Mitral regurgitation resident survival guide
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Raviteja Guddeti, M.B.B.S. [2]
Overview
Mitral regurgitation is a disorder of the valve of the heart present between the left atrium and left ventricle. Blood from the left ventricle enters the left atrium along with aorta, because of the incompetence of the mitral valve (dual outlet left ventricle).
Classification
Mitral regurgitation can be acute or chronic. Acute mitral regurgitation causes sudden overload of the left atrium and left ventricle and can cause pulmonary congestion. Chronic regurgitation develops over months to years and in this phase the left ventricle develops eccentric hypertrophy in order to compensate for the pressure changes in the heart and if decompensated the left ventricle enters a dysfunctional phase. Long standing volume overload on the left ventricle causes left ventricle to dysfunction.
Causes
Mitral regurgitation (MR) can be caused by either the valve or the ventricle.
Valvular mitral regurgitation is caused by
- Degenerative
Ventricular cause of mitral regurgitation is otherwise called functional MR and it is caused by:
Natural History
Natural history of mitral regurgitation is dictated by the etiology.
- Papillary muscle rupture and deihisced mitral valve prosthesis - poor prognosis without surgery.
- Endocarditis - response to antibiotics decides the natural history and progression of mitral regurgitation.
- Chordal rupture - depends on tolerance of severe MR.
Patients with normal left ventricular function and severe acute pulmonary edema are supposed to have severe MR.
Diagnosis
Symptoms
- Acute miral regurgitation presents with the following symptoms:
- Chronic mitral regurgitation may have a prolonged asymptomatic interval phase before the heart enters a decompensated phase where the patient may have the symptoms of low cardiac output and pulmonary congestion. By the time symptoms develop, left ventricular dysfunction may have already occurred.
Physical Examination
- S3 and S4 may be heard on auscultation.
- A holosystolic murmur is heard in the apex region of the heart and radiating to the axilla. MR murmur may be soft, short and even absent. 70% papillary muscle rupture cases have no murmur.