Mitral Regurgitation Flashcards
what is the definition of mitral regurgitation
retrograde blood flow from LV to LA in systole
what is the aetiology of mitral regurg
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
what CTDs increase risk of mitral regurg
POEMS pseudoxanthoma elasticum osteogenesis imperfecta ehlers-danlos syndrome marfans SLE
what is the epidemiology of mitral regurg
5% of adults
most common in young females
what history would you expect from acute mitral regurg
symptoms of LV failure
what history would you expect from chronic mitral regurg
asymptomatic
exertional dyspnoea
palpitations if in AF
fatigue
what history would you expect from mitral valve prolapse
asymptomatic
atypical chest pain
palpitations
what would you expect to find on examination with mitral regurg
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
what would you expect to find on examination with mitral valve prolapse
mid-systolic ‘click’
late systolic murmur
what would you expect to happen to the mid-systolic ‘click’ in mitral valve prolapse when standing and lying down
standing moves towards hs1
lying moves towards hs2
what investigations would be performed in suspected mitral regurg
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
what would broad bifid p wave(P mitrale) on an ECG indicate
delayed activation of LA
due to LA enlargement
what is the definitive investigation for mitral regurg
TTE