Mitral Regurgitation Flashcards
Define mitral regurgitation
Backflow of blood through the mitral valve in systole
Aetiology of mitral regurgitation
Infective endocarditis
LV dilation (myocarditis or ischaemia)
Calcification
Rheumatic fever
Ischaemic papillary muscle dysfunction or rupture
Mitral valve prolapse
Ruptured chordae tendinae
Connective tissue disorders e.g. Marfan’s, Ehlers-Danlos
Cardiomyopathy
Appetite suppressants e.g. fenfluramine, phentermine
Symptoms of mitral regurgitation
Dyspnoea (especially on exertion)
Fatigue
Palpitations
Oedema
Symptoms of the causative factors
Orthopnoea
PND
Diaphoresis
Differentials for mitral regurgitation
Aortic stenosis
Pulmonary stenosis
Ventricular septal defect
Tricuspid regurgitation
Signs of mitral regurgitation on examination
AF/irregular pulse
Displaced, hyperdynamic apex beat
Pansystolic murmur over the mitral area, radiates to the axilla
Soft S1 and loud S2 (split S2 if pulmonary HTN present)
Investigations for mitral regurgitation
ECG: AF, P-mitrale, ?rhythm disturbance
FBC, U&Es, NT-proBNP, lipids, glucose
Echo: diagnose MR, assess severity and suitability for repair
- Severe: jet width >40, systolic pulmonary flow reversal, regurgitant volume >60mL
CXR: LA/LV hypertrophy, valve calcification, pulmonary oedema
Cardiac catheterisation: diagnosis
Coronary angiography
Management for mitral regurgitation
General:
- MDT (Cardio, GP, specialist nurse, cardiothoracics, dietician, OP/PT)
- RF modification: QRISK,
- Regular follow up: echo every 6-12 months if moderate
Medical
- Control co-morbs e.g. HTN, cholesterol, DM
- Control any AF (rate, rhythm, anticoagulation)
- Reduce afterload: ACEi, BB, diuretics
Surgical: valve replacement
Complications of mitral regurgitation
Atrial fibrillation
Pulmonary hypertension
Left ventricular dysfunction and congestive heart failure
Post-op:
Stroke
Prosthesis stenosis
Recurrent MR
Prosthesis dysfunction
Endocarditis
Prognosis for mitral regurgitation
Asymptomatic for >10 years
Symptomatic: 25% mortality at 5 years
