Mitral Regurgitation

Question 1

Severity MR

Answer 1

• Jerky pulse (very severe)
• Displaced apex beat + signs of failure
• AF
• Soft S1
• Early A2 (LV contents all going to the LA so early A2)
• 3rd HS (not always reliable)
• Apical thrill
• Signs of PAH: (a wave in JVP, RV impulse, loud P2, PR, TR)

Question 2

Surgery indications MR

Answer 2

• NYHA II – IV regardless of ejection fraction, or NYHA I + LV dysfunction
• EF <60% regardless of symptoms
• LVESD < 45 mm regardless of symptoms
• PAH > 50 mm H2O

Question 3

Causes MR

Answer 3

Chronic

• Ischaemic disease
• Dilated cardiomyopathy
• Secondary to Mitral valve prolapse
• Infective endocarditis
• Rheumatic heart disease
• Collagen diseases such as SLE, Marfan‘s
• Congenital
• HOCM

** Acute**

• Ischaemic event with papillary muscle rupture
• Failure of prosthetic valve