Mitral regurgitation

Question 1

Define mitral regurgitation

Answer 1

Retrograde flow of blood from left ventricle to left atrium during systole

Question 2

Explain the aetiology/risk factors of mitral regurgitation

Answer 2

Broadly speaking, it is caused by mitral valve damage
or dysfunction, which, in turn could be caused by
any of the following:
Rheumatic heart disease (MOST COMMON)

Infective endocarditis

Mitral valve prolapse

Papillary muscle rupture or dysfunction (secondary to IHD or cardiomyopathy)

Chordal rupture and floppy mitral valve associated with connective tissue disease (e.g. Ehlers-Danlos syndrome, Marfan’s syndrome)

Question 3

Summarise the epidemiology of mitral regurgitation

Answer 3

Affect ~5% of adults

Mitral valve prolapse is common in young females

Question 4

Recognise the presenting symptoms of mitral regurgitation

Answer 4

Acute MR-may present with symptoms of
left ventricular failure

Chronic MR-may be asymptomatic or present with:
Exertional dyspnoea
Palpitations if in AF
Fatigue

Mitral Valve Prolapse- asymptomatic or atypical chest pain or palpitation

Question 5

Recognise the signs of mitral regurgitation on physical examination

Answer 5

Pulse may be irregularly irregular (if in AF)

Laterally displaced apex beat with thrusting (due to left ventricular dilation)

Pansystolic murmur - Loudest at apex beat, Radiating to the axilla

Soft S1
S3 may be heard due to rapid ventricular filling in early diastole

Signs of left ventricular failure in acute mitral regurgitation

Mitral Valve Prolapse
Mid-systolic click
Late systolic murmur
The click moves towards S1 when standing and away when lying down

Question 6

Identify appropriate investigations for mitral regurgitation

Answer 6

ECG - NORMAL
May show AF or p mitrale (indicates left atrial hypertrophy)

CXR
ACUTE mitral regurgitation may produce signs of left ventricular failure
CHRONIC mitral regurgitation shows:
Left atrial enlargement
Cardiomegaly (due to LV dilation)
Mitral valve calcification (if rheumatic heart disease is
the cause)

Echocardiography
Performed every 6-12 months in moderate-severe MR
Allows assessment of LV ejection fraction and end-systolic dimension