[7] Mitral Regurgitation

Question 1

What stages can the pathophysiology of mitral regurgitation be broken into?

Answer 1

• Acute
• Chronic compensated
• Chronic decompensated

Question 2

What does acute mitral regurgitation?

Answer 2

Sudden volume overload of both the left atrium and left ventricle.

Question 3

Why does the left ventricle develop volume overload in mitral regurgitation?

Answer 3

Because it now has to pump out the blood going into the aorta, and the blood that regurgitaes into the left atrium

Question 4

What can the pressure overload in the left ventricle cause in acute mitral regurgitation?

Answer 4

Pulmonary congestion

Question 5

When will the chronic compensated phase of mitral regurgitation develop?

Answer 5

• If the regurgitation develops slowly over months or years
• If the acute phase cannot be managed with medical therapy

Question 6

What happens in the chronic compensated phase of mitral regurgitation?

Answer 6

The left ventricle develops eccentric hypertrophy in order to better manage the increased stroke volume

Question 7

What is the result of the compensation in the chronic compensated phase of mitral regurgitation?

Answer 7

The patient may be asymptomatic, and have a normal exercise tolerance

Question 8

What happens in the decompensated phase of mitral regurgitation?

Answer 8

The patient develops left ventricular dysfunction, where the ventricular myocardium is no longer able to contract adequately to compensate for the volume overload of mitral regurgitation, and the stroke volume of the left ventricle will decrease

Question 9

What are the causes of mitral regurgitation?

Question 10

What are the symptoms of mitral regurgitation?

Answer 10

• Dyspnoea, especially on exertion or when lying down
• Fatigue
• Palpitations
• Oedema

Question 11

What is involved in the investigation of mitral regurgitation?

Answer 11

• Examination
• ECG
• CXR
• Echocardiogram

Question 12

What are the examination features of mitral regurgitation?

Answer 12

• Displaced, volume loaded apex beat
• Very rarely, find thrill at apex
• Chest x-ray in mitral valve regurgitation
• Big left atrium and left ventricle
• Mitral valve calcification
• Pulmonary oedema

Question 13

What are the ECG findings in mitral regurgitation?

Answer 13

Same as in mitral stenosis

Question 14

What are the components in management of mitral regurgitation?

Answer 14

• Control of atrial fibrillation, including rate control and anti-coagulation
• Management of hypertension
• Mitral valve repair
• Mitral valve replacement

Question 15

What are the initial treatment options in acute MR?

Answer 15

• Nitrates
• Diuretics
• Sodium nitroprusside
• Positive inotropic agents
• Intra-aortic balloon pumps

Question 16

Which mitral regurgitation patients should ACE inhibitors be considered in?

Answer 16

Once heart failure has developed in patients with advanced MR and severe symptoms who are not suitable for surgery, or have residual symptoms following surgery

Question 17

When is surgery indicated in mitral regurgitation?

Answer 17

• In patients with signs of LV dysfunction
• Patients with preserved LV dysfunction, but new onset atrial fibrillation or pulmonary hypertension

Question 18

What is associated with better outcomes in surgery for mitral regurgitation?

Answer 18

Early surgery (within 2 months)

Question 19

Why is early surgery associated with better outcomes in mitral regurgitation?

Answer 19

As the development of even mild symptoms by the time of surgery is associated with adverse changes in cardiac function after surgery

Question 20

What are the complications of mitral regurgitation?

Answer 20

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