Mitral Regurgitation

Question 1

What is mitral regurgitation also known as?

Answer 1

Mitral insufficiency

Question 2

What is mitral regurgitation due to?

Answer 2

An incompetent mitral valve

Question 3

What happens during mitral regurgitation?

Answer 3

Blood leaks back through the mitral valve during systolic contraction of the left ventricle

Question 4

Where is the mitral valve located?

Answer 4

Between the left atrium and ventricle

Question 5

During which stage of contraction does the blood leak with mitral regurgitation?

Answer 5

During systole

Question 6

How is the mitral regurgitation murmur described?

Answer 6

Pan-systolic, high pitched “whistling” murmur

Question 7

Where does the murmur caused by mitral regurgitation radiate?

Answer 7

The left axilla

Question 8

How can the other heart sounds be affected during mitral regurgitation?

Answer 8

S1 may be quiet
Widely split S2 (third heart sound)

Question 9

Why might S1 be quiet in someone with mitral regurgitation?

Answer 9

Due to incomplete closure of the valve

Question 10

What investigations might you do if someone presents with suspected mitral regurgitation?

Answer 10

ECG
Chest x-ray
Echocardiogram

Question 11

How may someone with mitral regurgitation present clincially?

Answer 11

Usually asmptomatically

Question 12

What clinical presentations might you see in someone presenting with mitral regurgitation?

Answer 12

Fatigue
Shortness of breath
Oedema.

Question 13

What might you see on an ECG of someone presenting with mitral regurgitation?

Answer 13

A broad P wave

Question 14

What does a broad p wave indicate?

Answer 14

Atrial enlargement

Question 15

What might you see on a chest x-ray of someone presenting with mitral regurgitation?

Answer 15

Cardiomegaly- enlarged left atria and ventricle

Question 16

What is the use of an echocardiogram in the assessment of mitral regurgitation?

Answer 16

Essential for diagnosis and to assess severity

Question 17

What are the risk factors of mitral regurgitation?

Answer 17

• Female sex
• Lower body mass
• Age
• Renal dysfunction
• Prior myocardial infarction
• Prior mitral stenosis or valve prolapse
• Collagen disorders

Question 18

Which collagen disorders increase the risk of mitral regurgitation?

Answer 18

Marfan’s Syndrome
Ehlers-Danlos syndrome

Question 19

What are the main causes of mitral regurgitation?

Answer 19

Following coronary artery disease or post-MI
Mitral valve prolapse
Infective endocarditis
Rheumatic fever
Congenital

Question 20

How does coronary artery disease or post-MI cause mitral regurgitation?

Answer 20

Damage to surrounding structures

Question 21

How does mitral valve prolapse cause mitral regurgitation?

Answer 21

Leaflets of the mitral valve is deformed so the valve does not close properly and allows for backflow.

Question 22

How does infective endocarditis cause mitral regurgitation?

Answer 22

Vegetations from the organisms colonising the heart grow on the mitral valve, it is prevented from closing properly

Question 23

Where does rheumatic fever typically cause mitral regurgitation?

Answer 23

Underdeveloped countries

Question 24

What are the symptoms of mitral regurgitation due to?

Answer 24

Pulmonary oedema
or
Left heart failure

Question 25

What is the management of symptomatic patients with mitral regurgitation?

Answer 25

Mitral valve repair or replacement