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VALVE DISEASE : MITRAL

Why does Mitral Valve Disease occur ?

Mitral stenosis is caused by rheumatic fever which is now rare. Mitral regurgitation is also caused by rheumatic fever but there are other causes too. Diseases of the left ventricle may affect the valve by damaging the papillary muscles or altering the valve structure. Coronary disease may do this by causing a heart attack (myocardial infarction). Heart muscle disease (cardiomyopathy) can do the same. The cusps and chordae may deteriorate. This is called mitral valve prolapse. Infection on an abnormal mitral valve leads to a condition called infective endocarditis, which causes mitral regurgitation.

Treatment involved in Mitral Valve Disease

DIAGNOSIS The diagnosis is usually made at a medical examination, but tests such as chest x-rays and electrocardiograms (ECGs) are helpful. A test, called echocardiography, uses high frequency sound (ultrasound) to confirm the diagnosis and to judge how severe it is. The ultrasound comes from a microphone-like instrument, called a transducer, placed on the chest. The sound is reflected off the heart, back to the transducer, where it is converted into electrical impulses which are displayed as a TV picture. A similar method (Doppler) measures the blood flowing through the valve. It is a good way of measuring valve narrowing or leaking. If there is doubt about the severity, a cardiac catheterization is needed. This involves threading small tubes, called catheters, into the heart from blood vessels in the arm or groin. It is usually needed before an operation.

TREATMENT A mild valve abnormality needs no treatment. Breathlessness and ankle swelling need medicines called diuretics. These get rid of excess fluid that the kidneys retain and you pass more urine. If this treatment is not enough or if the heart is getting worse, valve surgery may be needed. A narrowed valve can sometimes be opened up and a leaking valve repaired, but frequently the valve must be replaced. If the heart rhythm changes to atrial fibrillation, treatment is needed to slow the heart. Usually, the drug digoxin is used. With atrial fibrillation, blood clots may form in the left atrium and travel to other parts of the body. They can cause damage such as strokes. The clotting risk must then be reduced with a blood-thinning medicine called warfarin. This treatment is called anticoagulation and it must be started either before, or immediately after the heart rhythm changes. Anticoagulation is often carried out for the rest of the patient's life.

During treatment of Mitral Valve Disease

Regular check-ups are important to make sure that the valve defect and its effect on the heart's pumping does not become dangerous. Should breathlessness occur or get worse, seek advice from your doctor. Treatment may need to be started or increased. It is especially important to seek help if you develop rapid palpitation. This may cause a sudden increase in breathlessness even at rest. If germs get into the bloodstream there is a risk of getting infection on an abnormal mitral valve. This is called infective endocarditis. Germs get into the blood through the gums after dental treatment or with other operations or investigations which use instruments passed inside the body. Prevention, by taking antibiotics, is better than cure. They are given, usually by mouth, an hour before dentistry or an operation. You should carry a card with all the details. Show it to any doctor or dentist treating you.

If Mitral Valve Disease is  left Untreated

If valve surgery is left too late it may not provide the expected improvement. If the heart rhythm is allowed to change without the right treatment there is a risk of blood clots causing strokes or other serious damage.

Effects on family of Mitral Valve Disease

You should be able to lead a relatively normal life, although you may have to take less exercise. This should not affect your family or friends unduly. An abnormal mitral valve will need medical supervision and regular medical check-ups. Remember to have antibiotics before dentistry or other surgery. Seek medical help quickly if the heart rhythm seems to change.