Valve diseases - Mitral Regurgitation

Question 1

Definition

Answer 1

Insufficient mitral valve - backflow through the mitral valve during systole

Question 2

Epidemiology + Risk factors

Answer 2

Associated with females
Advanced age
Lower BMI
Prior MI
Mitral valve prolapse
Hx of rheumatic fever
Ehlers Danlos syndrome

Question 3

Aetiology

Answer 3

MYXOMATOUS MITRAL VALVE - MC - mass of cells in valve connective tissue makes leaflets heavier + prolapse causing LA dilation) = from marfans or ehlers danlos syndrome
Functional (dilatation)
Annular calcification
Rheumatic fever
Infective endocarditis
Mitral valves prolapse

Question 4

Pathophysiology

Answer 4

Regurg into left atrium = left atrium dilatation but little increase in atrial pressure if regurg is longstanding as flow is accommodated by large left atrium.
Pure volume overload due to leakage of blood into left atrium during systole
Compensatory mechanisms:
- Left atrial enlargement
- Left vent hypertrophy
- Left atrial dilatation
- Progressive left ventricular volume overload

Question 5

Signs

Answer 5

PAN-SYSTOLIC BLOWING MURMUR RADIATING TO AXILLA at APEX
- Soft 1, prominent S3 in heart failure (severe cases)

Question 6

Symptoms

Answer 6

Exertional Dyspnoea (due to pulmonary HTN, from backlogged)
Fatigue
Palpitations

Question 7

Diagnosis

Answer 7

GOLD STANDARD = ECHO = LA size + LV function analysis
ECG
CXR

Question 8

Treatment

Answer 8

ACE-I
Beta blocker + senal ECHO monitoring
IF SEVERE: Valve repair/ replaced