Mitral Regurgitation

Question 1

Define

Answer 1

Retrograde flow of blood from LV to left atrium during systole

Question 2

Causes

Answer 2

due to mitral valve damage or destruction
􏰀 Rheumatic heart disease
􏰀 Infective endocarditis
􏰀 Mitral valve prolapse
􏰀 Functional – LV dilatation
􏰀 Cardiomyopathy
􏰀 Annular calcification (in elderly)
􏰀 Papillary muscle rupture or dysfunction (e.g. due to
ischemic heart disease or cardiomyopathy)
􏰀 Connective tissue disorders (e.g. SLE, Marfan’s, Ehlers-
Danlos)
􏰀 Congenital

Question 3

Epidemiology

Answer 3

5% of adults

Mitral valve prolapse more common in young women

Question 4

Symptoms

Answer 4

Laura Tan CARDIO 5
Dyspnoea, fatigue, palpitations, infective endocarditis
Acute MR: May present with symptoms of left ventricular failure Chronic MR: asymptomatic or present with exertional dyspnoea, palpitations if in AF, plus fatigue
Mitral valve prolapse: Asymptomatic or atypical CP, palpitations

Question 5

Signs

Answer 5

Pansystolic murmur, loudest at apex, radiates to axilla
􏰀 Palpable thrill
􏰀 RV heave
􏰀 ±S3 sound (rapid ventricular filling in early diastole), plus
soft S1 and split S2
􏰀 ±Apex beat laterally displaced, hyper-dynamic
􏰀 ±AF irregularly irregular pulse
􏰀 Signs of LV failure if acute MR
Mitral valve prolapse → mid-systolic click and late systolic murmur

Question 6

Investigations

Answer 6

ECG
Chest xray
Echo