Mitral Regurgitation Flashcards
what does acute mitral regurgitation present with?
- sudden onset pulmonary oedema
- hypotension
- cardiogenic shock
what are the broad causes of acute mitral regurgitation?
- ischaemic MR
- non-ischaemic MR
- prosthetic valve MR
decribe ischaemic causes of acute mitral regurgitation
due to papillary muscle rupture secondary to MI
decribe non-ischaemic causes of acute mitral regurgitation
chordae tendineae rupture
* myxomatous disease (mitral prolapse)
* infective endocarditis
* rheumatic heart disease
* trauma
* spontaneous rupture
describe the prosthetic valve causes of acute mitral regurgitation
- tissue valvelet rupture due to endocarditis, degeneration or calcification
- paravalvular regurgitation due to infection or suture rupture
- valve thrombus or infection causing impaired closure
what are the broad categories of causes of chronic mitral regurgitation?
- leaflet related causes
- chordae related causes
- papillary muscle related causes
- annular related causes
- prosthesis related causes
describe leaflet related causes of chronic mitral regurgitation
- degenerative disease
- rheumatic fever - presents typically in younger patients
- infective endocarditis
- systemic inflammatory disorder - e.g. SLE, scleroderma
- connective tissue disorder - e.g. marfan’s, ehlers-danlos syndromes
- congenital causes
- hypertrophic cardiomyopathy
- drug related damage
describe chordae related causes of chronic mitral regurgitation
- myxomatous valve disease
- trauma
describe papillary muscle related causes of chronic mitral regurgitation
- MI
- dilated cardiomyopathy
describe annular related causes of chronic mitral regurgitation
- calcifcation - either due to rheumatic fever or age-related
- diltation
describe prosthesis causes of chronic mitral regurgitation
- paravalvular leak
- ring or strut fracture
- leaflet deterioration in tissue valves
- infective endocarditis
- thrombus or pannus formation
what are the complications of mitral regurgitation?
- heart failure
- thromboembolism secondary to AF
- haemoptysis secondary to pulmonary hypertension
- infective endocarditis
what is the typical presentation of chronic mitral regurgitation?
may be asymptomatic - until systolic dysfunction, pulmonary hypertension or AF
* atrial fibrillation
* fatigue
* exertional dyspnoea
what is the typical presentation of acute mitral regurgitation?
- shortness of breath
- exertional dyspnoea
- fatigue
- weakness
typically have pulmonary oedema, hypotension and signs of cardiogenic shock
describe the auscultation in mitral regurgitation
pansystolic murmur
* loudest at the apex
* radiates to the axilla
* louder on expiration and on rolling to the left
* S1 may be quite or absent
how would a patient in decompensated heart failure present?
- bilateral lung crepitations
- raised JVP
- S3/S4
- peripheral/sacral oedema
how do you diagnose mitral regurgitation?
echocardiogram
what are the ECG findings in mitral regurgitation?
- p-mitrale (broad notched p wave due to left atrial enlargement)
- right ventricular hypertrophy
- right axis deviation
how do you manage mitral regurgitation?
- mitral valve repair (mitral valvuloplasty)
- mitral valve replacement
what is mitral valve prolapse?
abnormal buldging of one or both of the mitral valve leaflets into the left atrium during ventricular systole
how do you diagnose mitral valve prolapse?
echocardiogram - >2mm above the annular plane
what conditions are associated with mitral valve prolapse?
- marfan’s syndrome
- ehlers-danlos
- pseudoxanthoma imperfecta
- oestogenesis imperfecta
- turner’s syndrome
what are the symptoms of mitral valve prolapse?
- chest pain
- palpitations
- dyspnoea
- exercise intolerance
- dizziness
what are the examination findings in mitral valve prolapse?
- non-ejection click
- mitral regurgitation murmur
