Mitral valve regurgitation

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Tests and diagnosis

By Mayo Clinic staff

If you have signs and symptoms of mitral valve regurgitation, you may need several diagnostic tests. But first your doctor will ask you about your general health, including your symptoms, prior tests and history of heart disease in your family.

Next, your doctor performs a physical examination. He or she listens to your heart sounds with a stethoscope. Mitral valve regurgitation usually produces a heart murmur. The murmur is the sound of blood leaking backward through the mitral valve.

With this information, your doctor decides which tests to request so that he or she can make a diagnosis and develop a treatment plan. You may be referred to a cardiologist — a doctor who specializes in the study of the heart and its function. Common tests used to diagnose heart valve problems include:

  • Echocardiogram. This test uses sound waves to produce an image of your heart. In an echocardiogram, sound waves are directed at your heart from a wand-like device (transducer) held on your chest. An echocardiogram helps your doctor get a close look at the mitral valve and how well it is — or isn't — working.
  • Chest X-ray. With an X-ray of your chest, your doctor can see the size and shape of your heart to determine whether the left ventricle is enlarged. A chest X-ray also allows your doctor to evaluate your lungs. Mitral valve regurgitation may result in blood backing up into your lungs, which causes congestion that's visible on an X-ray.
  • Electrocardiogram (ECG). In this test, adhesive patches with wires (electrodes) are attached to your skin to measure the electrical impulses given off by your heart. Impulses are recorded as waves displayed on a monitor or printed on paper. An ECG gives information about heart rhythm and, indirectly, heart size. With mitral valve regurgitation, the left ventricle may be enlarged and you may have heart rhythm irregularities (arrhythmias).
  • Holter monitor. A Holter monitor is a portable device that you wear to record a continuous ECG, usually for 24 to 72 hours. Holter monitoring is used to detect intermittent heart rhythm irregularities that may be associated with mitral valve regurgitation.
  • Transesophageal echocardiogram. This type of echocardiogram allows an even closer look at the mitral valve. The esophagus, the tube that runs from your throat to your stomach, lies close to your heart. In a transesophageal echocardiogram, a small transducer attached to the end of a tube is inserted down the esophagus. Because the esophagus lies close to your mitral valve, having the transducer there provides a clearer picture of valve structure and blood flow through it.
  • Exercise tests. Various exercise tests can help measure your tolerance for activity and check your heart's response to exertion (exercise).
  • Cardiac catheterization. In this procedure, a doctor threads a thin tube (catheter) through a blood vessel in your arm or groin into your heart. The catheter is used to deliver dye into the heart chambers and the blood vessels of your heart. The dye, appearing on X-ray images as it moves through your heart, gives your doctors detailed information about your heart and heart valves. Some catheters used in cardiac catheterization have miniature devices (sensors) at the tips that can measure pressure within heart chambers, such as the left ventricle.
Treatments and drugs Preparing for your appointment
References
  1. Gaasch WH. Overview of the management of chronic mitral regurgitation. http://www.uptodate.com/home/index.html. Accessed May 19, 2011.
  2. Otto CM. Etiology, clinical features, and evaluation of chronic mitral regurgitation. http://www.uptodate.com/home/index.html. Accessed May 19, 2011.
  3. Heart valve disease. National Heart, Lung, and Blood Institute. http://www.nhlbi.nih.gov/health/dci/Diseases/hvd/hvd_all.html. Accessed May 19, 2011.
  4. Heart valves. American Heart Association. http://www.americanheart.org/presenter.jhtml?identifier=4598. Accessed May 24, 2011.
  5. Bonow RO, et al. 2008 Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. 2008;118:523.
  6. Ferri FF. Mitral regurgitation. In: Ferri FF. Ferri's Clinical Advisor 2011. Philadelphia, Pa.: Mosby Elsevier; 2011. http://www.mdconsult.com/books/page.do?sid=1161209007&eid=4-u1.0-B978-0-323-05610-6..00022-6--s29555&isbn=978-0-323-05610-6&uniqId=247741773-5. Accessed May 19, 2011.
  7. Gaasch WH. Indications for and types of corrective surgery in severe chronic mitral valve regurgitation. http://www.uptodate.com/home/index.html. Accessed July 14, 2009.
  8. Schmitto JD, et al. Minimally invasive valve surgery. Journal of the American College of Cardiology. 2010;56:455.
  9. Lehr EJ, et al. Robotic cardiac surgery. Current Opinion in Anesthesiology. 2011;24:77.
  10. Nishimura RA. ACC/AHA guideline update on valvular heart disease: Focused update on infective endocarditis. Circulation. 2008;118:887.
DS00421 Sept. 15, 2011

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