Causes of Mitral Regurgitation
• Chronic rheumatic heart disease.
• Mitral valve prolapse.
• Papillary muscle dysfunction.
• Infective endocarditis.
• Trauma or mitral valvotomy.
• Connective tissue diseases (rheumatoid arthritis, SLE, Marfan’s syndrome, Ehler-Danlos
syndrome).
• Ankylosing spondylitis.
• Cardiomyopathy.
• Secondary to left ventricular dilatation (hypertension, aortic valve disease).
Symptoms
• Breathlessness on exertion.
• Palpitation.
• Cough.
• Weakness.
Signs
Precordium
• Inspection:
–– Visible cardiac impulse in mitral area.
• Palpation:
–– Apex beat is shifted, diffuse, thrusting in character.
–– Systolic thrill in mitral area.
• Auscultation:
–– 1st heart sound—soft in mitral area, normal in other areas.
–– 2nd sound—normal in all the areas.
• Pansystolic murmur in mitral area, which radiates to the left axilla.
Investigations
• X-ray chest P/A view (cardiomegaly may be found).
• ECG (LVH, LAH).
• Echocardiogram, preferably colour doppler.
• Cardiac catheterization may be needed in some cases.
Complications
• Acute LVF.
• Infective endocarditis.
• Embolism.
• Arrhythmia (atrial fibrillation, ectopics).
• CCF.
Treatment
• In mild to moderate case—
–– Diuretic—frusemide or thiazide.
–– Vasodilator—ACE inhibitor.
–– If fast AF—digoxin.
–– Anticoagulant if associated AF or history of pulmonary embolism.
–– Prophylactic penicillin to prevent endocarditis.
–– Follow-up every 6 months by echocardiogram.
–– If ejection fraction falls to 55% and left ventricular dilatation > 60 mm, valve replacement
may be considered.
• In severe MR—replacement of valve.
Indications of Surgery in MR
• Symptomatic MR.
• Asymptomatic patient with severe MR with mild to moderate LV dysfunction or pulmonary
hypertension.