Mitral Regurgitation

Question 1

Mitral Regurgitation Classification

Answer 1

Primary MR
-Intrinsic lesions affect components of the valve
-Papillary muscle rupture, infective endocarditis, prolapse, trauma
-Degenerative MR is most common cause
Secondary MR (also called functional)
-Valve leaflets and chordae are structurally normal and dysfunction occurs due to distortion of the annulus
-e.g. from MI, LV enlargement, cardiomyopathy

Question 2

Mitral Regurgitation Epidemiology

Answer 2

• Trivial MR frequent
• Moderate to severe is second most prevalent heart disease after aortic valve stenosis
• Associated with female sex, lower BMI, advanced age…

Question 3

Mitral Regurgitation Aetiology

Answer 3

• Degeneration
• Coronary artery disease (papillary muscle)
• Infective endocarditis
• Myxomatous degeneration
• SLE
• Rheumatic fever (less common now)

Question 4

Mitral Regurgitation Presentation

Answer 4

• Acute MR leads to rapid pulmonary oedema, requires emergency repair
• Chronic is well tolerated but dilation of left ventricle eventually causes heart failure and breathlessness
• Pansystolic murmur at apex
• Acute MR due to papillary muscle rupture should be considered in patients presenting with acute pulmonary oedema or shock following acute MI

Question 5

Mitral Regurgitation Ix

Answer 5

• CXR (pulmonary oedema)
• ECG shows broad P waves left atrial enlargement
• Echocardiography
• Coronary angiography if MI suspected

Question 6

Mitral Regurgitation Management

Answer 6

• Management if asymptomatic is controversial but surgery may be an option
• Surgery is indicated patients with signs of LV dysfunction
• Initial drug treatments include nitrates, diuretics, sodium nitroprusside, positive inotropic agents, intra-aortic balloon pump
• ACE inhibitors in heart failure
• If LV function preserved, monitor yearly

Question 7

Mitral Regurgitation Surgery

Answer 7

• Indicated with acute severe MI
• Repair is more favourable
• Replacement when repair is not possible

Question 8

Mitral Regurgitation Complications

Answer 8

• Pulmonary hypertension
• LV dysfunction
• AF
• Thromboembolism

Question 9

Mitral Regurgitation Prognosis

Answer 9

-Best prognosis for asymptomatic patients operated on