Mitral regurgitation

Question 1

give five causes of acute mitral regurgitation

Answer 1

• papillary muscle infarction
• ruptured chorae teninae
• acute rheumatic fever
• IE
• trauma

Question 2

give some causes of chronic mitral regurg

Answer 2

• mitral valve prolapse
• rheumatic HD
• calcification
• congential
• connective tissue disease

Question 3

describe the pathophysiology of MR

Answer 3

backflow into the LA causes a decrease in CO

This results in an increase in LA pressure and dilatation

In acute MR, a lack of physiological compensation causes haemodynamic instability and pulmonary oedema.

In chronic MR, compensatory mechanisms occur leading to a decrease CO over time

Question 4

describe the pulse in MR

Answer 4

regular, but AF is common

Question 5

describe the murmur of MR

Answer 5

pansystolic murmur heard at the apex radiating to the axilla (blowing murmur)

Question 6

describe the apex beat of MR

Answer 6

thrusting and displaced inferolaterally

Question 7

describe the heart sounds of MR

Answer 7

soft first heart sound

loud third sound

Question 8

descirbe the first line investigations for MR

Answer 8

ECHO and doppler - regurgitant blood flow

ECG

CXR - enlarged LA and LV in chronic MR, signs of congestive HF

Question 9

how do you manage acute MR

Answer 9

ABDCE

Ionotropes and intra-aortic balloon pumps

Surgery for Mitral valve repair

Question 10

how do you manage chronic MR

Answer 10

anti-coagulation

surgical intervention