Mitral Regurgitation

Question 1

Mitral regurgitation is a floppy mitral valve caused by…

Answer 1

Myxomatous mitral valve
Connective tissue disorders

Question 2

What is a myxomatous mitral valve?

Answer 2

Deformity in connective tissue makes valve leaflets heavier, thickened, floppy and can prolapse due to redundancy (extend beyond normal range)

Question 3

What are risk factors of mitral regurgitation?

Answer 3

Female
Age
Low BMI
Prior MI
Connective tissue disorder

Question 4

What are symptoms of mitral regurgitation?

Answer 4

Exertion dyspnoea (due to pulmonary hypertension from the backlogging blood)
Palpitations (atrial enlargement or associated AF)
Cough (pulmonary congestion, worse lying at night)

Question 5

Describe the murmur in mitral regurgitation

Answer 5

Pan systolic blowing murmur radiating to axilla

Question 6

Where is a mitral regurgitation murmur heard best?

Answer 6

Apex of heart, mid-clavicular line, 5th intercostal space

Question 7

Describe the heart sounds in mitral regurgitation

Answer 7

Soft S1
Pansystolic blowing murmur (incomplete closure of mitral valve)
Normal S2
S3 gallop (rapid ventricular filling in early diastole)

Question 8

How is mitral regurgitation diagnosed?

Answer 8

ECG
CXR
Gold standard = ECHO showing any left atrial enlargement, analyses left ventricular functioning and any dilation

Question 9

What is treatment for mitral regurgitation?

Answer 9

ACE-inhibitor (prevent adverse cardiac remodelling)

Beta-blocker (reduces cardiac contractility decrease rate of LV dilation. Also alleviates dyspnoea)

Serial ECHO monitoring

If severe symptoms at rest then valvular repair or replacement.