history.

What is the difference between mitral stenosis and mitral regurgitation?

Mitral stenosis occurs when the valve opening narrows, restricting blood flow from the left atrium to the left ventricle. Mitral regurgitation (or insufficiency) occurs when the valve doesn’t close properly, allowing blood to leak backward into the left atrium. Some people may have both conditions simultaneously.

How often should I see my doctor if I have mitral valve disease?

The frequency of follow-up visits depends on the severity of your condition. Mild cases may require check-ups every 2-3 years, while moderate to severe cases typically need evaluation every 6-12 months or more frequently. Your doctor will establish a monitoring schedule appropriate for your specific situation.

Can mitral valve disease get worse over time?

Yes, mitral valve disease can progress over time, especially if left unmonitored or untreated. This is why regular follow-up with your cardiologist is important. The rate of progression varies greatly between individuals. Some people remain stable for many years, while others may experience more rapid deterioration requiring intervention.

References:

• Mayo Clinic – Mitral Valve Disease
• American Heart Association – Mitral Valve Problems
• National Heart, Lung, and Blood Institute – Heart Valve Diseases
• Johns Hopkins Medicine – Mitral Valve Disease
• Cedars-Sinai – Mitral Valve Disease