Is medication doing enough to manage your mitral regurgitation?
By ShareMD Connect
If you’ve been diagnosed with mitral regurgitation that’s caused by a problem in your ventricle (like damage due to a heart attack), and your condition is considered mild or moderate, it’s possible that your physician has put you on a treatment plan that includes medications.
These medications are used to relieve the symptoms of heart failure, prevent structural changes from happening to your heart, and reduce the amount of work your heart has to do to keep pumping blood around your body.
But sometimes, medication just isn’t enough. Especially if your mitral regurgitation is severe (in which case you should be considering a procedure or surgery), you may still have symptoms even after taking your medicines. Here’s what to do if that happens.
What medications can do for mitral regurgitation
Your doctor may put you on a specific regimen of medications even if you don’t have serious symptoms yet. It’s called Guideline Directed Medical Therapy (GDMT).
Guideline Directed Medical Therapy is a regimen of specific medications that aims to prevent further damage to your heart and relieve some symptoms of heart failure. A GDMT plan includes medications like:
- ACE/ARB inhibitors (ex: Lisinopril or Losartan)
- Beta-blockers (ex: Metoprolol)
- Diuretics (ex: Lasix. These can also be called “water pills”)
- Mineralocorticoid receptor antagonists (ex: Aldactone or Spironolactone)
More commonly, these medications are thought of as pills to lower blood pressure or heart rate and reduce the amount of fluid in your body.
Once you’re on these pills, your symptoms should improve, and you should be able to delay disease progression. But that doesn’t happen for everyone. Some people experience symptoms like heart palpitations, shortness of breath, and fatigue - even after being on a GDMT plan. So what if that’s happening to you?
What happens if you’re still having symptoms?
If you're still experiencing symptoms and your heart is still showing signs of remodeling itself - even after being on a GDMT plan - you may be a candidate for a procedure.
Procedures to repair the mitral valve are suitable for more than 95% of patients with degenerative mitral valve regurgitation.
There are two main approaches for mitral valve repair: open heart surgery or a minimally invasive procedure.
Heart valve specialists use specific criteria to determine the best option for you. They take detailed measurements of the left ventricle of the heart, look at the valve anatomy, and consider other factors like your age and if you have other co-occurring conditions. Once they have all of this information, your team will share it with you, and together you’ll make a decision.
Which choice is right for you is unique to your specific case, but having persistent symptoms after trying a GDMT approach could qualify you for the minimally invasive procedure TEER (also known as TVMr or MitraClip).
Sometimes symptoms change so slowly that you may not realize they’re getting worse, or you may get used to them and think “this isn’t a big deal.” But the reality is that ongoing symptoms of mitral regurgitation could be a sign that your disease has progressed. This is when it becomes important for you to listen to your body and take note of what it’s telling you.
It can be helpful to keep track of your symptoms in between appointments and write it down when you notice that something makes your symptoms better or worse. The more detailed you can be, the better your doctor can address the issue.
The most important thing to do if you’re still having symptoms is to talk to your heart valve team.