Mitral regurgitation

Mitral regurgitation

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  MITRAL REGERGITATION K. KavindyaM. Fernando JMJ 1
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  Mitral regergitation • Mitralvalve – Consist of fibrous annulus, – Anterior & posterior leaflets – Chordae tendinae, – Papillary muscle JMJ 2
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  Causes • Can bedue to abnormalities of the – valve leaflets – Annulus – Chordae tendineae – Papillary muscle of the left ventricle JMJ 3
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  Causes • Most commoncauses – Degenerative (myxomatous) disease – Ischemic heart disease – Rheumatic heart disease – Infectious endocarditis JMJ 4
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  Causes • MR alsoseen 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 JMJ 5
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  Pathophysiology • Due toregurgitation 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 JMJ 6
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  Pathophysiology • Thus inacute 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 JMJ 7
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  Pathophysiology JMJ 8
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  Pathophysiology JMJ 9
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  Pathophysiology JMJ 10
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  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 JMJ 11
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  Signs • Pulse :sinus rhythm or atrial fibrillation • Apex: Forceful, displaced, Systolic thrill • Sounds : Soft S1, S3 • Murmurs: Pansystolic JMJ 12
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  Signs JMJ 13
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  Signs of uncomplicatedMR • 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 JMJ 14
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  Investigation • Chest X-ray •Electrocardiogram • Echocardiogram • Cardiac catheterization JMJ 15
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  Investigation – X-ray •Left atrial, Left ventricular enlargement • Increase in CTR, and valve calcification is seen JMJ 16
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  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) JMJ 17
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  Investigation – ECG JMJ18
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  Investigation – Echocardiogram •Dilate left atrium and left ventricle • May be specific features of chordal or papillary muscle rupture • TOE can be done JMJ 19
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  Treatment • Prophylaxis againstendocarditis • Any evedence of progressive cardiac enlargement  surgical – Mitral valve repair – Mitral valve replacement JMJ 20
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  Prolapsing (Billowing) mitralvalve • 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 JMJ 21
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  JMJ 22