Mitral regurgitation causes: Difference between revisions

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|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | Dysfunction or injury to the mitral valve following a heart attack, [[papillary muscle rupture]] or dysfunction that is associated with [[ST elevation myocardial infarction]], infection of the heart valve (infective endocarditis), [[mitral valve prolapse]] (accounts for 45% of cases in the western world <ref name='MedicineNetMVP-Kulick'>{{cite web|url=http://www.medicinenet.com/mitral_valve_prolapse/article.htm|title=Mitral Valve Prolapse (MVP) |accessdate=2010-01-18 |last=Kulick |first=Daniel |work=MedicineNet.com |publisher=MedicineNet, Inc }}</ref>, MVP is a common cause. However, most patients with MVP do not develop severe mitral regurgitation. Older age, male gender, and auscultatory evidence of severe MR are prognostic clues that identify patients with mitral valve prolapse who are at a relatively high risk of complications), [[ischemic heart disease]] ([[coronary artery disease]]), [[rheumatic heart disease]] (this was the most common cause of MR in the western world), [[balloon valvuloplasty]] of the mitral valve, heart tumors, high blood pressure and swelling of the left lower heart chamber.
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | Dysfunction or injury to the mitral valve following a heart attack, [[papillary muscle rupture]] or dysfunction that is associated with [[ST elevation myocardial infarction]], infection of the heart valve (infective endocarditis), [[mitral valve prolapse]] (accounts for 45% of cases in the western world <ref name='MedicineNetMVP-Kulick'>{{cite web|url=http://www.medicinenet.com/mitral_valve_prolapse/article.htm|title=Mitral Valve Prolapse (MVP) |accessdate=2010-01-18 |last=Kulick |first=Daniel |work=MedicineNet.com |publisher=MedicineNet, Inc }}</ref>, MVP is a common cause. However, most patients with MVP do not develop severe mitral regurgitation. Older age, male gender, and auscultatory evidence of severe MR are prognostic clues that identify patients with mitral valve prolapse who are at a relatively high risk of complications), [[ischemic heart disease]] ([[coronary artery disease]]), [[rheumatic heart disease]] (this was the most common cause of MR in the western world), [[balloon valvuloplasty]] of the mitral valve, heart tumors, high blood pressure and swelling of the left lower heart chamber.
Dilatation of the [[left ventricle]], causing stretching of the [[mitral valve]] annulus and displacement of the [[papillary muscles]] ( causes include [[dilated cardiomyopathy]], [[aortic insufficiency]] and [[Takotsubo cardiomyopathy]] <ref name="pmid19774331">{{cite journal |author=Haghi D, Röhm S, Suselbeck T, Borggrefe M, Papavassiliu T |title=Incidence and clinical significance of mitral regurgitation in Takotsubo cardiomyopathy |journal=[[Clinical Research in Cardiology : Official Journal of the German Cardiac Society]] |volume=99 |issue=2 |pages=93–8 |year=2010 |month=February |pmid=19774331 |doi=10.1007/s00392-009-0078-1 |url=http://dx.doi.org/10.1007/s00392-009-0078-1 |accessdate=2011-04-16}}</ref><ref name="pmid17692942">{{cite journal |author=Brunetti ND, Ieva R, Rossi G, Barone N, De Gennaro L, Pellegrino PL, Mavilio G, Cuculo A, Di Biase M |title=Ventricular outflow tract obstruction, systolic anterior motion and acute mitral regurgitation in Tako-Tsubo syndrome |journal=[[International Journal of Cardiology]] |volume=127 |issue=3 |pages=e152–7 |year=2008 |month=July |pmid=17692942 |doi=10.1016/j.ijcard.2007.04.149 |url=http://linkinghub.elsevier.com/retrieve/pii/S0167-5273(07)01161-8 |accessdate=2011-04-16}}</ref>).
Dilatation of the [[left ventricle]] <ref>[http://www.uptodate.com/patients/content/topic.do?topicKey=~Ux3kbGWsXmiaqiH Functional mitral regurgitation] By William H Gaasch, MD. Retrieved on Jul 8, 2010</ref>, causing stretching of the [[mitral valve]] annulus and displacement of the [[papillary muscles]] ( causes include [[dilated cardiomyopathy]], [[aortic insufficiency]] and [[Takotsubo cardiomyopathy]] <ref name="pmid19774331">{{cite journal |author=Haghi D, Röhm S, Suselbeck T, Borggrefe M, Papavassiliu T |title=Incidence and clinical significance of mitral regurgitation in Takotsubo cardiomyopathy |journal=[[Clinical Research in Cardiology : Official Journal of the German Cardiac Society]] |volume=99 |issue=2 |pages=93–8 |year=2010 |month=February |pmid=19774331 |doi=10.1007/s00392-009-0078-1 |url=http://dx.doi.org/10.1007/s00392-009-0078-1 |accessdate=2011-04-16}}</ref><ref name="pmid17692942">{{cite journal |author=Brunetti ND, Ieva R, Rossi G, Barone N, De Gennaro L, Pellegrino PL, Mavilio G, Cuculo A, Di Biase M |title=Ventricular outflow tract obstruction, systolic anterior motion and acute mitral regurgitation in Tako-Tsubo syndrome |journal=[[International Journal of Cardiology]] |volume=127 |issue=3 |pages=e152–7 |year=2008 |month=July |pmid=17692942 |doi=10.1016/j.ijcard.2007.04.149 |url=http://linkinghub.elsevier.com/retrieve/pii/S0167-5273(07)01161-8 |accessdate=2011-04-16}}</ref>).


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| '''Rheum / Immune / Allergy'''
| '''Rheum / Immune / Allergy'''
|bgcolor="Beige"| [[Collagen vascular disease]]s; [[Systemic Lupus Erythematosus|SLE]] and [[Marfan's syndrome]].
|bgcolor="Beige"| [[Collagen vascular disease]]s; [[Systemic Lupus Erythematosus|SLE]] and [[Marfan's syndrome]] <ref name=agabegi2nd-ch1/>.


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===Chronic Mitral Regurgitation===
*'''Developed World:''' [[Mitral valve prolapse]] ([[MVP]]).<ref name='MedicineNetMVP-Kulick'>{{cite web|url=http://www.medicinenet.com/mitral_valve_prolapse/article.htm|title=Mitral Valve Prolapse (MVP) |accessdate=2010-01-18 |last=Kulick |first=Daniel |work=MedicineNet.com |publisher=MedicineNet, Inc }}</ref> 
*'''Developing World:''' [[Rheumatic heart disease]]
*[[Ischemic mitral regurgitation]]: [[Ischemic heart disease]] causes mitral regurgitation by the combination of ischemic dysfunction of the [[papillary muscles]], the abnormal motion of the underlying wall, and the dilatation of the [[left ventricle]] that is present in ischemic heart disease, with the subsequent displacement of the papillary muscles and the dilatation of the [[mitral valve]]annulus.
*Secondary mitral regurgitation due to the dilatation of the [[left ventricle]], caused by stretching of the mitral valve annulus and displacement of the papillary muscles.  This dilatation of the left ventricle can be due to any cause of [[dilated cardiomyopathy]], including [[aortic insufficiency]], nonischemic dilated [[cardiomyopathy]] and [[Noncompaction Cardiomyopathy]]. It is also called '''functional mitral regurgitation''', because the papillary muscles, chordae, and valve leaflets are usually normal.<ref>[http://www.uptodate.com/patients/content/topic.do?topicKey=~Ux3kbGWsXmiaqiH Functional mitral regurgitation] By William H Gaasch, MD. Retrieved on Jul 8, 2010</ref>
*[[Marfan's syndrome]] <ref name=agabegi2nd-ch1/>


===Acute Mitral Regurgitation===
===Acute Mitral Regurgitation===

Revision as of 14:39, 16 September 2011

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]; Varun Kumar, M.B.B.S.; Lakshmi Gopalakrishnan, M.B.B.S.; Mohammed A. Sbeih, M.D. [3]

Overview

Regurgitation means leaking from a valve that doesn't close all the way. It is caused by diseases that weaken or damage the valve or its supporting structures. Mitral regurgitation becomes chronic when the condition persists rather than occurring for only a short time period. The causes of chronic mitral regurgitation should be distinguished from the acute mitral regurgitation causes.

Common Causes of Mitral Regurgitation

  • Acute Mitral Regurgitation.
  • Dysfunction or injury to the mitral valve following a heart attack. Papillary muscle rupture or dysfunction that is associated with ST elevation myocardial infarction.
  • Infection of the heart valve (infective endocarditis). These conditions may rupture the valve or surrounding structures, leaving an opening for blood to move backwards.
  • Trauma.
  • Chronic Mitral Regurgitation.

Complete Differential Diagnosis of the Causes of Mitral Regurgitation

(By organ system)

Cardiovascular Dysfunction or injury to the mitral valve following a heart attack, papillary muscle rupture or dysfunction that is associated with ST elevation myocardial infarction, infection of the heart valve (infective endocarditis), mitral valve prolapse (accounts for 45% of cases in the western world [1], MVP is a common cause. However, most patients with MVP do not develop severe mitral regurgitation. Older age, male gender, and auscultatory evidence of severe MR are prognostic clues that identify patients with mitral valve prolapse who are at a relatively high risk of complications), ischemic heart disease (coronary artery disease), rheumatic heart disease (this was the most common cause of MR in the western world), balloon valvuloplasty of the mitral valve, heart tumors, high blood pressure and swelling of the left lower heart chamber.

Dilatation of the left ventricle [2], causing stretching of the mitral valve annulus and displacement of the papillary muscles ( causes include dilated cardiomyopathy, aortic insufficiency and Takotsubo cardiomyopathy [3][4]).

Chemical / poisoning No underlying causes
Dermatologic No underlying causes
Drug Side Effect Certain forms of medication (e.g. fenfluramine) can cause mitral regurgitation.
Ear Nose Throat No underlying causes
Endocrine No underlying causes
Environmental No underlying causes
Gastroenterologic No underlying causes
Genetic No underlying causes
Hematologic No underlying causes
Iatrogenic No underlying causes
Infectious Disease Infective endocarditis (the predominant organism is S. aureus, but varies depending upon the patient [5]) and untreated syphilis (rare).
Musculoskeletal / Ortho No underlying causes
Neurologic No underlying causes
Nutritional / Metabolic No underlying causes
Obstetric/Gynecologic No underlying causes
Oncologic No underlying causes
Opthalmologic No underlying causes
Overdose / Toxicity No underlying causes
Psychiatric No underlying causes
Pulmonary No underlying causes
Renal / Electrolyte No underlying causes
Rheum / Immune / Allergy Collagen vascular diseases; SLE and Marfan's syndrome [5].
Sexual No underlying causes
Trauma Trauma to the heart (stab wound).
Urologic No underlying causes
Miscellaneous Congenital (present from birth) mitral regurgitation is most often part of a more complex heart defect or syndrome,

Differential Diagnosis of the Causes of Acute Mitral Regurgitation

In alphabetical order:












Differential Diagnosis of the Causes of Chronic Mitral Regurgitation

In alphabetical order:



Acute Mitral Regurgitation

References

  1. ↑ Kulick, Daniel. "Mitral Valve Prolapse (MVP)". MedicineNet.com. MedicineNet, Inc. Retrieved 2010-01-18.
  2. ↑ Functional mitral regurgitation By William H Gaasch, MD. Retrieved on Jul 8, 2010
  3. ↑ Haghi D, Röhm S, Suselbeck T, Borggrefe M, Papavassiliu T (2010). "Incidence and clinical significance of mitral regurgitation in Takotsubo cardiomyopathy". Clinical Research in Cardiology : Official Journal of the German Cardiac Society. 99 (2): 93–8. doi:10.1007/s00392-009-0078-1. PMID 19774331. Retrieved 2011-04-16. Unknown parameter |month= ignored (help)
  4. ↑ Brunetti ND, Ieva R, Rossi G, Barone N, De Gennaro L, Pellegrino PL, Mavilio G, Cuculo A, Di Biase M (2008). "Ventricular outflow tract obstruction, systolic anterior motion and acute mitral regurgitation in Tako-Tsubo syndrome". International Journal of Cardiology. 127 (3): e152–7. doi:10.1016/j.ijcard.2007.04.149. PMID 17692942. Retrieved 2011-04-16. Unknown parameter |month= ignored (help)
  5. ↑ 5.0 5.1 5.2 5.3 Elizabeth D Agabegi; Agabegi, Steven S. (2008). Step-Up to Medicine (Step-Up Series). Hagerstwon, MD: Lippincott Williams & Wilkins. ISBN 0-7817-7153-6. Chapter 1: Diseases of the Cardiovascular system > Section: Valvular Heart Disease

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