Mitral Regurgitation

• What is mitral regurgitation?


  Incomplete closure of valve -> retrograde blood flow from LV into LA during systole
• How can mitral regurgitation lead to HF?


  As degree of regurgitation becomes more severe → body’s O2 demand may exceed CO → cardiac hypertrophy → overtime, myocardium becomes less efficient & eventually leads to HF
• What are the signs & symptoms of mitral regurgitation?


  Mostly asymptomatic

  SOB OE

  Decreased exercise tolerance

  Fatigue

  Pansystolic murmur (often 'blowing', heard best at apex, radiates to axilla)

  S1 may be quiet

  Widely split S2 (severe MR)
• What are the RFs of mitral regurgitation?


  Female

  Lower BMI

  Renal dysfunction

  Prior MI/ischaemia

  Prior mitral stenosis or valve prolapse

  IE

  Collagen disorders

  Hx of rheumatic fever

  Hypertrophic cardiomyopathy

  HTN
• What are the Inx of mitral regurgitation?


  Obs

  Full Hx & examination

  ECG

  Bloods (FBC, U&Es, LFTs, CRP)

  CXR

  Echo (crucial in diagnosis & assessing severity)
• What will an ECG show in MR?


  Broad P wave or prior infarction
• What may a CXR show in MR?


  Cardiomegaly
• What are the DDx of MR?


  ACS

  IE

  Other valvular disease

  Atrial myxoma
• What is the treatment & management of acute severe MR?


  Emergency surgery

  • Repair or replace supporting valve structures
  • Prosthetic ring can be inserted to reshape valve
  • Prior to surgery, reduce afterload via diuretics, sodium nitroprusside, and/or intra-aortic balloon counterpulsation
• What is the treatment & management of chronic severe MR?

  Asymptomatic

  • Consider surgery (if LVEF < 60%)
  • Or watchful waiting

  Symptomatic

  • Surgery
  • If surgery cannot be done → transcatheter mitral valve intervention or extended HF management

  Secondary MR

  • Medical therapy (to manage HF)
  • Surgery
  • If surgery cannot be done → transcatheter mitral valve intervention or extended HF management