Mitral Regurgitation

Question 1

What is it?

Answer 1

Occurs when the mitral valve doesnt shut properly causing abnormal leaking of blood from the left ventricle back into the atrium

Question 2

What are the primary causes? (4)

Answer 2

Intrinsic lesions affecting one or several components of the valve, Papillary muscle rupture, infective endocarditis, trauma e.g surgery

Question 3

What are the secondary causes? (2)

Answer 3

The valve leaflets and chordae tenindae are normal but distortion to the valve occurs because of left ventricular enlargement e.g dilation, or due to cardiomyopathy

Question 4

Is it common?

Answer 4

The second most common valve disease

Question 5

Who does it affect?

Answer 5

More common in females with low BMI

Question 6

What are the risk factors? (6)

Answer 6

Female, low BMI, increasing age, Renal dysfunction, mitral stenosis, infective endocarditis

Question 7

Symptoms (3)

Answer 7

Dyspnoea, fatigue, palpitations

Question 8

Signs (5)

Answer 8

Pulmonary oedema, Atrial fibrillation, hyperdynamic apex, Right ventricular heave (right failure due to pulmonary hypertension), pansystolic murmur

Question 9

What bloods would you do? (8)

Answer 9

FBC, U&E, LFT, CRP, Lipids, Glucose, Cultures if new, BNP

Question 10

Other investigations (5)

Answer 10

Chest xray, ECG, ECHO, Cardiac MRI, Coronary Angiography

Question 11

What treatment is there? (6)

Answer 11

Atrial fibrillation rate control e.g Beta blocker or Digoxin; Warfarin/NOAC, ACE inhibitor, Diuretic e.g Spironolactone or Furosemide; Surgical repair of valve/valvular components, valve replacement

Question 12

Complications (4)

Answer 12

Pulmonary hypertension, Left ventricular dysfunction, atrial fibrillation, thromboembolic events due to AF

Question 13

Is there a good prognosis?

Answer 13

Acute mitral regurgitation is poorly tolerated, limiting symptoms has poor prognosis