The phrase “leaky heart” is a common way to describe heart valve regurgitation or insufficiency, a medical condition where one or more of the heart’s four valves do not close properly. This allows blood to flow backward, reducing the efficiency of the heart’s pumping action. Regurgitation can affect any of the valves: the mitral, aortic, tricuspid, or pulmonary. While mild leakage may not cause noticeable problems, severe regurgitation strains the heart over time, forcing the muscle to work harder and potentially leading to serious health complications.
Understanding Heart Valve Regurgitation
The heart contains four one-way valves that regulate the direction of blood flow through its chambers and out to the body and lungs. These valves act like finely tuned doors, opening to allow blood through and then snapping shut to prevent backflow.
Regurgitation occurs when a valve’s leaflets, or flaps, fail to seal completely when they close. This mechanical failure allows blood to leak backward into the previous heart chamber. For example, in mitral regurgitation, blood leaks back into the upper left chamber (atrium) instead of moving entirely into the lower left chamber (ventricle).
This backward flow reduces the amount of blood pumped forward to the rest of the body. Simultaneously, the chamber receiving the backflowing blood experiences an increase in volume and pressure. Over time, the heart muscle must enlarge and thicken to compensate for the inefficiency, a response that can eventually lead to muscle weakening.
Common Underlying Causes
The reasons a heart valve might fail to close tightly are varied, often involving damage to the valve structure itself or changes in the surrounding heart muscle.
One frequent cause is age-related wear and tear, known as myxomatous degeneration. This is where the valve tissue weakens and stretches over decades, often leading to mitral valve prolapse where the leaflets bulge backward during contraction, preventing a proper seal.
Infections can also severely compromise valve integrity. Infective endocarditis occurs when bacteria attach to the valve and erode the tissue. Another infectious cause is rheumatic fever, a complication of untreated strep throat, which can cause scarring of the valve leaflets years after the initial illness.
Conditions that strain the heart muscle can cause functional or secondary regurgitation, even if the valve tissue is healthy. This occurs when the heart’s main pumping chamber (the ventricle) enlarges due to high blood pressure or damage from a heart attack. As the ventricle widens, the supporting ring of tissue stretches, pulling the leaflets apart and creating a gap that allows leakage.
Recognizing the Physical Symptoms
Symptoms of heart valve regurgitation result from the heart’s reduced pumping efficiency and fluid backup. Shortness of breath (dyspnea) is common because the backward flow of blood creates pressure that backs up into the lungs. This breathlessness is often noticed during physical exertion or when lying flat (orthopnea).
Chronic fatigue and weakness are frequently reported because the leaky valve reduces the amount of oxygenated blood reaching the body’s tissues. The heart attempts to compensate for this reduced output by beating harder or faster, which may be felt as palpitations or an irregular heartbeat.
Fluid retention, appearing as swelling (edema) in the ankles, feet, or abdomen, is another physical manifestation. This develops because the inefficient heart cannot effectively return blood from the extremities. A physician often detects a heart murmur, a distinct whooshing sound caused by the turbulent blood flow leaking backward through the faulty valve.
Diagnosis and Management Options
The process of identifying heart valve regurgitation begins with a physical examination, where a doctor listens for the characteristic heart murmur. The definitive diagnostic tool is the transthoracic echocardiogram (TTE), an ultrasound of the heart. This non-invasive test uses sound waves to create detailed images of the heart chambers and valve structure. The echocardiogram employs Doppler technology to visualize the direction and speed of blood flow, allowing clinicians to measure the severity of the backward leak. Supporting tests, such as an electrocardiogram (EKG) or a chest X-ray, may also be used.
Management strategies range from careful monitoring to immediate surgical intervention, depending on the severity of the leak and symptoms. For mild cases, the approach is watchful waiting, coupled with regular echocardiograms. Lifestyle modifications, such as managing blood pressure and maintaining a heart-healthy diet, are recommended to minimize strain.
Medication is used to manage symptoms and reduce the heart’s workload. Diuretics help reduce fluid retention and lung congestion. Drugs like beta-blockers or ACE inhibitors can help lower blood pressure and lighten the burden on the heart muscle. These treatments aim to delay the progression of heart failure.
For severe regurgitation, an interventional procedure is necessary, especially when symptoms are present or the heart muscle shows damage. Valve repair is generally the preferred option, as it preserves the patient’s own tissue and often results in better long-term outcomes than replacement. Repair techniques involve tightening the valve ring or reconnecting torn support structures.
If the valve is too damaged for repair, replacement is performed using either a mechanical valve (requiring lifelong blood thinners) or a biological valve (made from animal tissue). Minimally invasive procedures, such as transcatheter techniques like the MitraClip, are available for certain patients, allowing repair to be performed via a catheter inserted through a blood vessel, avoiding open-heart surgery.