Mitral Regurgitation

1. MitralRegurgitation

2. • Mitral regurgitation(MR) mayresultfromanabnormalityor disease process that affectsanyone or
moreof thefivefunctional components of themitralvalveapparatus
1. leaflets
2. annulus
3. chordae tendineae
4. papillarymuscles,and
5. subjacent myocardium

3. Etiology
AcuteCauses
• Infective Endocarditis
• Papillarymusclerupture(post-MI)
• Chordal rupture/leafletflail(MVP, IE)
• Blunt trauma

4. Chronic Causes
Primary (affecting leaflets,
chordae)
1. Myxomatous (MVP,Barlow’s)
2. Rheumatic fever
3. IE (healed)
4. Congenital (cleft, AV canal)
Radiation
Secondary (leaflets, chordae are
“innocent bystanders”)
1. Ischemic cardiomyopathy
2. Dilated cardiomyopathy
3. HOCM (with SAM)
4. Chronic AF withLA enlargement and
annulardilatation

5. Pathophysiology
Acute MR-
• The regurgitant blood flows into small left atrium causing acute
elevation of LAP and pulmonary arterial pressure
• Left ventricle is unable to effectively increase cardiac output
• Both these factors lead to acute pulmonary edema and cardiogenic
shock .

6. Chronic MR

7. Symptoms
1. Palpitations –most common
2. Fatigability , weakness , exhaustion ,loss of weight – Symptoms of
reduced cardiac output
3. Exertional breathlessness , orthopnea and PND – Symptoms of LVF

8. Signs
1. Pulse – pseudocollapsing in severe MR (rapid upstroke,rapid
downstroke and sustained peak )
2. Blood pressure – wide pulse pressure in severe MR
3. JVP – Normal
4. Apex – hyperdynamic

9. Heart sounds
1. S1 –Soft (d/t loss of coaptation)
2. S2 –Early A2 (wide split A2)
3. S3 – present in moderate to severe MR
4. S4 -Not heard

10. Murmur
• High pitched ,blowing, Pansystolic
• Radiating to left axilla
• Heard best in left lateral position .