Mitral Regurgetation

Question 1

Pathophysiology of MR

Answer 1

Blood flows in 2 direction during systole . Some flows normally to aortic valve and some leaks back to LA
Can be caused by distrusting of any part of MV .

• MR increases blood Volume and Pressure in LA
• the increased LA pressure may transmitted to pulmonary veins >PHTN
• the extra blood volume in LA leads to LA enlargement > AF
• risk for LA thrombus >systemic embolization or stroke
• sever MR > volume overload on LV > LV dialation &deterioration of LV function >LVF

Question 2

Causes pf MR

Answer 2

-Acute :

1•EI
2•Blunt chest trauma
3•ruptured chordae tendinae (flail MV)
4•myocardial infarction (ruptured papillary muscle)

-chronic :
1•RHD in1/3 of MR causes 
2• Mitral annular calcification 
3•cardiopathy (dialated , hypertrophic)
4•ischemic heart disease  
5•MV Prolapses (MVP)
6•IE
7•connective tissue disease (SLE,RA,ankylosing spondylitis) 
8•congenital lesions (endocardium Cushing defect )

Question 3

Symptom of MR

Answer 3

• Acute MR :
• Acute pulmonary edema (often the initial manifestation)
• cardiogenic Shock in sever MR (d/t reduced forward stroke volume)
• Dyspnea ,orthopnea,fatigue
• chronic MR:
• asymptomatic for years (compensating)
• exertional dyspnea ,orthopnea,fatigue(LV dysfunction)
• palpitation if AF develops
• abdominal dystention lower limb edema if PHTN & RHF develops

Question 4

PX ( general examination findings: MR

Answer 4

BP:usually normal

Pulse:brisk sharp upstroke in chronic sever MR

JVP : prominente a Wave (in pulmonary HTN )
and CV Wave if TR develops

Patient may be in HF

Question 5

Pericardial px findings in mr:

Answer 5

-inspection:
Hyperdynamic LV Impulse in sever mr & can cause occasional shaking of entire pericardium

Cardiac pulsation that are visible lateral to the Left mid clavicular line suggest cardiac enlargement

-palpation:
The apex beat is hyperdynamic , displaced laterally ,if LV dialation present

Apical systolic thrill

Parasternal heave , palpable P2 in 2ed intercostal space (signs of PHTN)

-Auscultation :

S1 : absent or dimenshed
S2:wide splitting d/t early closure of AV
S3:as a result of LV volume overload /LV dysfunction
•loud accentuated P2 of pulmonary HTN present
•characteristic murmur :PAN-SYSTOLIC murmur ,best Heard- at apex and radiate to AXILLA
•findings of MS if co-existed
•TR murmur if present

Question 6

Systemic px findings of MR:

Answer 6

• chest : bi-basal creptation
• ascites and hepatomegally if RVF
• bilateral perephral edema : if HF

Question 7

Investigation of mr

Answer 7

-CXR :
LV enlargement
LA enlargement
Pulmonary congestion (my not be observed till heart failure develops)

-ECG :
LA enlargement, RA enlargement
Occasionally LVH

-echocardiography: