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Health condition

Mitral valve regurgitation, from a quiet murmur to a timed intervention.

A leaking mitral valve can sit quietly for years or demand urgent attention overnight. Echocardiography and a heart-team plan tell you which.

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A radiographer guides a patient onto the bed of an advanced 3 Tesla MRI scanner in a London imaging suite

Why trust this guide

  • 01

    Editorial team

    Written by our editorial team from the UK sources listed on each page.

  • 02

    Sourced from guidance

    Checked against ESC, BSE and AHA valve-disease guidance you can see at the end.

  • 03

    Current for 2026

    Reflects the heart team approach to timing, repair-first surgery and transcatheter options.

Key facts

Mitral valve regurgitation at a glance.

The essentials, in plain English - what it is, why it happens, and how it’s assessed and treated in the UK today.

  • What it is

    Backflow of blood from the left ventricle into the left atrium during systole, because the mitral valve fails to close fully.

  • Two broad types

    Primary (degenerative) disease of the valve itself, or secondary (functional) regurgitation from a stretched, dysfunctional left ventricle.

  • Leading cause

    Mitral valve prolapse is the commonest cause of primary MR in developed countries - see our separate guide on prolapse.

  • Classic finding

    A pansystolic murmur heard best at the apex, radiating to the axilla.

  • Gold-standard test

    Echocardiography - it defines the mechanism, severity, and the effect on the heart chambers and lungs.

  • Best surgical option

    Mitral valve repair, where anatomically feasible, generally outperforms replacement.

Why this guide matters

Two different diseases, one shared valve.

Primary and secondary mitral regurgitation look similar on a stethoscope but need different plans. The three points below shape everything else on this page.

  • The cause changes the plan

    A structurally abnormal valve (primary MR) is usually a surgical problem; a dilated, weak ventricle (secondary MR) is often a medical one first.

  • Symptoms lag behind severity

    Severe regurgitation can exist for years without symptoms - which is exactly why echocardiographic follow-up matters.

  • Repair beats replacement

    When the valve anatomy allows it, mitral repair generally gives better long-term outcomes than putting in a new valve.

How the diagnosis is made

From a murmur to a heart-team plan.

The steps a UK GP or cardiologist will normally follow, in order - so you know what to expect and why.

  1. 01

    Assessing

    History and examination

    Exertional breathlessness, fatigue, palpitations and a pansystolic murmur radiating to the axilla point towards mitral regurgitation.

  2. 02

    Assessing

    Electrocardiogram

    May show atrial fibrillation from left atrial stretch, or left ventricular hypertrophy in longstanding disease.

  3. 03

    Assessing

    Chest X-ray

    Can show left atrial and ventricular enlargement, and pulmonary congestion in more advanced cases.

  4. 04

    Confirming

    Transthoracic echocardiogram

    The gold-standard test - defines the mechanism, quantifies severity, and assesses ventricular size, function and pulmonary pressures.

  5. 05

    Confirming

    Transoesophageal echocardiogram

    A closer, more detailed view used selectively for pre-intervention planning, particularly before repair.

  6. 06

    Confirming

    Exercise testing or cardiac MRI

    Used selectively - exercise testing checks functional capacity in apparently well patients, cardiac MRI gives a more precise regurgitant volume.

  7. 07

    Deciding

    Heart team review

    Cardiology and cardiac surgery jointly decide on timing and type of intervention, weighing symptoms, severity and ventricular changes.

Typical timeline: a first murmur to an echo-confirmed diagnosis in a matter of weeks.

Symptoms

What mitral regurgitation actually feels like.

Often nothing at all for years, then a gradual creep of breathlessness and fatigue. And the features that mean it’s time to call for help immediately.

  • Often silent for years

    Mild to moderate regurgitation with gradual onset can produce no symptoms at all, sometimes for decades.

  • Exertional breathlessness

    Progressive dyspnoea on exertion is usually the first symptom as regurgitation becomes more significant.

  • Fatigue

    Reduced forward blood flow can leave people persistently tired, even with everyday activity.

  • Palpitations

    Left atrial enlargement predisposes to atrial fibrillation, felt as an irregular or racing heartbeat.

  • Pansystolic murmur

    The classic examination finding - a murmur heard throughout systole, loudest at the apex and radiating to the axilla.

  • Heart failure symptoms

    Orthopnoea, paroxysmal nocturnal dyspnoea and ankle swelling appear as regurgitation becomes severe.

  • Advanced or long-standing disease

    Reduced exercise tolerance and swelling that build up gradually over months or years, often minimised by patients.

  • Red flag - acute severe regurgitation

    Sudden pulmonary oedema and shock from chordal or papillary muscle rupture is a cardiac emergency.

Treatment

How mitral regurgitation is treated in the UK.

Medical therapy for functional disease, repair-first surgery where the anatomy allows, and transcatheter options for those at higher surgical risk.

  • Heart failure therapy

    For secondary/functional MR, optimising ACE inhibitors or ARNI, beta-blockers, MRAs and SGLT2 inhibitors can meaningfully reduce regurgitation by improving ventricular remodelling.

  • Rate control and anticoagulation

    When atrial fibrillation develops alongside mitral regurgitation, rate control and anticoagulation are added to the overall plan.

  • Mitral valve repair

    The preferred surgical approach wherever technically feasible, particularly for primary degenerative disease such as prolapse - generally better outcomes than replacement.

  • Mitral valve replacement

    Used when repair is not feasible, with either a mechanical or bioprosthetic valve, chosen with the patient’s age and lifestyle in mind.

  • Transcatheter mitral valve repair

    A percutaneous edge-to-edge clip procedure for patients at high surgical risk with suitable valve anatomy, particularly useful in functional MR.

  • Timing of intervention

    Even without symptoms, evidence of ventricular dilatation or dysfunction on echocardiogram can be enough reason to intervene early - a heart-team decision.

  • Emergency stabilisation

    Acute severe MR from papillary muscle rupture or chordal rupture needs urgent diuretics, vasodilators, inotropes or mechanical support, followed by emergency surgery.

  • Serial echocardiographic monitoring

    Patients managed conservatively are followed with regular echocardiograms to catch any change in severity or ventricular function early.

What this guide is based on

The sources behind every claim on this page.

UK and European national guidance and specialist society standards, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your GP or cardiologist knows your heart and history and can tell you which parts apply to you. If in doubt, get seen.

  • European Society of Cardiology (ESC) / EACTS. Guidelines for the management of valvular heart disease.

  • British Society of Echocardiography (BSE). Guidance on the assessment of mitral regurgitation.

  • American Heart Association / American College of Cardiology (AHA/ACC). Guideline for the management of patients with valvular heart disease.

  • NICE. Heart valve disease presenting in adults - investigation and management (NG208).

Red flags

When mitral regurgitation needs urgent attention.

Most mitral regurgitation is manageable with planned outpatient care. These are the situations that aren’t - and where urgent or specialist help is needed.

  • Acute severe mitral regurgitation

    Sudden pulmonary oedema and cardiogenic shock, often from papillary muscle rupture after a heart attack or spontaneous chordal rupture - an emergency requiring immediate hospital care.

  • New atrial fibrillation

    A new irregular pulse in someone with known or suspected mitral regurgitation warrants prompt cardiology assessment.

  • Symptoms of heart failure

    Orthopnoea, paroxysmal nocturnal dyspnoea or new ankle swelling suggest the regurgitation has become haemodynamically significant.

  • Post-myocardial infarction murmur

    A new murmur after a heart attack should raise concern for papillary muscle dysfunction or rupture and needs urgent echocardiography.

  • Infective endocarditis

    Fever with a new or changing murmur needs urgent assessment - leaflet destruction from endocarditis can cause rapidly worsening regurgitation.

  • Marfan syndrome or connective tissue disease

    These patients need closer surveillance, as connective tissue weakness can accelerate valve and chordal degeneration.

  • Asymptomatic severe regurgitation

    Absence of symptoms does not mean absence of risk - severe MR with ventricular changes on echocardiogram still needs specialist input on timing of surgery.

Living with it

A watchful condition, with a clear plan behind it.

Four things that make the biggest difference day to day - keeping scans, noticing new symptoms, protecting your heart generally, and knowing the plan.

A quiet reminder

Feeling well is not the same as being unchanged.

Severe regurgitation can progress silently - which is exactly why the follow-up echocardiogram matters, even when you feel fine.

  1. 01 Monitor

    Keep echocardiogram appointments

    Regular scans track ventricular size and function even when you feel entirely well - this is how silent progression gets caught.

  2. 02 Report

    Notice changes early

    New breathlessness, palpitations or swelling in the ankles are worth reporting promptly rather than waiting for the next routine review.

  3. 03 Heart

    Support overall heart health

    Blood pressure control, regular activity within advice, and not smoking all help protect the left ventricle from additional strain.

  4. 04 Plan

    Understand your intervention plan

    Ask your heart team what triggers a move to surgery or a transcatheter procedure, so you know what to expect if things change.

Frequently asked

Everything we get asked about mitral valve regurgitation.

Quick answers on causes, diagnosis, timing of surgery and what an emergency looks like.

  • What is mitral valve regurgitation?

    It is backflow of blood from the left ventricle into the left atrium during systole, because the mitral valve leaflets do not close completely. It ranges from mild, often incidental findings to severe disease needing surgery.

  • What is the difference between primary and secondary mitral regurgitation?

    Primary (degenerative) regurgitation comes from a structural problem with the valve itself, such as prolapse, ruptured chordae, rheumatic disease or endocarditis. Secondary (functional) regurgitation occurs with normal leaflets, when a dilated or weakened left ventricle distorts the valve’s geometry, typically in dilated cardiomyopathy or after a heart attack.

  • Can mitral regurgitation be mild and never need treatment?

    Yes. Many people have mild regurgitation picked up incidentally that never progresses to needing intervention. These cases are usually followed with periodic echocardiograms rather than treated.

  • How is mitral regurgitation diagnosed?

    Echocardiography is the gold-standard test, assessing the mechanism, severity, and the effect on the left atrium, left ventricle and pulmonary pressures. Transoesophageal echocardiography and cardiac MRI are used selectively for more detailed planning.

  • When is surgery needed for mitral regurgitation?

    Timing depends on symptoms, severity and evidence of left ventricular dilatation or dysfunction, even in people who feel well. A heart team of cardiologists and cardiac surgeons weighs these factors together, and repair is generally favoured over replacement when technically possible.

  • What is acute severe mitral regurgitation and why is it an emergency?

    It is a sudden, severe leak, most often from papillary muscle rupture after a heart attack or spontaneous chordal rupture. It causes rapid pulmonary oedema and cardiogenic shock, and needs emergency stabilisation followed by urgent surgery.

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