Mitral Regurgitation

Question 1

What are the aetiologies of mitral regurgitation?

Answer 1

Rheumatic fever
Mitral valve prolapse
Infective endocarditis
Degeneration

Question 2

What is the pathophysiology of mitral regurgitation?

Answer 2

Regurgitation into left atrium produces left atrial dilation but if chronic there is little increase in left atrial pressure as flow is accommodated by left atrium
In acute circumstances the normal compliance doesn’t allow much dilation and atrial pressure rises which increases pulmonary venous pressure and leads to oedema
Stroke volume is then increased to maintain forward cardiac output which leads to left ventricular hypertrophy

Question 3

What are the symptoms of mitral regurgitation?

Answer 3

Palpitations
Dyspnoea
Orthopnoea
fatigue

Question 4

What are the signs of mitral regurgitation?

Answer 4

Laterally displaced apex beat
Systolic thrill
Soft S1
Pansystolic murmur
Prominent S3

Question 5

What investigations are used in mitral regurgitation?

Answer 5

CHEST X-RAY - left atrial and ventricular enlargement, increased CTR and valve calcification
ELECTROCARDIOGRAM - left atrial delay, left ventricular hypertrophy, atrial fibrillation
ECHOCARDIOGRAM - dilated left atrium and left ventricle, specific features of muscle rupture

Question 6

What is the treatment for mitral regurgitation?

Answer 6

Little treatment when symptoms absent - prophylaxis against IE and serial echoes
Mitral valve repair or replacement if signs of cardiac enlargement
ACEI, diuretics, anticoagulants