Mitral Regurgitation Flashcards
What are some causes of acute MR
PER
Post-MI - papillary muscle rupture or dysfunction
Endocarditis - perforation of a valve leaflet
Ruptured chordae
What are some causes of chronic MR
“Functional MR” - arises in heart failure, due to abnormally-shaped dilated ventricle
Mitral valve prolapse
Rheumatic heart disease
How might a patient with MR present
MR causes symptoms of heart failure
Acute MR:-
Rapidly progressive SOB
Peripheral oedema
Chronic MR:- Insidious onset Reduced exercise tolerance Palpitations Peripheral oedema
*MR can also be asymptomatic if moderate severity
Why does MR cause palpitations
Raised left atrial pressure promotes AF
What would you expect to find on examination of a patient with MR
Pansystolic murmur - loudest at the apex, radiating to the axilla
3rd heart sound (if heart failure)
Displaced apex - if dilated left ventricle (if heart failure)
Basal crepitations + peripheral oedema (if heart failure)
What might you see on a CXR in a patient with MR
Cardiomegaly
Prominent pulmonary vasculature
Why would you do an ECG on a patient with MR
LVH
Looking for previous infarcts causing functional MR
AF
What is the medical management of MR
ACE-I
Beta blockers
Diuretics - for breathlessness and oedema
Treat AF if present - rate controlled and anticoagulated with warfarin
What is the surgical management of MR
Mitral valve repair
Mitral valve replacement - +anticoagulation if mechanical valve (look for bruising)
What are the indications for surgery in MR
Symptomatic
Poor LV function
What are some complications of MR
AF
Pulmonary hypertension
LV dysfunction and congestive heart failure
What are the differentials for a pansystolic murmur
Mitral regurgitation
Tricuspid regurgitation
VSD
What are the indications for mitral valve replacement in mitral regurgitation?
Signs of LV dysfunction
Ejection fraction less than or equal to 60% (even in absence of symptoms)
Left ventricular end-systolic diameter greater than or equal to 45mm (even in absence of symptoms)
