7 Key Symptoms of Mitral Valve Regurgitation You Should Know

Mitral valve regurgitation, also known as mitral regurgitation or mitral insufficiency, is a heart condition where the mitral valve doesn’t close properly, causing blood to flow backward into the left atrium. This backward flow can range from mild mitral regurgitation to severe cases, and understanding the symptoms is crucial for early detection and management.

Many people with trace mitral regurgitation or mild forms may not experience any symptoms initially. However, as the condition progresses, various signs can emerge that indicate the heart is working harder to compensate for the inefficient valve function. Recognizing these mitral regurgitation symptoms early can help you seek appropriate medical care and prevent complications.

In this comprehensive guide, we’ll explore the key symptoms associated with mitral valve regurgitation, what causes this condition, and answer common questions to help you better understand this cardiac disorder.

1. Fatigue and Weakness

One of the most common symptoms of mitral valve regurgitation is persistent fatigue and general weakness, particularly during physical activity. This occurs because your heart isn’t pumping blood as efficiently as it should, meaning your body’s tissues and organs aren’t receiving adequate oxygen-rich blood.

Patients often describe feeling:

• Unusually tired even after adequate rest
• Difficulty completing daily activities that were previously easy
• Need for frequent breaks during routine tasks
• Reduced exercise tolerance

This fatigue tends to worsen gradually as the regurgitation becomes more severe. In mild mitral regurgitation, fatigue may only be noticeable during strenuous activities, but as the condition progresses, even minimal exertion can leave you feeling exhausted. The body is essentially working overtime to compensate for the inefficient blood flow, leading to this overwhelming sense of tiredness.

2. Shortness of Breath (Dyspnea)

Shortness of breath is a hallmark symptom of mitral regurgitation and can manifest in several ways. When the mitral valve leaks, blood backs up into the lungs, causing fluid accumulation and making it harder to breathe comfortably.

This symptom typically presents as:

• Exertional dyspnea: Difficulty breathing during physical activity or exercise
• Orthopnea: Shortness of breath when lying flat, often requiring multiple pillows to sleep comfortably
• Paroxysmal nocturnal dyspnea: Sudden breathlessness that wakes you from sleep
• Dyspnea at rest: In severe cases, breathing difficulty even during rest

The severity of breathlessness often correlates with the degree of regurgitation. People with trace mitral regurgitation may never experience breathing problems, while those with moderate to severe regurgitation may find themselves gasping for air after climbing stairs or walking short distances. This symptom should never be ignored, as it indicates that fluid is accumulating in the lungs due to the heart’s inability to pump effectively.

3. Heart Palpitations

Heart palpitations are sensations where you become acutely aware of your heartbeat, which may feel irregular, rapid, or unusually forceful. In mitral valve regurgitation, palpitations occur as the heart attempts to compensate for the inefficient valve by beating faster or harder.

Patients commonly describe palpitations as:

• A fluttering sensation in the chest
• Feeling like the heart is racing or pounding
• Skipped or extra heartbeats
• A “flip-flopping” feeling in the chest

These palpitations may occur sporadically or become more frequent as the condition worsens. They can be particularly noticeable during rest or when lying down at night. While palpitations can be alarming, they’re often the body’s way of signaling that the heart is under stress. In some cases, mitral regurgitation can lead to atrial fibrillation, an irregular heart rhythm that increases the risk of stroke and other complications, making it essential to report any heart rhythm abnormalities to your healthcare provider.

4. Swelling in the Lower Extremities (Edema)

Swelling in the feet, ankles, and legs is a common symptom when mitral regurgitation becomes more severe and the heart’s pumping efficiency declines significantly. This swelling, known medically as peripheral edema, occurs because blood isn’t being circulated effectively throughout the body, causing fluid to accumulate in the lower extremities due to gravity.

Characteristic features of this swelling include:

• Progressive swelling that worsens throughout the day
• Pitting edema (when you press on the swollen area, an indentation remains temporarily)
• Tight-fitting shoes by the end of the day
• Swelling that may improve slightly after elevating the legs or overnight rest
• In advanced cases, swelling may extend to the abdomen (ascites)

The presence of edema typically indicates that the heart failure component of mitral regurgitation has developed, meaning the heart is struggling significantly to maintain adequate circulation. This symptom warrants prompt medical evaluation, as it suggests the condition has progressed beyond the mild stage.

5. Chest Discomfort or Pain

While chest pain isn’t as common in mitral regurgitation as in some other heart conditions, some patients do experience chest discomfort. This can manifest differently from the classic chest pain associated with coronary artery disease.

The chest sensations may include:

• A feeling of pressure or heaviness in the chest
• Vague discomfort rather than sharp, severe pain
• Discomfort that may worsen with physical exertion
• A sensation of fullness or tightness

It’s important to note that any chest pain or discomfort should be evaluated by a healthcare professional, as it can indicate various cardiac issues. In mitral regurgitation, chest discomfort may result from the heart working harder to compensate for the leaky valve, or it could indicate coexisting coronary artery disease. Never dismiss chest pain as insignificant, as it could be a warning sign requiring immediate medical attention.

6. Lightheadedness and Dizziness

Feeling lightheaded, dizzy, or even fainting can occur in mitral valve regurgitation, particularly when the condition is moderate to severe. These symptoms result from inadequate blood flow to the brain because the heart isn’t pumping efficiently enough to maintain proper circulation.

These symptoms may present as:

• Dizziness upon standing (orthostatic hypotension)
• Feeling faint during or after physical exertion
• Brief episodes of lightheadedness throughout the day
• In severe cases, actual fainting spells (syncope)
• Difficulty concentrating or mental fogginess

Lightheadedness can be particularly concerning because it increases the risk of falls and injuries. If you experience frequent dizzy spells or have fainted, it’s crucial to inform your doctor immediately, as these symptoms may indicate that your brain isn’t receiving adequate oxygenated blood. Your healthcare provider may need to adjust your management strategy or investigate whether the regurgitation has worsened.

7. Persistent Cough

A chronic cough, particularly one that’s worse when lying down or during the night, can be a symptom of mitral regurgitation. This occurs when blood backs up into the lungs (pulmonary congestion), causing fluid accumulation that irritates the airways and triggers the cough reflex.

The cough associated with mitral regurgitation often has these characteristics:

• Dry or minimally productive (though sometimes produces pink-tinged or frothy sputum in severe cases)
• Worse at night or when lying flat
• Not responsive to typical cough medications or cold remedies
• May be accompanied by wheezing or a feeling of chest congestion
• Persistent despite absence of respiratory infection

Many people initially attribute this cough to allergies, asthma, or a lingering cold, which can delay proper diagnosis. However, a cardiac cough has distinct features: it typically doesn’t respond to cough suppressants and is positional, meaning it changes with body position. If you have a persistent cough that seems unrelated to respiratory illness and worsens when lying down, it’s worth discussing with your doctor to rule out cardiac causes like mitral regurgitation.

Main Causes of Mitral Valve Regurgitation

Understanding what causes mitral valve regurgitation can help identify risk factors and potentially prevent or slow progression of the condition. The causes can be broadly categorized into degenerative, functional, and other specific conditions:

Degenerative Causes

• Mitral Valve Prolapse: The most common cause in developed countries, where the valve leaflets bulge back into the left atrium
• Age-related degeneration: Natural wear and tear of the valve over time
• Myxomatous degeneration: Weakening of the valve tissue, often genetic

Functional Causes

• Heart muscle disease (cardiomyopathy): Enlargement or weakening of the heart muscle can prevent proper valve closure
• Previous heart attack: Damage to the heart muscle supporting the valve
• Ischemic heart disease: Reduced blood flow affecting heart muscle function

Other Causes

• Rheumatic fever: Particularly common in developing countries, this can scar and damage the valve
• Endocarditis: Infection of the heart valve
• Congenital heart defects: Born with abnormal valve structure
• Connective tissue disorders: Conditions like Marfan syndrome or Ehlers-Danlos syndrome
• Medications: Certain drugs, though rare, can cause valve problems
• Radiation therapy: Previous chest radiation can damage heart valves
• Trauma: Chest injury affecting the heart

Prevention Strategies

While not all cases of mitral valve regurgitation can be prevented—particularly those caused by genetic factors or congenital abnormalities—there are several strategies that may reduce your risk or slow progression:

Prevent Rheumatic Fever

• Promptly treat strep throat infections with appropriate antibiotics
• Complete the full course of antibiotics as prescribed
• Seek medical attention for persistent sore throats

Maintain Heart Health

• Control blood pressure: High blood pressure puts extra strain on the heart and valves
• Manage cholesterol levels: Reduce risk of coronary artery disease that can lead to functional regurgitation
• Maintain healthy weight: Obesity increases cardiac workload
• Exercise regularly: Moderate physical activity strengthens cardiovascular health
• Eat a heart-healthy diet: Focus on fruits, vegetables, whole grains, and lean proteins

Prevent Endocarditis

• Practice good dental hygiene to prevent oral bacteria from entering the bloodstream
• Inform your dentist and doctors about any existing valve problems
• In some cases, your doctor may recommend preventive antibiotics before dental procedures
• Avoid intravenous drug use

Regular Medical Care

• Attend regular check-ups to monitor heart health
• If you have mild mitral regurgitation, follow your doctor’s monitoring schedule
• Manage underlying conditions like diabetes and heart disease
• Report new symptoms promptly

Lifestyle Modifications

• Quit smoking, as it damages blood vessels and the heart
• Limit alcohol consumption
• Manage stress through relaxation techniques
• Get adequate sleep

Frequently Asked Questions

Can you live a normal life with mitral valve regurgitation?

Yes, many people with mild to moderate mitral regurgitation live normal, active lives with proper monitoring and management. Trace or mild mitral regurgitation often requires no treatment other than regular check-ups. However, severe regurgitation may require lifestyle modifications or medical interventions. The key is working closely with your healthcare provider to monitor the condition and address any changes promptly.

What is the difference between mild and severe mitral regurgitation?

The classification is based on how much blood flows backward through the valve. Mild (or trace) mitral regurgitation involves minimal backflow and often causes no symptoms. Moderate regurgitation involves more significant backflow and may cause symptoms during exertion. Severe regurgitation means a large volume of blood flows backward, typically causing noticeable symptoms even at rest and potentially leading to heart failure if untreated. Your doctor determines severity using echocardiography and other diagnostic tests.

Does mitral regurgitation get worse over time?

Not always, but it can. Some people with mild mitral regurgitation remain stable for years or even decades. However, depending on the underlying cause, the condition can progress. Degenerative causes tend to worsen gradually over time, while functional regurgitation may improve if the underlying heart condition is treated. Regular monitoring through echocardiograms helps track any progression.

When should I see a doctor about mitral regurgitation symptoms?

You should see a doctor if you experience any symptoms such as unexplained fatigue, shortness of breath, heart palpitations, swelling in your legs or feet, persistent cough, or chest discomfort. If you have already been diagnosed with mitral regurgitation, contact your doctor if your symptoms worsen or new symptoms develop. Seek emergency care if you experience severe chest pain, extreme shortness of breath, or fainting.

Can exercise help with mitral valve regurgitation?

For people with mild to moderate mitral regurgitation, regular moderate exercise is generally beneficial and helps maintain cardiovascular health. However, the type and intensity of exercise should be discussed with your doctor, as recommendations vary based on severity. Those with severe regurgitation may need to limit strenuous activities. Never start a new exercise program without consulting your healthcare provider if you have this condition.

Is mitral valve regurgitation hereditary?

Some causes of mitral regurgitation have genetic components. Mitral valve prolapse, which often leads to regurgitation, can run in families. Connective tissue disorders like Marfan syndrome that affect the valve are also hereditary. However, many cases result from acquired conditions like rheumatic fever or heart attacks that aren’t directly inherited. If you have a family history of valve problems, inform your doctor so appropriate screening can be considered.

What tests diagnose mitral valve regurgitation?

The primary diagnostic tool is an echocardiogram (ultrasound of the heart), which visualizes the valve structure and measures blood flow. Your doctor may also use: a physical examination to listen for a heart murmur, chest X-ray to assess heart size and check for lung congestion, electrocardiogram (ECG) to evaluate heart rhythm, stress tests to see how your heart responds to exertion, and in some cases, cardiac MRI or CT scans for detailed imaging.

Can mitral regurgitation cause a stroke?

Mitral regurgitation itself doesn’t directly cause strokes, but it can increase stroke risk indirectly. The condition can lead to atrial fibrillation (irregular heart rhythm), which significantly increases stroke risk because blood clots can form in the heart chambers. Additionally, if the regurgitation is caused by endocarditis (valve infection), bacteria or debris can break off and travel to the brain. Managing the underlying condition and any associated arrhythmias is important for reducing stroke risk.

References:

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