mitral regurgitation Flashcards
what is mitral regurgitation
Backflow of blood from LV to the LA during systole
causes of mitral regurgitation
Myxomatous degeneration - mitral valve prolapse
Rheumatic heart disease – from rheumatic fever
Infective Endocarditis
Ischaemic mitral valve
Dilated cardiomyopathy
risk factors for mitral regurgitation
Female
Lower BMI
Advanced age
Renal dysfunction
Previous MI
pathology for mitral regurgitation
Pure volume overload due to leakage from LV into LA 🡪LA dilatation
compensatory mechanisms for mitral regurgitation
LA enlargement
LV hypertrophy – since LV must put in same effort to pump less blood
Increased contractility
Progressive LA dilatation and RV dysfunction due to pulmonary hypertension
Progressive LV volume overload leads to dilatation and progressive HF
symptoms of mitral regurgitation
Exertional dyspnoea
Fatigue and lethargy
Palpitations
Right sided HF and can lead to congestive heart failure
signs of mitral regurgitation
Collapsing pulse with wide pulse pressure
Hyperdynamic and displaced apex beat
Heart sounds
what heart sounds can you hear with mitral regurgitation
Soft S1
Pansystolic murmur at apex radiating to axilla
Diastolic blowing murmur at left sternal border
Austin flint murmur (at apex) – regurgitant jet impinges on anterior mitral valve causing it to vibrate
Systolic ejection murmur – due to increased flow across AV
investigations for mitral regurgitation
CXR – shows enlarged LA and LV
Echocardiogram – estimation of LA, LV size and function.
ECG
general treatment for mitral regurgitation
consider IE prophylaxis
medical treatment for mitral regurgutaion
Vasodilators - ACE inhibitors and hydralazine
Rate control for AF – beta blockers, calcium channel blockers, digoxin
Anticoagulant for AF and flutter
Diuretics - furosemide
what are serial echocardiograms used for
to monitor progression
when is surgical treatment used
to replace valve if patient has:
ANY symptoms at rest or exercise
Asymptomatic
If IE < 60%, LVESD > 45mm
If new onset AF/raised PAP
