Mitral Regurgitation

Question 1

Define Mitral Regurgitation?

Answer 1

Retrogade flow of blood from left ventricle to left atrium during systole

Question 2

What is the epidemiology of Mitral Regurgitation?

Answer 2

Affects roughly 5% of adults

Mitral valve prolapse is common in young females

Question 3

What is the aetiology of Mitral Regurgitation?

Answer 3

It is caused by mitral valve damage or dysfunction

Question 4

What are some of the causes of Mitral Valve damage or dysfunction?

Answer 4

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

Question 5

What the presenting symptoms of Acute Mitral Regurgitation?

Answer 5

May be present with symptoms of left ventricular failure

Question 6

What are some of the presenting symptoms of Chronic Mitral Regurgitation?

Answer 6

May be asymptomatic or present with:

• Exertional Dyspnoea
• Palpiatations if in AF
• Fatigue

Question 7

What are some of the presenting symptoms of Mitral Valve Prolapse?

Answer 7

Asymptomatic or atypical chest pain or palpitations

Question 8

What are the signs of Mitral Regurgitation on physical examination?

Answer 8

Pulse may be irregularly irregular (if in AF)
Laterally displaced apex beat with thrusting (due to left ventricular dilation)
Pansystolic murmur
Signs of Left Ventricular Failure in acute Mitral Regurgitation

Question 9

What are some of the features of the Pansystolic Murmur in Mitral Regurgitation?

Answer 9

Loudest at apex beat
Radiating to the axilla
Soft S1
S3 may be heard due to rapid ventricular filling in early diastole

Question 10

What are some of the presenting symptoms of Mitral Valve Prolapse caused Mitral Regurgitation?

Answer 10

Mid-systolic click
Late Systolic Murmur
The click moves towards S1 when standing and away when lying down

Question 11

What might we see on an ECG for Mitral Regurgitation?

Answer 11

Normal

May show AF or p mitrale (indicates left atrial hypertrophy)

Question 12

What is P-mitrale

Answer 12

P-mitrale occurs when the depolarization of the right atrium and left atrium are both visible in the P wave. This is seen as a notch in the P wave and occurs when the left atrium is markedly enlarged

Question 13

What might we see on a CXR for Acute Mitral Regurgitation?

Answer 13

Signs of Left Ventricular Failure

Question 14

What might we see on a CXR for Chronic Mitral Regurgitation?

Answer 14

Left Atrial Enlargement
Cardiomegaly (due to LV dilation)
Mitral Valve calcification (if rheumatic heart disease is the cause)