The document discusses mitral regurgitation, detailing its causes such as degenerative disease, ischemic heart disease, and infectious endocarditis. It explains the pathophysiology, symptoms, signs, and investigation methods including echocardiograms and electrocardiograms. Treatment options are mentioned, focusing on prophylaxis against endocarditis and options for surgical intervention if progressive cardiac enlargement is detected.

1. MITRAL REGERGITATION
K. Kavindya M. Fernando
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2. Mitral regergitation
• Mitral valve
– Consist of fibrous annulus,
– Anterior & posterior leaflets
– Chordae tendinae,
– Papillary muscle
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3. Causes
• Can be due to abnormalities of the
– valve leaflets
– Annulus
– Chordae tendineae
– Papillary muscle of the left ventricle
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4. Causes
• Most common causes
– Degenerative (myxomatous) disease
– Ischemic heart disease
– Rheumatic heart disease
– Infectious endocarditis
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5. Causes
• MR also seen in diseases of the
myocardium (dialated and hypertrophic
cardiomyopathy),
• Rheumatic autoimmune diseases
• Eg: SLE
• Collagen diseases
• Eg: Marfan’s syndrome
• Ehlers –Danlos syndrome
• Drugs inducing centrally acting appetite
suppressants, and dopamine agonists
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6. Pathophysiology
• Due to regurgitation into L atrium
– L/ atrium dilates
– Little increase in left atrial pressure if the
regurgitation is long standing
• In acute MR
– L/ atriam does not dilate
– So pressure inside it increases
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7. Pathophysiology
• Thus in acute MR
– Left arterial v-wave is greatly increased
– Pulmonary venous pressure rises to produce
pulmonary edema
• Proportion of the stroke volume
regurgitate
• Stroke volume increases to maintain CO
• So Left ventricle enlarges
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8. Pathophysiology
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9. Pathophysiology
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10. Pathophysiology
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11. Symptoms
• Increased SV 
– symptoms of R/ heart failure
– Eventually leads to congestive cardiac failure
• Cardiac cachexia may developed
• Thromboembolism is less common
• Sub-acute infective endocarditis is much
more commoner
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12. Signs
• Pulse : sinus rhythm or atrial
fibrillation
• Apex: Forceful, displaced,
Systolic thrill
• Sounds : Soft S1, S3
• Murmurs: Pansystolic
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13. Signs
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14. Signs of uncomplicated MR
• Laterally displaced diffuse apex beat and a
systolic thrill
• Soft 1st heart sound
• Pansystolic murmur
– Loudest at apex
– Radiating widely over the precordium & into
the axilla
• With a floppy mitral valve : there may be a
mild systolic click
• Prominent 3rd heart
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15. Investigation
• Chest X-ray
• Electrocardiogram
• Echocardiogram
• Cardiac catheterization
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16. Investigation – X-ray
• Left atrial, Left ventricular
enlargement
• Increase in CTR, and valve calcification
is seen
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17. Investigation – ECG
• Features of
– left atrial delay (bifid P wave)
– Left ventricular hypertrophy
• Tall R waves in left lateral leads (I & V6)
• Deep S wave in R sided precordial area ( V1, V2)
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18. Investigation – ECG
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19. Investigation – Echocardiogram
• Dilate left atrium and left ventricle
• May be specific features of chordal or
papillary muscle rupture
• TOE can be done
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20. Treatment
• Prophylaxis against endocarditis
• Any evedence of progressive cardiac
enlargement  surgical
– Mitral valve repair
– Mitral valve replacement
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21. Prolapsing (Billowing) mitral valve
• Barlow’s syndrome/ floppy mitral valve
• Due to excessively large mitral valve
leaflets,enlarged mitral annulus
• More common in young females
• Cause is unknown but associate with
Marfan’s syndrome, thyrotoxicosis,
rheumatic or ischemic heart disease
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