Mitral regurgitation

Question 1

Define mitral regurgitation

Answer 1

Retrograde flow of blood from left ventricle to left atrium during systole

Question 2

Aetiology of mitral regurgitation

6

Answer 2

Caused by mitral valve damage or dysfunction, which can be caused by:
Rheumatic heart disease (MOST COMMON)
Infective endocarditis
Mitral valve prolapse
Papillary muscle rupture or dysfunction (2º to IHD or cardiomyopathy)
Chordal rupture & floppy mitral valve associated w/ connective tissue disease (e.g. Ehlers-Danlos syndrome, Marfan’s)

Question 3

Epidemiology of mitral regurgitation

prevalence, gender

Answer 3

Affects 5% adults

Mitral valve prolapse common in young females

Question 4

Presenting symptoms of mitral regurgitation

3 presentations

Answer 4

Acute MR
Chronic MR
Mitral valve prolapse

Question 5

Presenting symptoms of mitral regurgitation - acute

Answer 5

May present w/ symptoms of left ventricular failure

Question 6

Presenting symptoms of mitral regurgitation - chronic

3

Answer 6

May be asymptomatic or present with:
exertional dyspnoea
palpitations if in AF
fatigue

Question 7

Presenting symptoms of mitral regurgitation - mitral valve prolapse

Answer 7

Asymptomatic or atypical chest pain or palpitations

Question 8

Signs of mitral regurgitation on physical examination

5

Answer 8

Pulse may be irregularly irregular (if in AF)

Laterally displaced apex beat w/ thrusting (due to left ventricular dilatation)

Pansystolic murmur
loudest at apex beat
radiating to axilla
soft S1
S3 may be heard due to rapid ventricular filling in early diastole

Signs of left ventricular failure in acute mitral regurgitation

Mitral valve prolapse
mid systolic click
late systolic murmur
click moves towards S1 when standing & away when lying down

Question 9

Investigations for mitral regurgitation

3 types

Answer 9

ECG
CXR
Echocardiography

Question 10

Investigations for mitral regurgitation - ECG

2

Answer 10

Normal

May show AF or p mitrale (indicates left atrial hypertrophy)

Question 11

Investigations for mitral regurgitation - CXR

1 acute, 3 chronic

Answer 11

Acute mitral regurgitation
May produce signs of left ventricular failure

Chronic mitral regurgitation
Left atrial enlargement
Cardiomegaly (due to LV dilation)
Mitral valve calcification (if rheumatic heart disease if cause)

Question 12

Investigations for mitral regurgitation - echocardiography

2

Answer 12

Performed every 6-12 months in moderate to severe MR

Allows assessment of LV ejection fraction & end systolic dimension