Mitral regurgitation

Question 1

Define:

Answer 1

Retrograde flow of blood from the left ventricle into the left atrium due to mitral valve insufficiency.

Question 2

Aetiology/risk factors:

Answer 2

This is due to mitral valve damage or deformities:

• infective endocarditis
• rheumatic heart disease (most common cause)
• connective tissue disorders leading to floppy mitral valve such as Ehler’s Danlos and Marfans
• papillary muscle rupture (IHD and cardiomyopathy)
• LV dilation
• Annular calcification (usually in the elderly)
• Congential
• cardiomyopathy
• appetite supressants

Question 3

Epidemiology:

Answer 3

affect approx 5% of adults

Mitral valve prolapse is common in females

Question 4

Symptoms:

Answer 4

Symptoms of LV failure - usually in acute

Chronic - syncope, exertional dyspnoea and fatigue

Mitral valve prolapse- asymp or atypical chest pain or paliptations

Question 5

Signs:

Answer 5

Irregularly irregular pulse (if they are in AF)

Laterally displaced apex with thrusting

PANSYTOLIC MURMUR (loudest at the apex –> radiates to the axilla –> soft S1 and may hear S3 due to rapid ventricular filling)

Left ventricular failure signs

Question 6

signs of mitral valve prolapse:

Answer 6

mid systolic click (towards s1 when standing away when lying down)

LATE SYSTOLIC MURMUR

Question 7

Investigations:

Answer 7

ECG - normal with signs of AF or p mitriale (left atrial hypertrophy)

CXR - signs of LV failure
chronic - left atrial enlargement, cardiomegaly, mitral valve calcification (in rheumatic heart disease) and pulmonary oedema

Echo - assess LV function and aetiology

Doppler echo - to asses severity and size and locate where the regurgitant jet is

cardiac catheterisation - confirm diagnosis and exclude other causes