“Why Is Ankle Swelling A Symptom Of Mitral Regurgitation?” Asks Andrea
By Adam Pick on May 8, 2013
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?”
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.
Keep on tickin!