[7] Mitral Regurgitation Flashcards
What stages can the pathophysiology of mitral regurgitation be broken into?
- Acute
- Chronic compensated
- Chronic decompensated
What does acute mitral regurgitation?
Sudden volume overload of both the left atrium and left ventricle.
Why does the left ventricle develop volume overload in mitral regurgitation?
Because it now has to pump out the blood going into the aorta, and the blood that regurgitaes into the left atrium
What can the pressure overload in the left ventricle cause in acute mitral regurgitation?
Pulmonary congestion
When will the chronic compensated phase of mitral regurgitation develop?
- If the regurgitation develops slowly over months or years
- If the acute phase cannot be managed with medical therapy
What happens in the chronic compensated phase of mitral regurgitation?
The left ventricle develops eccentric hypertrophy in order to better manage the increased stroke volume
What is the result of the compensation in the chronic compensated phase of mitral regurgitation?
The patient may be asymptomatic, and have a normal exercise tolerance
What happens in the decompensated phase of mitral regurgitation?
The patient develops left ventricular dysfunction, where the ventricular myocardium is no longer able to contract adequately to compensate for the volume overload of mitral regurgitation, and the stroke volume of the left ventricle will decrease
What are the causes of mitral regurgitation?
What are the symptoms of mitral regurgitation?
- Dyspnoea, especially on exertion or when lying down
- Fatigue
- Palpitations
- Oedema
What is involved in the investigation of mitral regurgitation?
- Examination
- ECG
- CXR
- Echocardiogram
What are the examination features of mitral regurgitation?
- Displaced, volume loaded apex beat
- Very rarely, find thrill at apex
- Chest x-ray in mitral valve regurgitation
- Big left atrium and left ventricle
- Mitral valve calcification
- Pulmonary oedema
What are the ECG findings in mitral regurgitation?
Same as in mitral stenosis
What are the components in management of mitral regurgitation?
- Control of atrial fibrillation, including rate control and anti-coagulation
- Management of hypertension
- Mitral valve repair
- Mitral valve replacement
What are the initial treatment options in acute MR?
- Nitrates
- Diuretics
- Sodium nitroprusside
- Positive inotropic agents
- Intra-aortic balloon pumps
Which mitral regurgitation patients should ACE inhibitors be considered in?
Once heart failure has developed in patients with advanced MR and severe symptoms who are not suitable for surgery, or have residual symptoms following surgery
When is surgery indicated in mitral regurgitation?
- In patients with signs of LV dysfunction
- Patients with preserved LV dysfunction, but new onset atrial fibrillation or pulmonary hypertension
What is associated with better outcomes in surgery for mitral regurgitation?
Early surgery (within 2 months)
Why is early surgery associated with better outcomes in mitral regurgitation?
As the development of even mild symptoms by the time of surgery is associated with adverse changes in cardiac function after surgery
What are the complications of mitral regurgitation?
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