Mitral Regurgitation

Question 1

what is the definition of mitral regurgitation

Answer 1

retrograde blood flow from LV to LA in systole

Question 2

what is the aetiology of mitral regurg

Answer 2

1 mitral valve damage dysfunction
-rheumatic heart disease (commonest)
-infective endocarditis
-mitral valve prolapse (into LA in systole)
-papillary muscle rupture/dysfunction (secondary to IHD/cardiomyopathy_
-chordal rupture+floppy mitral valve with CTDs
2 secondary to LV dilation

Question 3

what CTDs increase risk of mitral regurg

Answer 3

POEMS
pseudoxanthoma elasticum
osteogenesis imperfecta
ehlers-danlos syndrome
marfans
SLE

Question 4

what is the epidemiology of mitral regurg

Answer 4

5% of adults

most common in young females

Question 5

what history would you expect from acute mitral regurg

Answer 5

symptoms of LV failure

Question 6

what history would you expect from chronic mitral regurg

Answer 6

asymptomatic
exertional dyspnoea
palpitations if in AF
fatigue

Question 7

what history would you expect from mitral valve prolapse

Answer 7

asymptomatic
atypical chest pain
palpitations

Question 8

what would you expect to find on examination with mitral regurg

Answer 8

normal pulse/irregularly irregular rhythm(AF)
normal apex beat/laterally displaced and thrusting(LV dilation)
pansystolic murmur(loudest at apex, radiates to axilla/palpable thrill)
soft hs1
possible hs3 due to rapid ventricular filling in early diastole
signs on LV failure in acute mitral regurg

Question 9

what would you expect to find on examination with mitral valve prolapse

Answer 9

mid-systolic ‘click’

late systolic murmur

Question 10

what would you expect to happen to the mid-systolic ‘click’ in mitral valve prolapse when standing and lying down

Answer 10

standing moves towards hs1

lying moves towards hs2

Question 11

what investigations would be performed in suspected mitral regurg

Answer 11

1 ECG
-normal
-AF
-broad bifid P wave(P mitrale)
2 CXR
-acute mitral regurg shows signs of LV failure
-chronic mitral regurg shows signs of LA enlargement/cardiomegaly/mitral valve calcification in rheumatic fever
3 echo
-every 6-12months for moderate/severe mitral regurg
-assesses LVEF and end-systolic dimension

Question 12

what would broad bifid p wave(P mitrale) on an ECG indicate

Answer 12

delayed activation of LA

due to LA enlargement

Question 13

what is the definitive investigation for mitral regurg

Answer 13

TTE