Mitral Regurg Summary

Question 1

Causes and Pathophysiology for Mitral Regurg

Answer 1

1º: ∆ MV mobility:
-decreased (scar - rheumatic fever)
-normal but leak (endocarditis)
-increased (prolapse or flail (detached))
2º: LV enlargement pulls valve apart
Problem of ↑↑ LV volumes → compensatory eccentric LVH

Question 2

Describe clinical syndromes for Mitral Regurg

Answer 2

Acute: LA has not remodelled, Large back pressure.
Chronic: Long asymptomatic period, then gradual onset of symptoms (HF), usually later LV dysfunction

Question 3

Symptoms for Mitral Regurg

Answer 3

Fatigue, weakness, symptoms of pulmonary edema

Question 4

Signs and Physical findings for Mitral Regurg

Answer 4

A fib., Heart failure,
Acute: S3 and S4 (early and late LV filling), systolic murmur (LV to LA)
Chronic: Large apex, thrills possible, S3, pansystolic and diastolic murmurs. Murmurs don’t change with heart intensity (unlike AS)

Question 5

Key lab tests and findings for Mitral Regurg

Answer 5

ECG: maybe detect enlargement
CXR: see enlargement, signs of pulm. edema
Echo is best: see in action, size, severity
Cardiac catheterization: pressures are high, check coronaries

Question 6

Tx for Mitral Regurg

Answer 6

Acute: diuretics, lower BP.
Chronic: no direct Tx except valve replacement Sx.
Tx for heart failure, rate-slowing drugs and coumadin for A fib.

Question 7

Indications for surgery for Mitral Regurg

Answer 7

Want to catch symptoms early for best outcome. Necessary if HF starts or if LV is dilating (asymptomatically). LV can bounce back if caught early enough