Mitral Regurgitation

Question 1

What is mitral regurgitation?

Answer 1

Backflow of blood from the left ventricle to the left atrium, during systole.

Question 2

What are some common causes of mitral regurgitation?

Answer 2

• Rheumatic Fever
• Infective endocarditis
• Mitral valve prolapse
• Papillary muscle dysfunction/rupture
• Congenital e.g. Marfan’s, Ehlers-Danlos

Question 3

What is the most common cause of MR?

Answer 3

Rheumatic fever

Question 4

What can papillary muscle rupture be secondary to?

Answer 4

Cardiomyopathy

IHD

Question 5

In which population is mitral valve prolapse most common in?

Answer 5

Young females

Question 6

If mitral valve prolapse is the cause what might the presentation be?

Answer 6

Atypical chest pain

Palpitations

Question 7

How would mitral regurgitation present?

Answer 7

• Exertional dyspnoea, peripheral oedema, fatigue
• Laterally displaced apex beat
• Pan-systolic murmur radiating to apex
• Possible S3

Question 8

How might you investigate MR?

Answer 8

• Bloods - FBC, Cardiac enzymes
• ECG - may show broad bifid P-wave, check for infarction/arrhythmia
• CXR - left heart enlargement
• Echo + Dopler - visualise, assess ejection fraction, assess severity

Question 9

How would you treat MR?

Answer 9

Conservative: ACEi, BB, diuretics, anticoag

Surgery: valve replacement with bioprosthetic in >65yo and mechanical in <65

Question 10

When would surgery be indicated?

Answer 10

If patient has chronic MR + symptoms,
OR
with pulmonary HTN, LV enlargement or new-onset AF