Mitral Valve Disease: Causes, Symptoms & Treatment Options

What Is Mitral Valve Disease?

Mitral valve disease refers to conditions that prevent the mitral valve from functioning properly, disrupting normal blood flow through the heart. The mitral valve acts as a one-way door between your heart's left atrium and left ventricle, ensuring blood flows in the correct direction.

According to the CDC, mitral valve disease occurs when the valve either does not open wide enough (stenosis) or does not close tightly enough (regurgitation). These problems can develop gradually over years or occur suddenly due to infection or injury. Some people are born with mitral valve abnormalities, while others develop mitral valve disease later in life due to various factors, including rheumatic fever, infections, or age-related changes.

The severity of mitral valve disease varies significantly between individuals. Mild cases may cause no symptoms and require only monitoring, whilst severe cases can lead to serious complications such as congestive heart failure if left untreated.

How Does the Mitral Valve Work?

• Location and structure: The mitral valve sits between your left atrium (upper chamber) and left ventricle (lower chamber), featuring two leaflets connected to supporting cords
• Opening phase: When your left atrium fills with oxygen-rich blood from your lungs, the valve opens completely to allow blood flow into the ventricle
• Closing phase: As your left ventricle contracts to pump blood to your body, the valve snaps shut to prevent backward flow
• Pressure regulation: Proper valve function maintains healthy blood pressure levels throughout your cardiovascular system
• Coordination: The mitral valve works in perfect timing with your aortic valve to ensure efficient blood circulation

What Are the Main Types of Mitral Valve Disease?

1. Mitral regurgitation: The most common form, where blood leaks backwards from the ventricle to the atrium due to incomplete valve closure
2. Mitral stenosis: The valve opening becomes narrowed, restricting blood flow from the atrium to the ventricle
3. Mitral valve prolapse: One or both valve leaflets bulge backwards into the atrium during heart contraction
4. Mixed mitral valve disease: A combination of stenosis and regurgitation affecting the same valve
5. Primary versus secondary disease: Primary disease affects the valve structure itself, whilst secondary disease results from other heart conditions.

What Causes Mitral Valve Disease?

Mitral valve disease develops when the valve leaflets, supporting cords, or surrounding heart structures become damaged, thickened, or stretched. The underlying cause significantly influences both symptoms and treatment approaches.

Several factors can lead to mitral valve disease:

• Rheumatic heart disease remains a leading cause globally, resulting from untreated streptococcal throat infections that trigger rheumatic fever, causing valve scarring and fusion

• Age-related degeneration affects valve tissue over time, leading to mitral valve prolapse or calcification, particularly common in people over 60

• Coronary artery disease and heart attacks can damage the papillary muscles that support the mitral valve, causing secondary regurgitation

• Cardiomyopathy or heart failure stretches the heart chambers, pulling the valve leaflets apart and preventing proper closure

• Infective endocarditis occurs when bacteria infect the valve, potentially destroying leaflets or supporting structures

• Congenital abnormalities present from birth, such as cleft mitral valve or abnormal chordal attachments

• Connective tissue disorders like Marfan syndrome affect the proteins that give valve tissue its strength and flexibility

• Previous chest radiation for cancer treatment can cause progressive valve thickening and calcification years later

What Are the Risk Factors?

• Age: Risk increases significantly after age 60 due to natural valve deterioration
• Family history: Genetic predisposition to valve problems, especially mitral valve prolapse
• Previous rheumatic fever: Even decades-old episodes can cause progressive valve damage
• Heart disease history: Including coronary artery disease, heart attack, or cardiomyopathy
• High blood pressure: Long-term hypertension can strain and damage heart valves
• Infections: History of endocarditis or conditions increasing infection risk
• Connective tissue disorders: Such as Marfan syndrome or Ehlers-Danlos syndrome
• Gender: Women show higher rates of mitral valve prolapse
• Chest radiation: Previous cancer treatment involving chest radiation

What Are the Symptoms of Mitral Valve Disease?

Many people with mild mitral valve disease initially have no symptoms, and the condition is discovered during routine examinations when doctors hear heart murmurs. However, as the disease progresses, your heart and lungs must work harder to maintain circulation.

Mitral valve disease symptoms typically develop gradually:

• Shortness of breath during everyday activities or when lying flat, often the first noticeable symptom

• Fatigue and weakness that seem disproportionate to your activity level, particularly during exercise

• Heart palpitations or irregular heartbeats, especially if you develop atrial fibrillation

• Chest discomfort or pressure, particularly during physical exertion

• Persistent cough that may produce blood-tinged sputum in advanced cases

• Swelling in legs, ankles, or feet, indicating fluid retention from heart failure

• Dizziness or lightheadedness, especially when standing quickly or during exercise

• Frequent respiratory infections as fluid backs up into your lungs

How Do Symptoms Differ by Type?

• Mitral regurgitation: Often causes fatigue, shortness of breath, and palpitations; symptoms may develop gradually over years
• Mitral stenosis: Typically produces more dramatic shortness of breath, especially when lying down, plus frequent respiratory infections
• Mitral valve prolapse: Many people experience no symptoms, though some report chest pain, anxiety, or palpitations unrelated to exertion
• Mixed disease: Combines symptoms from both stenosis and regurgitation, often creating more complex presentations

When Should You See a Doctor?

You should seek medical attention if you experience persistent shortness of breath, especially if it worsens when lying down or wakes you from sleep. Don't ignore chest pain, particularly if accompanied by other symptoms like dizziness or palpitations. Any sudden onset of symptoms warrants immediate medical evaluation, as this might indicate acute valve damage requiring urgent treatment.

Regular check-ups become particularly important if you have risk factors for mitral valve disease or a family history of heart problems.

How Is Mitral Valve Disease Diagnosed?

• Physical examination: Includes listening for heart murmurs, checking for swelling, and assessing overall cardiovascular health
• Medical history review: Focusing on symptoms, family history, previous infections, and risk factors
• Blood tests: To check for signs of infection, inflammation, or other conditions affecting heart function
• Electrocardiogram (ECG): Records your heart's electrical activity to detect rhythm abnormalities
• Chest X-ray: Shows heart size and any fluid accumulation in the lungs

Imaging & Diagnostic Tests for Mitral Valve Disease

• Echocardiography: The gold standard test using sound waves to create moving pictures of your heart and valve function
• Transesophageal echocardiogram (TEE): Provides more detailed images by positioning the probe in your oesophagus

• Chest X-ray: Shows heart size, lung congestion, or calcium deposits on valves
• Cardiac catheterisation: Involves threading a thin tube through blood vessels to measure pressures and assess valve function directly

• Cardiac MRI: Offers detailed images of the heart structure and can quantify the severity of valve problems
• CT scanning: Sometimes used to evaluate valve anatomy and surrounding structures

• TMT (Stress test): Evaluates how valve disease affects your heart's ability to meet increased demands

• BNP (B-type natriuretic peptide, measured in EDTA plasma): Helps diagnose heart failure and asymptomatic left ventricular dysfunction

• Cardiac Profiles: Such as Cardiac Risk Profile, Cardiac Screen Profile - 1 and Cardiac Screen Profile - 2 support the monitoring of lipid profile, enzymes, and inflammatory markers

What Are Treatment Options?

Mitral valve disease treatment varies significantly depending on the type, severity, and your overall health status. Treatment goals focus on relieving symptoms, preventing complications, and maintaining quality of life.

Treatment approaches include:

• Watchful waiting for mild, asymptomatic disease with regular monitoring
• Medication management to control symptoms, prevent complications, and slow disease progression
• Lifestyle modifications, including diet changes and exercise recommendations
• Minimally invasive procedures such as balloon valvuloplasty or clip repair
• Surgical valve repair to restore normal valve function
• Valve replacement with mechanical or biological prosthetic valves when repair is not feasible
• Treatment of underlying conditions, such as blood pressure control or atrial fibrillation management

What Medications Are Used?

• Diuretics reduce fluid retention and lung congestion, particularly helpful for patients with congestive heart failure

• ACE inhibitors or ARBs lower blood pressure and reduce the workload on your heart

• Beta-blockers control heart rate and reduce symptoms in patients with mitral valve prolapse

• Anticoagulants prevent blood clots in patients with atrial fibrillation or mechanical valve replacements

• Antiarrhythmic medications help maintain a normal heart rhythm in patients with irregular heartbeats

• Antibiotic prophylaxis before dental procedures in high-risk patients to prevent infective endocarditis

Minimally Invasive & Surgical Procedures

1. Mitral valve repair: Surgeons fix the existing valve by reshaping leaflets, replacing supporting cords, or implanting rings to improve closure
2. Mitral valve replacement: Complete valve replacement with either mechanical or biological prosthetic valves
3. Transcatheter mitral valve repair (TMVR): Minimally invasive procedure using clips or other devices to improve valve function
4. Balloon valvuloplasty: Used primarily for mitral stenosis, in which a balloon catheter is inserted to widen the narrowed valve opening
5. Robotic-assisted surgery: Allows for smaller incisions and potentially faster recovery times

Can Mitral Valve Disease Be Prevented?

• Prevent rheumatic fever: Promptly treat strep throat infections with appropriate antibiotics to prevent rheumatic mitral valve disease
• Maintain good dental hygiene: Regular dental care prevents bacteria from entering your bloodstream
• Control blood pressure: Keep hypertension well-managed to reduce valve strain
• Manage other heart conditions: Properly treat coronary artery disease and prevent heart attacks

• Avoid intravenous drug use: Reduces risk of infective endocarditis
• Follow antibiotic prophylaxis: If recommended by your doctor before specific procedures

What Is the Outlook & Prognosis?

The prognosis for mitral valve disease varies significantly depending on the type, severity, and timing of treatment. Many patients with mild mitral valve prolapse live everyday lives without symptoms or complications. However, severe mitral regurgitation or stenosis can lead to heart failure, stroke, or sudden cardiac death without appropriate treatment.

Early detection and treatment dramatically improve outcomes.

Modern surgical techniques achieve excellent results, with most patients experiencing significant symptom improvement and normal life expectancy. Regular follow-up care ensures optimal long-term management and early intervention if conditions change.

Living With Mitral Valve Disease

• Regular medical follow-up: Attend scheduled appointments for monitoring disease progression and treatment effectiveness
• Exercise appropriately: Work with your healthcare team to develop a safe exercise program that maintains cardiovascular fitness
• Monitor symptoms: Keep track of any changes in your condition and report concerns promptly
• Medication adherence: Take prescribed medications consistently and understand their purposes and potential side effects
• Dietary modifications: Follow heart-healthy eating patterns, potentially including sodium restriction if you have fluid retention
• Stress management: Learn techniques to manage anxiety and stress, which can affect heart rhythm and blood pressure

Common Complications

• Congestive heart failure from prolonged valve dysfunction
• Atrial fibrillation causes irregular heart rhythms and increases stroke risk
• Stroke from blood clots forming in enlarged heart chambers
• Pulmonary hypertension from increased pressure in the pulmonary circulation
• Sudden cardiac death in severe, untreated cases
• Endocarditis recurrence in patients with previous infections
• Bleeding complications in patients taking anticoagulant medications

Conclusion

Understanding mitral valve disease empowers you to take control of your heart health through informed decision-making and appropriate medical care. Whether you're experiencing symptoms, have been recently diagnosed, or are managing long-term valve disease, remember that effective treatments are available to help you maintain an active, fulfilling life.

The key to successful management lies in working closely with your healthcare team, following treatment recommendations, and staying alert to changes in your condition. Modern medical advances—including sophisticated diagnostics and innovative treatment options—offer hope and improved outcomes for individuals with all forms of mitral valve disease. Regular monitoring, appropriate lifestyle modifications, and timely intervention when needed can prevent serious complications and preserve your quality of life.

At Metropolis Healthcare, we support your heart health journey with comprehensive diagnostic services designed around your needs. Our extensive portfolio of over 4,000 tests includes specialised cardiac assessments to help detect and monitor the progression of mitral valve disease. Through our network of 220+ laboratories and 10,000+ touchpoints across India, we bring advanced diagnostics directly to your home, ensuring convenience without compromising accuracy.

FAQs

What does mitral valve disease feel like?

Most people experience shortness of breath during activity, fatigue, heart palpitations, and sometimes chest discomfort. Symptoms often develop gradually and may initially occur only during exertion.

Is mitral valve disease curable?

While there is no cure for structural valve damage, effective treatments—including repair, replacement, and medications—can restore normal function and relieve symptoms.

How long can you live with mitral valve disease?

Life expectancy with mitral valve disease depends on severity and treatment. Mild cases may not affect lifespan, whilst severe disease requires intervention. With proper treatment, most patients live normal lifespans.

What are the risks of mitral valve surgery?

Mitral valve surgery risks include bleeding, infection, stroke, and anaesthesia complications. However, modern techniques have significantly reduced these risks, with most patients experiencing successful outcomes and symptom improvement.

When should I see a doctor for mitral valve symptoms?

Seek medical attention for persistent shortness of breath, chest pain, heart palpitations, or swelling in your legs. Don't delay if symptoms worsen or occur at rest.