Mitral Regurgitation Flashcards

1
Q

what is the definition of mitral regurgitation

A

retrograde blood flow from LV to LA in systole

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2
Q

what is the aetiology of mitral regurg

A

1 mitral valve damage dysfunction
-rheumatic heart disease (commonest)
-infective endocarditis
-mitral valve prolapse (into LA in systole)
-papillary muscle rupture/dysfunction (secondary to IHD/cardiomyopathy_
-chordal rupture+floppy mitral valve with CTDs
2 secondary to LV dilation

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3
Q

what CTDs increase risk of mitral regurg

A
POEMS
pseudoxanthoma elasticum
osteogenesis imperfecta
ehlers-danlos syndrome
marfans
SLE
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4
Q

what is the epidemiology of mitral regurg

A

5% of adults

most common in young females

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5
Q

what history would you expect from acute mitral regurg

A

symptoms of LV failure

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6
Q

what history would you expect from chronic mitral regurg

A

asymptomatic
exertional dyspnoea
palpitations if in AF
fatigue

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7
Q

what history would you expect from mitral valve prolapse

A

asymptomatic
atypical chest pain
palpitations

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8
Q

what would you expect to find on examination with mitral regurg

A

normal pulse/irregularly irregular rhythm(AF)
normal apex beat/laterally displaced and thrusting(LV dilation)
pansystolic murmur(loudest at apex, radiates to axilla/palpable thrill)
soft hs1
possible hs3 due to rapid ventricular filling in early diastole
signs on LV failure in acute mitral regurg

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9
Q

what would you expect to find on examination with mitral valve prolapse

A

mid-systolic ‘click’

late systolic murmur

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10
Q

what would you expect to happen to the mid-systolic ‘click’ in mitral valve prolapse when standing and lying down

A

standing moves towards hs1

lying moves towards hs2

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11
Q

what investigations would be performed in suspected mitral regurg

A

1 ECG
-normal
-AF
-broad bifid P wave(P mitrale)
2 CXR
-acute mitral regurg shows signs of LV failure
-chronic mitral regurg shows signs of LA enlargement/cardiomegaly/mitral valve calcification in rheumatic fever
3 echo
-every 6-12months for moderate/severe mitral regurg
-assesses LVEF and end-systolic dimension

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12
Q

what would broad bifid p wave(P mitrale) on an ECG indicate

A

delayed activation of LA

due to LA enlargement

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13
Q

what is the definitive investigation for mitral regurg

A

TTE

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