Mitral Regurgitation

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Mitral Regurgitation

Causes

• Ischaemic Heart Disease
  • secondary to left ventricular dilatation
  • papillary muscle ischaemia
  • infarction
• Rheumatic fever
  • previous mitral valvotomy
• Mitral Valve Prolapse
• infective endocarditis
• connective tissue disorders
  • systemic lupus erythematosus
  • Rheumatoid arthritis
  • ankylosing spondylitis
  • Marfan's syndrome
  • Hypertrophic Obstructive Cardiomyopathy
• congenital

Pathophysiology

Acute

• increased in total stroke volume
• increase in ejection fraction
• decrease in systolic volume
• small hyperkinetic left ventricle
• threat(?) of pulmonary oedema

Chronic

• compensated
  • small hyperkinetic left ventricle
• transitional
  • compliant and enlarging
  • reduced pulmonary venous pressure
• decompensation

History

• asymptomatic until Left ventricle fails
• weakness
• fatigue
• reduced exercise tolerance
• thromboembolism
• haemoptysis
• right-sided congestive failure

Examination

• introduction / exposure
• hands
  • splinter haemorrhages
• pulse
  • brisk upstroke
  • reduced volume
  • sinus rhythm / Atrial Fibrillation
• blood pressure
• neck
• Praecordium
  • inspect
    • visible apex beat
  • palpate
    • apex
      • displaced
      • hyperdynamic / thrusting
    • systolic thrill
    • palpable S3
    • parasternal heave
      • large left atrium
  • auscultation
    • S1 diminished
    • S2 widely split - early closure A2, pulmonary hypertension leading to late P2
    • S3
    • S4 if left ventricular hypertrophy
    • murmur
      • if not prolapse
      • pan-systolic
      • radiates from apex to axilla
• lung bases
• ankle oedema

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