Mitral regurgitation

Question 1

What are the causes of mitral regurgitation?

Answer 1

Rheumatic heart disease.
Papillary muscle rupture.
Infective endocarditis.
Prolapse.

Question 2

What are the symptoms of mitral regurgitation?

Answer 2

Dyspnoea.
Palpitations if in AF.
Heart failure.
Symptoms of infective endocarditis.

Question 3

What are the signs of mitral regurgitation?

Answer 3

Irregularly irregular pulse if in AF.

Displaced apex beat.

Question 4

Describe the murmur of mitral regurgitation.

Answer 4

A harsh pan systolic murmur radiating to the axilla.

Question 5

What investigations should be performed if mitral regurgitation is suspected, and what findings would you expect?

Answer 5

ECG: atrial fibrillation, bifid P waves.
CXR: may see cardiomegaly and pulmonary oedema if patient has heart failure.
ECHO: confirms diagnosis, allows severity to be assessed.

Question 6

What is the conservative treatment of mitral regurgitation?

Answer 6

Manage cardiovascular risk factors, e.g. smoking cessation.

Question 7

What is the medical treatment of mitral regurgitation?

Answer 7

Manage heart failure and AF by following NICE guidelines.

Question 8

What is the surgical treatment of mitral regurgitation?

Answer 8

Valve repair is preferred since replacement may interfere with the function of the papillary muscles.

Question 9

What are the complications of mitral regurgitation?

Answer 9

AF
Heart failure
Infective endocarditis
Pulmonary hypertension