Mitral Regurgitation Flashcards
What is the definition of mitral regurgitation?
Retrograde flow of blood from left ventricle to left atrium during systole
What is the epidemiology of mitral regurgitation?
Affect ~5% of adults
Mitral valve prolapse is common in young females
What is the aetiology of mitral regurgitation?
Broadly speaking, it is caused by mitral valve damage or dysfunction, which, in turn could be caused by any of the following:
- Rheumatic heart disease (MOST COMMON)
- Infective endocarditis
- Mitral valve prolapse
- Papillary muscle rupture or dysfunction (secondary to IHD or cardiomyopathy)
- Chordal rupture and floppy mitral valve associated with connective tissue disease (e.g. Ehlers-Danlos syndrome, Marfan’s syndrome)
What are the presenting symptoms of mitral regurgitation?
Acute MR - may present with symptoms of left ventricular failure
Chronic MR - may be asymptomatic or present with:
- Exertional dyspnoea
- Palpitations if in AF
- Fatigue
Mitral Valve Prolapse - asymptomatic or atypical chest pain or palpitations
What are the signs of mitral regurgitation upon physical examination?
Pulse may be irregularly irregular (if in AF)
Laterally displaced apex beat with thrusting (due to left ventricular dilation)
Pansystolic murmur
- Loudest at apex beat
- Radiating to the axilla
- Soft S1
- S3 may be heard due to rapid ventricular filling in early diastole
Signs of left ventricular failure in acute mitral regurgitation
Mitral Valve Prolapse
- Mid-systolic click
- Late systolic murmur
- The click moves towards S1 when standing and away when lying down
What are the appropriate investigations for mitral regurgitation?
ECG
- NORMAL
- May show AF or p mitrale (indicates left atrial hypertrophy)
CXR
- ACUTE mitral regurgitation may produce signs of left ventricular failure
- CHRONIC mitral regurgitation shows:
- > Left atrial enlargement
- > Cardiomegaly (due to LV dilation)
- > Mitral valve calcification (if rheumatic heart disease is the cause)
Echocardiography
- Performed every 6-12 months in moderate-severe MR
- Allows assessment of LV ejection fraction and end-systolic dimension
