Mitral regurge

Question 1

Causes of acute MR

Answer 1

1. IE
2. Rupture of chordae tendinae - IE, ischaemia
3. Trauma

Question 2

Causes of chronic MR

Answer 2

1. Rheumatic fever
2. Mitral valve prolapse
3. IE
4. LV dilatation
5. Connective tissue diseases - Marfan’s, EDS, PSeudoxanthoma elasticum
6. Papillary muscle dysfunction

Question 3

Clinical signs of severe MR

Answer 3

Soft first heart sound
Third heart sound
Displaced apex beat (LV enlargement)
Precordial thrill
Widely split second heart sound
Pulmonary hypertension
Pulmonary congestion

Question 4

Differentials of a precordial pansystolic murmur

Answer 4

1. MR
2. Tricuspid regurge
3. VSD

Question 5

Characteristics of MR murmur

Answer 5

Pansystolic murmur loudest at the apex, radiating to the axilla. Loudest on expiration

Question 6

Commonly associated with which arrhythmia?

Answer 6

AF

Question 7

What could medical therapy for MR include?

Answer 7

Rate and rhythm control for AF
HF management

Question 8

Indications for surgery

Answer 8

Symptomatic despite optimal medical therapy
LVEF <60% or LV end systolic diameter >45mm

Question 9

Mitral valve prolapse associations

Answer 9

Polycystic kidneys, cardiomyopathy, Wolf-Parkinson-White syndrome, Patent ductus arteriosus, Marfans syndrome and muscular dystrophy

Question 10

Mitral valve prolapse murmur

Answer 10

Click, mid-late systolic murmur