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Valvular Regurgitation and the Enlarged Heart

Valvular regurgitation, or valve regurgitation, occurs when one of the heart's valves fails to close completely, allowing blood to leak back through the valve. Valvular regurgitation forces the heart to work harder to pump sufficient blood through the heart chambers. Left untreated, valve regurgitation can result in an enlarged heart and eventual heart failure.

Valvular regurgitation can affect any of the four heart valves—the aortic, tricuspid, mitral or pulmonary valves. However it is the mitral valve, located between the left atrium and left ventricle, that is particularly susceptible to valve regurgitation. After age 55, twenty percent of echocardiogram results show evidence of mitral valve regurgitation.

Valvular Regurgitation Symptoms

Valvular regurgitation is often asymptomatic—no noticeable symptoms are present. Symptoms of valve regurgitation may not become apparent for decades, by which time regurgitation may have already produced an enlarged heart or other damage.

Symptoms of valvular regurgitation vary depending on which heart valve is affected. Symptoms common to most cases of valve regurgitation include:

coughing
dizziness
exhaustion
fatigue
heart palpitations
lightheadedness
shortness of breath when exercising
shortness of breath when lying down.

Additional symptoms may develop depending on the heart valve affected.

Mitral Valve: An increase in nighttime urination sometimes accompanies mitral valve regurgitation.
Aortic Valve: Symptoms of angina (chest pain) and syncope (fainting) can accompany aortic valve regurgitation.
Tricuspid Valve: Regurgitation of the tricuspid valve may result in ascites (fluid in the abdomen) and edema (swelling of the extremities). An enlarged liver or enlarged spleen may also develop in response to tricuspid valve regurgitation.
Pulmonary Valve: Cyanosis (bluish-looking skin caused by insufficient oxygen in the blood) is a symptom of pulmonary valve regurgitation.

Acute Aortic Valve Regurgitation

Most symptoms of valvular regurgitation take years to appear. A notable exception is acute aortic valve regurgitation, a life-threatening form of valvular regurgitation characterized by swift symptom onset.

Symptoms of acute aortic valve regurgitation include rapidly developing shortness of breath, rapid heartbeat and lightheadedness. This variety of valvular regurgitation requires immediate emergency medical treatment, usually involving emergency open-heart surgery to repair or replace the defective aortic valve.

Causes of Valvular Regurgitation

Rheumatic fever is often responsible for valvular regurgitation. Rheumatic fever is a complication of strep throat that causes inflammation of the heart valves. Damage from inflammation may cause heart valves to function incorrectly, resulting in either valvular regurgitation or valvular stenosis (a failure to open completely).

Rheumatic fever is now rare in the US and other developed countries, but continues to be a significant cause of valvular regurgitation in less developed countries. Older Americans with valvular regurgitation often contracted rheumatic fever as children.

Other causes of valvular regurgitation include:

aging
atherosclerosis
birth defects
connective tissue diseases
endocarditis
enlarged heart
hypertension (high blood pressure)
mitral valve prolapse
syphilis (on rare occasions)
tumors
use of the now banned diet supplement Fen-Phen for longer than four months.

Diagnosis of Valvular Regurgitation

Valvular regurgitation can be detected with a stethoscope as a distinct heart murmur. Noticeable pulsations in the chest and neck suggest the presence of an enlarged heart. Unusual lung noises, including a crackling sound known as rails, also indicate possible valve regurgitation.

Once valvular regurgitation is suspected, the condition may be confirmed by a number of diagnostic tests including echocardiogram, cardiac-Doppler study, MRI or cardiac catheterization.

An Enlarged Heart and Valvular Regurgitation Complications

Valvular regurgitation forces the heart to work harder to transport blood. Over time, the heart muscles expand to compensate for regurgitation, leading to an enlarged heart. An enlarged heart deforms the heart chambers and causes further damage to the heart valve, increasing the severity of valvular regurgitation. Left untreated, valvular regurgitation and an enlarged heart can result in heart failure.

Untreated valvular regurgitation increases the risk of strokes, blood clots and fatal heart arrhythmias (irregular heart rhythms). Valvular regurgitation also increases the risk of endocarditis, a bacterial infection of the heart lining that can cause further heart valve damage.

Treatment of Valvular Regurgitation

Valvular regurgitation treatment varies depending on which valve is damaged. Mitral valve regurgitation is often controlled by monitoring symptoms and, when necessary, treating symptoms with medication. Severe valvular regurgitation symptoms may indicate a need for open heart surgery to repair or replace the defective heart valve.

Medication used to treat valvular regurgitation can include:

antiplatelet medications to lower blood clot risk
anticoagulants to reduce the risk of blood clots
digitalis to strengthen the heart beat
anti-arrythmic medication to control heart rhythm
prophylactic antibiotics prior to dental or medical surgery to lower the risk of endocarditis
vasodilators to reduce heart strain.

People with symptomatic valvular regurgitation are advised to avoid strenuous exercise or competitive activities. Quitting smoking, avoiding oral contraceptives and eating a heart-healthy, low sodium diet are recommended. Regular dental hygiene is also important, as bacteria from the mouth can enter the bloodstream and cause endocarditis.

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