Mixed Mitral Valve Disease

Question 1

What are the examination findings/signs of mixed mitral valve disease?

Answer 1

1. Determining MR or MS dominant
   - MR dominant: thrusting deviated apex, soft S1, presence of S3 (MS insignificant)
   - MS dominant: tapping apex beat, loud S1, absent S3
2. Murmurs
   - PSM
   - MDM
   - In severe MR with functional MS -> no opening snap

** S3 caused by rapid filling of right venticle, incompatible with MS diagnosis

Question 2

What are the causes of mixed mitral valve disease?

Answer 2

1. Rheumatic heart disease
2. Calcific degeneration
3. Dysfunctional mitral valve repair/replacement (presence of scar)

Question 3

Determining predominant MS vs predominant MR

Answer 3

If unable to determine dominance, suggest for TTE, cardiac catheterisation