This document discusses how to evaluate mitral regurgitation using ECG and x-ray imaging. It outlines key things to examine on an ECG such as rate, rhythm, axis, waves, and intervals. It also describes what to examine on a chest x-ray such as views, exposure, cardiac position and size, and changes to the lungs that indicate pulmonary artery or vein hypertension. The document provides grading scales for pulmonary artery and vein hypertension based on x-ray findings.

1. MITRAL REGURGITATION
- ECG, X-Ray

2. • CALIBRATION
• RATE,RHYTHM
• AXIS
• WAVE MORPHOLOGY
• INTERVALS
• ST SEGMENT
Approaching ECG

3. ECG changes in MR
• LA enlargement
• LEFT AXIS DEVIATION / NORMAL AXIS / RIGHT AXIS DEVIATION
• LVH / RVH
• ATRIAL FIBRILLATION

4. RATE,RHYTHM

5. AXIS

6. WAVES
INTERVALS

8. X-Ray in MR
• VIEW
• EXPIRATORY OR INSPIRATORY
• MARKER LOCATION
• EXPOSURE
• CENTRALISATION
• ABDOMINAL SITUS
• BRONCHIAL SITUS
• CARDIAC POSITION
• CARDIAC APEX
• CTR
• CHAMBER ENLARGEMENTS
• PULMONARY VASCULAR CHANGES

11. 210.10 imager mm
45.39 imager mm

17. PAH Grade X-Ray findings
Mild (25-40mmHg) MPA Dilatation
Moderate (41-55mmHg) MPA Dilatation
RD PA Dilatation (>
14mm)
Peripheral pruning
Severe (>55mmHg) MPA Dilatation (+/-
Calcification)
Hilar prominence
Severe pruning
Loss of retrosternal space
(RV Enlargement
PVH Grade X-Ray findings
Mild (13-18mm Hg) Staghorn Sign
Moderate (19-24mmHg) Kerley A,B,C lines
Peribronchial Cuffing
Severe (>25mm Hg) Cotton wool/Batwing
appearance.
Pleural edema.
Ossific nodule.
Left Ventricular Enlargement
• CTR
• LV Type Apex
MITRAL VALVE CALIFICATION
Left atrial enlargement
• Straightening of the left heart border
• Double atrial shadow
• Elevated left bronchus
• Widening of the carinal angle
• Walking man sign
• Posterior displacement of the esophagus

18. Thank You