Mitral regurgitation

Question 1

Auscultation of mitral regurg

Answer 1

Pansystolic ribbon/plateua murmur

High pitched, blowing murmur.

At Apex, Radiates to axilla,
best heard when patient lies on their left side.

Widely split S2 sound from early Aortic valve closure
S3 heart sound appears “S3 gallop”

DISTINGUISHED from Tricuspid Regurg by Carvallo’s sign.
Mitral regurg increases on exhalation
Tricuspid regurg increases on inhalation.

Question 2

Symptoms of acute mitral regurgitation

Answer 2

Immediate heart failure, back and forwards

Pulmonary Edema and Respiratory Failure

Question 3

Symptoms and prognosis of chronic mitral regurgitation

Answer 3

Once symptoms emerge poor prognosis: 33% survival at 8 years without replacement.

Gradual left atria and ventricle hypertrophy,
Eventual backward left heart failure and pulmonary edema, pulmonary hypertension

Dyspnea, orthopnea

Fatigue

A. Fib, palpitations

Question 4

Mitral regurg treatment

Answer 4

Non surgical: For asymptomatic patients without pulm hypertension
- Diuretics, ACE-Is, Vasodilators, A.Fib rate control

Replacement surgery is effective, Valve REPAIR surgery is preferred if possible and restores normal life expectancy. If not, replacement is indicated.
Contra’s to Valve repair, indicating replacement:
- Multisegment prolapse.
- Heavy calcification

Indicated with strong benefits:
Any type of Symptomatic MR
Asymptomatic MR with EF 30-60%, and increased LVESDimension 45-55mm

Indicated with milder benefits:
Asymptomatic, with:
-Normal EF, but with A. Fib or Pulmonary hypertension
-Pulm systolic pressure above 50mmHG at rest, or 60mmHg on exertion
-LVESD 45-55mm
-EF below 30%

Question 5

A. Fib treatment

Answer 5

Warfarin or NOACs

plus

Beta blockers or Calcium channel blockers, dihydropyridines

Verapamil antiarrhythmic. Calcium channel blocker channel blocker.
or
Amiodarone: Potassium channel blocker.