Mitral Regurgitation

Question 1

What are the clinical symptoms of mitral regurgitation?

Answer 1

Acute MR

• breathlessness
• cardiogenic shock
• pulmonary eodema

Chronic MR

• Fatigue
• exhaustion
• right heart failure
• dyspnoea or palpitations due to AF

Question 2

What are the clinical presentations of a cute and chronic MR?

Answer 2

Normal pulse or may be reduced in heart failure
Prominence JVP if right heart failure
Apex beat is brisk and hyper dynamic
Right ventricular heave

Question 3

Explain the pathophysiology of mitral regurgitation

Answer 3

The atrial wall doesn’t allow much dissension which increases left atrial pressure
This causes pulmonary venous pressure to increase causing pulmonary oedema
Since a proportion of stroke volume is regurgitated, the stroke volume increases to maintain cardiac output
This puts more strain on the left ventricle so it enlarges

Question 4

What affects the regurgitation orifice?

Answer 4

The preload, afterload and LV contractibility

Question 5

What can cause acute Mitral regurgitation?

Answer 5

Perforation of the mitral valve

Chordate tendinae or papillary muscle detachment

Question 6

What is the aetiology of mitral regurgitation?

Answer 6

Degenerative
Infective endocarditis
Rheumatic heart disease
Mitral valve prolapse

Question 7

With mitral valve regurgitation, explain the 2 ways in which the left atrium can react.

Answer 7

It can try to compensate:
marked volume enlargement, lesser changes to the pulmonary,ovary vasculature but develop AF
It can put pressure on the lungs:
Marked pressure rise, thickening of the atrial myocardium, increase in pulmonary venous pressure and remodeling of the pulmonary vasculature due to pulmonary hypertension.

Question 8

What are the investigations carried out to diagnose mitral regurgitation?

Answer 8

ECG
CXR
Cardiac catheterization
Echocardiography
Cardiac magnetic resonance