In the outpatient clinic, I often see patients with a cardiac ultrasound and ask me nervously: “Doctor, my report says “mild mitral regurgitation”, does it matter? I’m going to tell you how to recognize your echocardiogram and how to look at your mitral regurgitation. Why do I need an echocardiogram? Usually cardiologists use three weapons to diagnose their patients: almost eighty to ninety percent of all heart diseases are detected by these three tests. First, the electrocardiogram: one function is to see if the heart is beating regularly, that is, to see if there is an arrhythmia; the other function is to see if there is myocardial ischemia. However, the diagnosis of myocardial ischemia by ECG is not entirely accurate. For patients with a high probability of coronary artery disease, a more accurate way to see if there is any blockage of the heart vessels (coronary arteries) is to perform a coronary CTA. What is a cardiac ultrasound? Ultrasound of the heart, also known as echocardiography, is a procedure in which a probe is placed on the chest wall and the ultrasound mechanism is used to look at the structure of the chambers of the heart, the structure of the valves, the function of the heart, and so on. This is why it is essential for the diagnosis of heart disease. What diseases can be diagnosed by cardiac ultrasound? A brief introduction to our heart. Our heart is the size of a fist and is located on the left side of the chest cavity. The left side of the heart is like a pump, which takes the arterial blood from the lungs and produces blood pressure through the contraction of the left side of the heart to supply the oxygen needed by all organs of the body. The left and right sides of the heart are each divided into two parts, called the left (right) atrium and the left (right) ventricle. Both arterial and venous blood flows from the atrium to the ventricle, and the necessary pathway is the door between the atrium and the ventricle, which is medically called the valve, and the mitral valve is the necessary pathway for arterial blood to travel from the left atrium to the left ventricle. The mitral valve is the pathway for arterial blood to travel from the left atrium to the left ventricle. If there is an enlarged atrium and ventricle, it indicates many heart diseases, such as hypertensive heart disease, coronary heart disease, etc. Echocardiography also allows us to see our valves, so we can also diagnose whether the valve morphology, closure, or opening is normal. If the valve pattern, opening, or closure is not normal, it indicates a possible valvular heart disease, most commonly rheumatic heart disease. However, not all valvular insufficiency is rheumatic heart disease, as I will explain next. Another function of the echocardiogram is to see if the heart is beating strongly. One of the indicators is the ejection fraction of the left ventricle. The normal ejection fraction is above 50%, but below this value is cardiac insufficiency. Is mild mitral regurgitation and reduced left ventricular diastolic function serious? After understanding the above simple medical knowledge, let’s talk about today’s key issue. What is the mitral regurgitation on the report card? As I mentioned earlier, the mitral valve is the gate through which arterial blood from the left atrium flows to the left ventricle. This door is a one-way valve, which means that when the heart is diastolic blood flows from the atrium to the ventricle is this door is open. When the heart is contracting and blood is flowing from the ventricle to the aorta, this door is closed to prevent blood from returning from the ventricle to the atrium. In some cases when this door does not close tightly when the heart is contracting, the blood will flow back from the ventricle to the atrium, and this becomes mitral regurgitation. Mitral regurgitation can occur in the heart due to disease of the mitral valve itself, such as rheumatic heart disease, or mitral valve prolapse, or due to enlargement of the heart chambers, which pulls on the mitral valve during heart contraction and produces secondary mitral regurgitation. Moderate or severe mitral regurgitation must be a disease that requires a good analysis of the cause by a doctor. Minimal or mild mitral regurgitation may be due to excessive blood flow or mild strain on the heart during contraction, and can be seen in anemic, hyperthyroid, or normal young adults. Sometimes it can also be seen in the elderly with degenerative disease such as valve calcification, so if the report only shows this one abnormality, and it is a small amount or a trace, there is no need to be concerned or nervous. In addition, some people’s ultrasound reports suggest that the left ventricular diastolic function is reduced, what is this? As the heart gets older, or for other reasons such as high blood pressure, the stiffness of the heart increases, just like a skin band that has lost its elasticity and cannot fully stretch out after contraction. This is called diastolic dysfunction. Diastolic dysfunction is a disease like atherosclerosis, but it is also an inevitable trend of aging. If the report card only reports mild diastolic dysfunction and no obvious symptoms of shortness of breath, no special treatment is needed, and blood pressure control is the main focus.