Mitral Regurgitation

Question 1

When does mitral regurgitation occur?

Answer 1

When blood leaks back through the mitral valve on systole.

Question 2

What are risk factors for mitral regurgitation?

Answer 2

• being female
• lower body mass
• age
• renal dysfunction
• prior myocardial infarction
• prior mitral stenosis or valve prolapse

Question 3

What causes mitral regurgitation?

Answer 3

• Following coronary artery disease or post MI.
• mitral valve prolapse
• infective endocarditis
• Rheumatic fever
• congenital

Question 4

What are the symptoms of mitral regurgitation?

Answer 4

Most patients are asymptomatic.
Symptoms tend to be due to failure of the left ventricle, arrhythmias or pulmonary hypertension.
these may present as SOB, fatigue and oedema.

Question 5

What are the signs of mitral regurgitation?

Answer 5

The murmur heard on auscultation of the chest is typically a pansystolic murmur described as “blowing”. It is heard best at the apex and radiating into the axilla. S1 may be quiet as a result of incomplete closure of the valve.

Question 6

What investigations could be done?

Answer 6

• ECG may show a broad P wave, indicative of atrial enlargement
• Cardiomegaly may be seen on a chest X-ray, with an enlarged left atrium and ventricles
• echocardiography is crucial to diagnose and to assess severity

Question 7

what medical management in acute cases involve?

Answer 7

nitrates, diuretics, positive inotropes and an intra-aortic balloon pump to increase cardiac output

Question 8

What medical management may be considered in patients with heart failure?

Answer 8

ACE inhibitors, along with beta-blockers and spironolactone.

Question 9

What medical management may be used in patients with acute, severe regurgitation?

Answer 9

surgery

if not possible to repair then valve replacement.