Member Case Study: Mitral Valve Regurgitation

author : AMSSM

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Initially most patients with mitral valve regurgitation have normal heart function. But when the heart starts to function poorly, patients will start to become more short of breath with exertion.

Member Question:

I was diagnosed with this condition a few years ago. I have an irregular heartbeat which sometimes palpitates, but it's really no issue. With the training, I've noticed that I am getting out of breath a lot during the day, which I wasn't expecting to happen, and also feeling weak every so often. I would have expected myself NOT to get breathless given that I'm getting fitter.

I've been on the net doing some research, and it seems that this RMV problem has these things as symptoms, and I'm unsure of whether or not I should be worrying about it or not. Is there any danger to training? I've never had anyone tell me that I shouldn't be training.
 

Answer:

Mitral Valve Regurgitation occurs when the mitral valve does not completely close, allowing blood to move backwards from the left ventricle, where blood is preparing to leave the heart, to the left atrium, the upper chamber of the left side of the heart. This extra blood is added to the blood already returning from the lungs, causing an increase in the amount of blood which is needed to be pumped forward during the next cycle to the left ventricle.

Over time, this overload of blood volume in the left atrium and ventricle causes the atrium heart to enlarge. The heart is able to function normally until enlargement and dilation occur to such an extent to that it is no longer able to work effectively.

Common causes of mitral valve regurgitation include mitral valve prolapse, when a portion of the valve balloons upwards toward the left atrium; a history of rheumatic fever which scars the heart valve, infection of the heart valves, and degeneration of the mitral valve leaflets. This common heart condition affects up to 20% of middle aged and older adults.

Initially most patients with mitral valve regurgitation have normal heart function as the heart is able to compensate for the excess blood. Initial symptoms of mitral valve regurgitation can include chest pain, palpitations (feeling of abnormal heart beats in the chest) and shortness of breath. As the left atrium dilates, the mitral valve will continue to leak more blood backwards, eventually causing the left atrium and ventricle to lose the ability to properly move blood towards the body. At this point when the heart starts to function poorly, patients will start to become more short of breath with exertion. Other signs of increased dilation of the left atrium include increasing palpitations and abnormal heart rhythms such as atrial fibrillation.

The heart’s function and the regurgitation of the valves are monitored by echocardiography, which is the use of sound waves to take a picture of the heart, its valves, and the flow of blood. Once the heart dilates to a certain extent, surgery is usually performed to replace or fix the heart valve, so as to prevent further damage of the heart chambers and improve the function of the heart.

Recommendations from the American College of Cardiology state athletes suffering from mitral regurgitation whom are in a regular (sinus) heart rhythm with normal function may exercise and compete. Once the heart is mildly enlarged but still functions normally, swimming should be limited. As the heart continues to enlarge and starts to function poorly, competitive sports are no longer allowed. If one is on blood thinners for atrial fibrillation, contact sports must be avoided.

Jeffrey Rosenberg MD, FAAFP, CAQ
Director-Sports Medicine Fellowship
Mountainside Family Medicine
Montclair, NJ

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date: November 19, 2006