Mitral regurgitation

Question 1

What is mitral regurgitation?

Answer 1

retrograde flow of blood from LV to LA during systole

Question 2

Give 2 epidemiological facts on MR

Answer 2

Affect ~5% of adults

F > M

Question 3

What causes mitral regurgitation?

Answer 3

Mitral valve damage or dysfunction

Question 4

What causes Mitral valve damage or dysfunction?

Answer 4

Rheumatic heart disease (MOST COMMON)
Infective endocarditis
Mitral valve prolapse caused by Connective tissue disease (e.g. Ehlers-Danlos, Marfan’s)
Papillary muscle rupture (secondary to IHD or cardiomyopathy)

Question 5

List 3 symptoms of MR

Answer 5

Dyspnoea
Palpitations
Fatigue

Question 6

List 5 signs of MR

Answer 6

Pansystolic murmur that radiates to axilla
Laterally displaced, thrusting apex beat
Soft S1
S3 due to rapid ventricular filling in early diastole
Irregularly irregular pulse (if in AF)

Question 7

List 3 signs of mitral valve prolapse

Answer 7

Mid-systolic click
Late systolic murmur
The click moves towards S1 when standing and away when lying down

Question 8

What does an ECG look like in MR?

Answer 8

NORMAL

May show AF or p mitrale (indicates LA hypertrophy)

Question 9

Describe the CXR findings in acute and chronic MR

Answer 9

ACUTE MR may produce signs of LV failure
CHRONIC MR shows:
LA enlargement
Cardiomegaly (due to LV dilation)
Mitral valve calcification (if cause is rheumatic heart disease)

Question 10

Why is echocardiography performed in MR?

Answer 10

Confirms diagnosis

Allows assessment of LV ejection fraction + end-systolic dimension