“Why Is Ankle Swelling A Symptom Of Mitral Regurgitation?” Asks Andrea

I received a great question from Andrea about the symptoms of heart valve disease. In her note, Andrea writes to me, “Hi Adam, My 81-year old mom is experiencing symptoms due to mitral regurgitation. She is constantly short of breath and has ankle swelling. My question is… Why are her ankles swelling? Will that go away after surgery?”

Ankle Swelling Symptom Heart Valve Disease

To answer Andrea’s question, I contacted Dr. Adam Harmon, a cardiac surgeon from Sequoia Hospital in Northern California who has performed over 3,000 heart procedures and more than 400 valve operations. In his response to Andrea, Dr. Harmon explained:

Mitral regurgitation is usually described as mild, moderate or severe based on several criteria (usually symptoms and findings on a sonogram of the heart or echocardiogram). Mild and even moderate mitral regurgitation can be fairly well tolerated bay patients — so long as there aren’t other associated heart problems like a history of heart attacks, aortic valve disease or coronary artery disease.


Dr. Adam Harmon, Cardiac Surgeon

Since the heart is a pump, like any other, valves are needed to have it work efficiently and keep blood moving in one direction. There are inflow valves (mitral and tricuspid) and outflow valves (aortic and pulmonic) that serve a similar function to valves in the cylinders of a car — or a water pump on the filter in a pool. Very simply, only two things can go wrong with a valve. It won’t open easily or becomes clogged (medically we call this stenosis), 0r it won’t close appropriately (regurgitation). Regurgitation, in this case “Mitral Regurgitation”, allows blood to partially flow backwards towards the lungs and leads to a form of heart failure.

When this gets severe enough, three things start happening.

  • First, the heart is not working as efficiently as it should. This results from less blood being pumped forward and requiring a higher “workload” on the heart.
  • Second, the heart becomes “overloaded” because it is receiving the usual load of circulating blood from the lungs PLUS the blood that leaked back into the lungs. This can result in permanent damage to the heart. It is also one reason to fix the mitral valve as early as possible to avoid this.
  • Third, the back-up of blood into the lungs can cause the lungs to get soggy like a wet sponge. We call this pulmonary edema or congestive heart failure. It makes it hard for the lungs to exchange oxygen and carbon dioxide and therefore harder to breathe.

I hope this begins to explain why your mother is tired and short of breath. Fixing the mitral valve will obviously help in all these regards but there are a lot of individual variables that should be discussed with both your cardiologist and a heart surgeon.

Now, as far as the swollen ankles are concerned, heart failure causes this problem (edema) by an extension of what we have already talked about. Blood or edema fluid results from a backup from the mitral valve to the lungs to the right side of the heart to the venous system and finally to the legs and ankles. It is worse in the ankles as that’s where gravity takes it’s toll. This can also be somewhat helped with water pills like Lasix and leg elevation. It should get better with the correction of the mitral regurgitation but like everything else, the body takes time to heal and reach equilibrium.

Also, please know that there are other reasons why people have swollen ankles such as venous insufficiency in the legs or severe varicose veins, Obviously fixing mitral regurgitation won’t cure these other ills. I hope this proves helpful.  Respectfully, Adam Harmon, MD

Many thanks to Andrea for her question about the ankle swelling symptom of mitral regurgitation and a special thanks to Dr. Adam Harmon for helping us better understand the reasons why patients may experience this symptom.

To learn more about Dr. Harmon, please click here.

Keep on tickin!
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Adam Pick
Written by Adam Pick

Adam Pick is a patient, author of The Patient's Guide To Heart Valve Surgery and the founder of HeartValveSurgery.com.

To learn how Adam has helped millions of people with heart valve disease, watch Adam's video, subscribe to his free newsletter, or visit his Facebook, or Twitter pages.

  • GARY WALDRIP

    I HAD A AROTA VALVE AND MY DESCENDING AORTIC REPAIR IN JUNE 2005 AND JULY 2005 I HAD INFECTION ENTERNAL BLEEDING WAS AROUND MY HEART AND LUNGS EVER SINCE THEN I NEVER MADE A FULL RECOVERY IM ALWAYS IN PAIN ACROSS MY CHEST AND STOMACH ALL AT THE SAME TIME, IT FEELS LIKE TIGHTENESS AND PRESSURE SHARP PAIN WITH TINGLING AND NUMBNESS ALL AT THE SAME TIME MY LEGS FEET AND ANKLE ARE SWOLLEN TOO, what can I do ?

  • Art Beem

    Thanks ADAM,
    As a severe Mitro regurgitation repair patient ( December 10, 2012) I was told that although I did not have any symptoms yet, I would with time. I was a runner and halfway in shape which may have been why I did not have any symptoms.
    I am doing well thanks to the Cleveland Clinic…
    Thanks,
    Art Beem

  • william greene

    Dr. I have my left ankle swollen, and I have shortness of breath , my sleeping is 2 hours at night and I cat nap all day , also both of my shoulders will go numb for a minuet or so , and I can’t move my arms till it passes ?? I’m 61 yrs old and can’t walk a block without my legs just stiffing up so bad I have to sit down , I don’t have a family doctor , I’m on medicade & mediicare ins. and no doctors will take me because they don’t get paid enough $$$ from that insurance. So what can I do ? thank you

  • Pearl Brown-Waldrop

    My sister has been told that her aortic is weak and does not pump enough blood and therefore she does not get enough osygen. She is on 4 liters of oxygen per. day and is very weak, extremely pale and has difficulty breathing. No one has mentioned surgery to her. I am concerned as to whether we should be doing more. She had pnuemonia about 2/3 months ago. and was in hospital 1 wk. and released. She is diabetic, has gout and very obese. I don’t know what to do or if there is anything that can help her get well. She is 60yrs. old. I would appreciate any advice.

    Sincerely,
    Pearl

  • Sandra Sasso

    I have mitral valve regurgitation & venous insufficiency. I am short of breath & both swell badly. Saw a heart surgeon & he said I’m not in congestive heart failure yet & wants to see me back in 6 months. I am limited as to what I can do physically. Do I have to wait until I have congestive heart failure to have the surgery on my mitral valve? Will vein stripping help my venous insufficiency? I would like to return to a normal life again. All of this started in October 2013. Also, I will be 64 this year.

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