Mitral regurgitation

Question 1

What is mitral regurgitation?

Answer 1

Leakage of blood from the left ventricle into the left atrium due to incomplete closure of the mitral valve during systole

Question 2

What are the causes of mitral regurgitation?

Answer 2

(Primary MR, caused by direct involvement of the valve leaflets or chordae tendinae) Degenerative mitral valve disease, Rheumatic fever, Infective endocarditis, Ischemic MR
(Secondary MR, caused by changes of the left ventricle that lead to valvular incompetence) Coronary heart disease

Question 3

What are the clinical features of mitral regurgitation?

Answer 3

(Acute) Dyspnea, Signs and symptoms of pulmonary edema (e.g., bibasilar, fine, late inspiratory crackles), Cardiogenic shock: poor peripheral perfusion, tachycardia, tachypnea, and hypotension, Palpitations, auscultation: Soft, systolic, decrescendo murmur
(Chronic) Dyspnea (including exertional dyspnea), dry cough, Fatigue, Palpitations, Holosystolic murmur

Question 4

How is mitral regurgitation diagnosed?

Answer 4

Transthoracic echocardiography (TTE)
 ECG and troponin in acute MR (for MI), or blood cultures for suspected endocarditis

Question 5

What is the treatment of mitral regurgitation?

Answer 5

Acute
(Surgical therapy) Valvular repair/replacement
(Meds) Treatment for heart failure, vasodilators (e.g.Nitroprusside, nitroglycerin), Diuretics (e.g., furosemide), Hypotension: inotropes (e.g., dobutamine )
Chronic
(Meds) Treatment of heart failure: Diuretics (e.g., furosemide), ACE inhibitors (e.g., lisinopril), Beta blockers (e.g., metoprolol tartrate)