Mitral regurgitation

Question 1

Main cause of mitral regurgitation?

Answer 1

Most common cause is rheumatic heart disease.

Question 1

What is mitral regurgitation?

Answer 1

Occurs when blood leaks back through the mitral valve during systole.

Question 2

Clinical presentation of acute mitral regurgitation?

Answer 2

Acute mitral regurgitation is usually a cardiac emergency and presents with sudden onset symptoms of:
- Shortness of breath
- Exertional dyspnoea
- Fatigue
- Weakness

Question 3

Clinical presentation of chronic mitral regurgitation?

Answer 3

The symptoms are associated with a degree of impairment:
- Patients with mild to moderate mitral regurgitation may be asymptomatic until there is significant systolic dysfunction.

Question 4

Signs of mitral regurgitation?

Answer 4

Pan-systolic murmur best heard at the apex (5th intercostal space mid-clavicular line).

Murmur radiates to the axilla

Displaced apex

Question 5

Investigations for mitral regurgitation?

Answer 5

CXR: may show evidence of pulmonary oedema and left atrial enlargement

ECG: left axis deviation, left atrial enlargement

Echocardiogram: to confirm diagnosis and assess severity

Question 6

Medical management of mitral regurgitation?

Answer 6

Treat concurrent complications:
- AF - rate control and anticoagulation
- Thromboembolism - anticoagulation
- Heart failure - diuretics, ACE inhibitors and beta blockers.

Question 7

Surgical management of mitral regurgitation?

Answer 7

Open heart surgery and valve repair (preferred) or replacement

Question 8

Complications of mitral regurgitation?

Answer 8

Heart failure

Thromboembolism secondary to AF

Haemoptysis secondary to pulmonary hypertension and symptoms of right heart failure