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Heart and cardiovascular system

Mitral insufficiency, fatigue and palpitations among the main symptoms

January 1, 2018


Mitral insufficiency is a condition characterized by a malfunction of the mitral valve that separates the two chambers located on the left side of the heart. It is more common in old age, especially after the age of 75, and may also be associated with other heart diseases. We talk about this topic with Dr. Daniela Pini, doctor of internal medicine and cardiologist at Humanitas.


The mitral valve

The mitral valve is made up of a ring, two flaps and two papillary muscles (one for each flap), which connect the flaps to the ventricular myocardium via tendon cords and contract in systole to keep them “closed”. The mitral valve separates the left atrium from the left ventricle. The blood, which should normally be pumped from the left ventricle to the other organs through the aorta, returns in part to the atrium and from there to the lungs, because the valve does not close properly. This anomaly forces the heart to work overtime.

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Functional insufficiency

Mitral insufficiency can be of two types: primitive or functional. In the primitive form, the valve closure defect is due to an anatomical alteration of the structures that compose it. This form mainly affects older people. On the other hand, in functional mitral impairment, the valve is anatomically normal and the closure defect is secondary to localized or general contractile deficits of the left ventricle, such as ischemic heart disease or heart failure, Dr. Pini says. In the case of ischemic heart disease, hypoperfusion or heart attack affecting a papillary muscle prevents it from shrinking in systole, so the valve no longer closes properly.


In the case of heart failure associated with dilated cardiomyopathy – continues the specialist – the papillary muscles move away from each other and thus exert tension on the flaps that no longer close completely. Pharmacological therapy for heart failure by virtue of its favorable effects on left ventricular remodeling, can prevent or reduce mitral insufficiency.



Mitral insufficiency may be asymptomatic for a long time, especially if it progresses gradually. Symptoms that may suggest this condition are fatigue but also palpitations since this condition may be accompanied by atrial fibrillation. This form of arrhythmia can also worsen functional mitral insufficiency.


A further worsening element of the insufficiency is hypertension: “After aortic stenosis, mitral insufficiency is the second most frequent valve disease on a degenerative basis. It is typical of the elderly who are not usually ideal candidates for surgery to correct insufficiency. In this context, good hypertension control is important to reduce the amount of mitral insufficiency,” Dr. Pini concludes.

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