MITRAL INCOMPETENCE (MITRAL REGURGITATION)
Mitral incompetence, mitral regurgitation, heart valve disease, rheumatic fever, heart murmur, cardiac failure, homeopathic treatment, valvular heart disease, cardiology, mitral valve prolapse
Definition
Mitral Incompetence, also known as Mitral Regurgitation, is a valvular heart disorder in which the mitral valve fails to close completely during ventricular systole. As a result, a portion of the blood flows back from the left ventricle into the left atrium, leading to volume overload and progressive dilation of the left atrium and ventricle.
Aetiology (Causes)
Mitral incompetence may be organic or functional:
Rheumatic heart disease – The most common cause, resulting from scarring and deformity of the valve leaflets and chordae tendineae.
Mitral valve prolapse – Degenerative or myxomatous changes lead to ballooning of the valve.
Ischemic heart disease – Papillary muscle dysfunction after myocardial infarction.
Infective endocarditis – Leads to perforation or destruction of valve leaflets.
Congenital malformations – Such as cleft mitral valve.
Functional incompetence – Due to left ventricular dilation secondary to hypertension or cardiomyopathy.
Trauma or collagen vascular disease – Can weaken valve structure.
History and Relation to Rheumatic Fever
Mitral incompetence often develops years after an episode of rheumatic fever, especially in patients who had rheumatic carditis in childhood or adolescence. The autoimmune inflammation damages the mitral valve apparatus, causing chronic leakage.
Patients may recall a history of sore throat, tonsillitis, or joint pains in childhood—classical signs of rheumatic infection due to Streptococcus pyogenes.
Clinical Features and Symptoms
The severity of symptoms depends on the degree of regurgitation and the adaptability of the heart.
Early Stages:
Often asymptomatic for years.
Mild fatigue and palpitations during exertion.
Progressive Stages:
Dyspnea (shortness of breath), initially on exertion, later even at rest.
Orthopnea (difficulty breathing while lying flat).
Paroxysmal nocturnal dyspnea (sudden night attacks of breathlessness).
Fatigue due to decreased cardiac output.
Palpitations, especially with atrial fibrillation.
Cough with blood-tinged sputum (hemoptysis) in advanced cases.
On Examination
General Examination:
May show signs of chronic heart failure — breathlessness, ankle swelling, cyanosis.
Pulse: Irregular in rhythm (if atrial fibrillation present).
Blood pressure: Normal or slightly low systolic; pulse pressure may be reduced.
Cardiac Examination:
Apex beat: Displaced downward and outward due to left ventricular enlargement.
Thrill: A systolic thrill may be felt at the apex.
Heart sounds:
First heart sound (S1) is soft or absent.
A pansystolic murmur is heard best at the apex, radiating to the axilla.
A third heart sound (S3) may be heard due to rapid ventricular filling.
Investigations
Electrocardiogram (ECG):
Shows left atrial enlargement, left ventricular hypertrophy, and sometimes atrial fibrillation.
Chest X-ray:
Enlarged left atrium and left ventricle; pulmonary congestion in advanced stages.
Echocardiography (ECHO):
Gold standard for diagnosis.
Reveals regurgitant flow, valve thickening, or prolapse.
Assesses severity (mild, moderate, severe).
Doppler Study:
Quantifies the degree of regurgitation and checks pulmonary pressure.
Cardiac catheterization:
Used when surgical correction is considered.
Differential Diagnosis
Aortic regurgitation – Murmur heard at base and along left sternal border.
Tricuspid regurgitation – Murmur increases on inspiration.
Mitral stenosis – Has a diastolic murmur.
Functional (flow) murmurs – Seen in anemia or hyperthyroidism.
Complications
Atrial fibrillation
Congestive cardiac failure
Pulmonary hypertension
Infective endocarditis
Thromboembolism
Sudden cardiac death (rare in chronic stable cases)
Treatment
Allopathic Management
Medical Treatment:
Diuretics (Furosemide, Spironolactone) to relieve pulmonary congestion.
ACE inhibitors / ARBs (Enalapril, Losartan) to reduce afterload.
Beta-blockers for heart rate control.
Anticoagulants (Warfarin) if atrial fibrillation present.
Antibiotic prophylaxis before dental or surgical procedures to prevent infective endocarditis.
Surgical Treatment:
Mitral valve repair (preferred when feasible).
Mitral valve replacement (mechanical or bioprosthetic valve) in severe, symptomatic cases.
Homeopathic Remedies
Homeopathic treatment focuses on constitutional healing and symptom management under the guidance of a qualified practitioner.
Common remedies include:
Digitalis purpurea: For weak pulse, palpitations, and slow, irregular heartbeat.
Cactus grandiflorus: Sensation as if the heart is constricted or grasped by an iron band.
Crataegus oxyacantha: Acts as a cardiac tonic; improves myocardial efficiency.
Strophanthus hispidus: Supports cardiac muscle in dilated heart conditions.
Arsenicum album: For breathlessness and restlessness in failing heart.
(Note: Homeopathic medicines should be used under medical supervision.)
Ayurvedic and Lifestyle Support
Arjuna (Terminalia arjuna): A well-known cardiac tonic improving cardiac tone and strength.
Ashwagandha and Brahmi: Enhance cardiac and mental endurance.
Dietary advice: Low salt, low fat, high fiber diet.
Regular light exercise: Walking and breathing exercises under physician’s guidance.
Avoid: Tobacco, alcohol, excessive stress.
Prognosis
The prognosis depends on the cause and degree of regurgitation.
Mild cases can remain stable for years, while severe untreated cases may lead to heart failure or arrhythmias. Early diagnosis and timely surgery can ensure near-normal life expectancy.
References
World Health Organization (WHO). Cardiovascular Diseases Fact Sheet, 2023.
American Heart Association. Mitral Valve Regurgitation Guidelines, 2022.
National Heart, Lung, and Blood Institute (NHLBI). Heart Valve Disease Overview.
Indian Council of Medical Research (ICMR). Rheumatic Heart Disease Control in India, 2021.
Cleveland Clinic Journal of Medicine. Diagnosis and Management of Mitral Regurgitation, Vol. 91, 2023.
Disclaimer
This article is for educational purposes only and should not replace professional medical consultation. Always seek advice from a qualified healthcare provider before starting any treatment, including homeopathic or Ayurvedic remedies.
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