mitral regurgitation Flashcards
define mitral regurgitation
mitral valve leaflets do not meet allowing backflow of blood into the atrium during systole
functional etiologies of mitral regurgitation
valve & valve apparatus are normal cardiomyopathy -ischemic -dilated -hypertrophic left atrial dilation
organic etiologies of mitral regurgitation
abnormal valve abnormal valve apparatus myxomatous changes - MVP rheumatic heart disease endocarditis collagen vascular disease papillary muscle dysfunction mitral annular calcification chordae rupture dilated cardiomyopathy
mitral valve prolapse
leaflet balloons and is occupying space in the left atria that it would normally not
often seen in collagen disorder patients (marfan/ehlers danlos)
seen in pts with skeletal deformities (pectus carinatum and excavatum)
chronic patient presentation
progressive dyspnea
dyspnea on exertion to PND to orthopnea
acute patient presentation
markedly symptomatic patient
severe orthopnea
flash pulmonary edema
physical exam findings for mitral regurgitation
-prominent, hyper-dynamic PMI left of the MCL
-systolic thrill over PMI
-prominent 3rd heart sound
-mid-systolic click
-pansystolic blocking/harsh murmur
a-fib common
MR murmur where to find
MR murmur: Auscultate @ apex: 5th ICS in Mid – clavicular line
MVP patients are at increased risk for developing IBE
mitral regurgitation on x-ray
Apex displacement downward
Cardiomegaly
Hilar haze
Pulmonary edema, typically R > L
chronic medical therapy
- Digoxin or beta blocker in the presence of Atrial Fib
- Oral Anticoagulation in the presence of Atrial Fib
- Antibiotic Prophylaxis against IBE
acute medical therapy
vasodilators (hydralazine, nifedipine, nitroprusside)
indications for surgery in chronic MR
Severe Dyspnea LVEF < 40% LVESV > 50mg/m2 Atrial Fibrillation Pulmonary Artery Systolic Pressure > 50mm Hg
indications for surgery in acute MR
severe symptoms that are refractory to medical therapy
should be done before left HF and severe pulmonary HTN
