Cardiovascular Medicine Book

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Mitral Regurgitation

Aka: Mitral Regurgitation
  1. Pathophysiology
    1. Early or compensated Mitral Regurgitation
      1. Volume overload
      2. Left Ventricular Hypertrophy
      3. Left atrial enlargement
    2. Late or decompensated Mitral Regurgitation
      1. Left Ventricular Failure
      2. Decreased ejection fraction
      3. Pulmonary congestion
  2. Causes
    1. Rheumatic Heart Disease (50%)
    2. Mitral Valve Prolapse
    3. Ischemic Heart Disease and papillary muscle dysfunction
    4. Left Ventricular dilatation
    5. Mitral annular calcification
    6. Hypertrophic Cardiomyopathy
    7. Infective endocarditis
    8. Congenital Mitral Regurgitation
  3. Symptoms
    1. Dyspnea
    2. Fatigue
    3. Weakness
    4. Cough
  4. Signs
    1. Holosystolic Murmur at Apex
      1. Harsh, medium pitched pansystolic murmur
      2. Murmur obliterates M1
      3. Radiation
        1. Axilla
        2. Upper sternal borders
        3. Subscapular region
    2. Soft or diminished First Heart Sound (S1)
    3. P2 heart sound augmented
    4. S2 Heart Sound with wide split
    5. S3 Gallop rhythm (indicative of severe disease)
    6. Accentuated and displaced precordial Apical Thrust
    7. Systolic thrill
  5. Electrocardiogram
    1. Left Ventricular Hypertrophy
    2. Left Axis Deviation
  6. Imaging
    1. Chest XRay
      1. Enlarged left atrium
      2. Dilated left ventricle
    2. Echocardiogram
      1. Enlarged left atrium
      2. Hyperdynamic left ventricle
      3. Doppler assesses severity
  7. Monitoring
    1. Annual or semi-annual echocardiogram
      1. Assess ejection fraction
      2. Assess end-systolic dimension
  8. Management
    1. SBE Prophylaxis
    2. Anticoagulation in Atrial Fibrillation
    3. Treat Congestive Heart Failure
      1. Diuretics
      2. Digoxin
      3. Afterload reduction
        1. ACE Inhibitor
        2. Hydralazine
        3. Nitroprusside IV
    4. Surgery: Mitral Valve repair or replacement
      1. Repair before Heart Failure develops
        1. Keep ejection fraction >60%
        2. Keep end-systolic dimension <45 mm
      2. Indications
        1. Cardiopulmonary Symptoms
        2. Left Ventricular function impaired
  9. References
    1. Kondos (1998) CMEA Medicine Review Lecture, San Diego
    2. Assi (1998) Postgrad Med 104(6):99-110
    3. Bonow (1998) Circulation 98:1949-84
    4. Carabello (1997) N Engl J Med 337(1):32-41
    5. Shipton (2001) Am Fam Physician 63(11):2201-8

Mitral Valve Insufficiency (C0026266)

Definition (NCI) The backward flow of blood from the left ventricle into the left atrium, owing to insufficiency of the mitral valve; it may be acute or chronic, usually due to mitral valve prolapse, rheumatic heart disease or a complication of cardiac dilatation.
Definition (CHV) blood flows backward because the mitral valve closes improperly
Definition (CHV) blood flows backward because the mitral valve closes improperly
Definition (CHV) blood flows backward because the mitral valve closes improperly
Definition (CHV) blood flows backward because the mitral valve closes improperly
Definition (CHV) blood flows backward because the mitral valve closes improperly
Definition (CHV) blood flows backward because the mitral valve closes improperly
Definition (CHV) blood flows backward because the mitral valve closes improperly
Definition (CHV) blood flows backward because the mitral valve closes improperly
Definition (CHV) blood flows backward because the mitral valve closes improperly
Definition (CSP) backflow of blood from the left ventricle into the left atrium, owing to imperfect functioning of the mitral valve.
Definition (NCI) The backward flow of blood from the left ventricle into the left atrium, owing to insufficiency of the mitral valve; it may be acute or chronic, usually due to mitral valve prolapse, rheumatic heart disease or a complication of cardiac dilatation.
Definition (NCI) Dysfunction of the mitral valve, with incomplete valve closure resulting in valvular regurgitation.
Definition (MSH) Backflow of blood from the LEFT VENTRICLE into the LEFT ATRIUM due to imperfect closure of the MITRAL VALVE. This can lead to mitral valve regurgitation.
Concepts Disease or Syndrome (T047)
MSH D008944
ICD10 I34.0
SnomedCT 48724000, 194977007
English Mitral Regurgitation, Mitral Insufficiency, Mitral Valve Insufficiency, Valve Insufficiency, Mitral, MITRAL VALVE, INCOMPETENCY, Mitral Valve Regurgitation, Mitral Incompetence, Mitral Valve Incompetence, Incompetence, Mitral, Incompetence, Mitral Valve, Regurgitation, Mitral, Regurgitation, Mitral Valve, Valve Incompetence, Mitral, Valve Regurgitation, Mitral, Insufficiency, Mitral, Insufficiency, Mitral Valve, MITRAL INSUFFICIENCY, MITRAL VALVE INSUFFICIENCY, MITRAL VALVE REGURGITATION, Mitral incompetence, mitral valve insufficiency, Mitral valve incompetence, NOS, Mitral valve insufficiency, NOS, Mitral valve regurgitation, NOS, Mitral (valve) insufficiency, Mitral regurgitation, NOS, MITRAL VALVE INCOMPETENCE, mitral regurgitation (diagnosis), mitral regurgitation, mr, mitral insufficiency, MITRAL REGURGITATION, INSUFFICIENCY, MITRAL, REGURGITATION, MITRAL, Mitral Valve Insufficiency [Disease/Finding], mitral regurgitation (MR), mitral valve regurgitation, mitral valve incompetence, Incompetence;mitral, mrs, mitral regurgitations, Mitral insufficiency, Mitral regurgitation, Mitral valve insufficiency, MI - Mitral incompetence, MR - Mitral regurgitation, Mitral valve regurgitation, Mitral valve incompetence, Mitral valve regurgitation (disorder), insufficiency; mitral, mitral; insufficiency, mitral incompetence
French INSUFFISANCE MITRALE, Régurgitation mitrale, Insuffisance valvulaire mitrale, INCOMPETENCE MITRALE, Insuffisance mitrale, Insuffisance de la valve mitrale
Italian Insufficienza della valvola mitrale, Rigurgito mitralico, Incompetenza mitralica, Insufficienza della valvola mitralica, Insufficienza mitralica
Dutch mitralisinsufficiëntie, mitralisregurgitatie, insufficiëntie; mitraal, mitraal; insufficiëntie, Mitralis(klep)insufficiëntie, mitralisklepinsufficiëntie, Mitralisrerurgitatie, Insufficiëntie, mitralisklep-, Mitralisinsufficiëntie, Mitralisklepinsufficiëntie
Portuguese Insuficiência mitral, Regurgitação mitral, INSUFICIENCIA DA VALVULA MITRAL, INSUFICIENCIA MITRAL, Insuficiência da válvula mitral, Incompetência da Valva Mitral, Incompetência Mitral, Insuficiência da Valva Mitral, Regurgitação Mitral
Spanish Incompetencia mitral, Regurgitación mitral, Insuficiencia mitral, Mitral valve incompetence, Mitral regurgitation, Mitral valve insufficiency, Mitral valve regurgitation, Mitral incompetence, INSUFICIENCIA MITRAL, incompetencia de la válvula mitral, insuficiencia de la válvula mitral (trastorno), insuficiencia de la válvula mitral, insuficiencia mitral, Insuficiencia de la válvula mitral, Incompetencia de la Válvula Mitral, Incompetencia Mitral, Insuficiencia de la Válvula Mitral, Regurgitación Mitral, Incompetencia de la Valvula Mitral, Insuficiencia de la Valvula Mitral, Regurgitacion Mitral
Japanese 僧帽弁不全, ｿｳﾎﾞｳﾍﾞﾝｷﾞｬｸﾘｭｳ, ｿｳﾎﾞｳﾍﾞﾝﾍｲｻﾌｾﾞﾝｼｮｳ, ｿｳﾎﾞｳﾍﾞﾝﾌｾﾞﾝ, 左房室弁閉鎖不全, 僧帽弁閉鎖不全症, 僧帽弁逆流, 僧帽弁閉鎖不全, 左房室弁閉鎖不全症, 僧帽弁逆流症
Swedish Mitralklaffinsufficiens
Czech mitrální chlopeň - insuficience, Inkompetence mitrální chlopně, Mitrální regurgitace, Mitrální insuficience, Mitrální inkompetence, insuficience mitrální chlopně, regurgitace mitrální chlopně
Finnish Hiippaläpän vuoto
Russian MITRAL'NOGO KLAPANA NEDOSTATOCHNOST', МИТРАЛЬНОГО КЛАПАНА НЕДОСТАТОЧНОСТЬ
German MITRALINSUFFIZIENZ, Mitralinsuffizienz, Mitralklappeninsuffizienz, Mitralregurgitation, Mitralklappenschlußunfähigkeit
Korean 승모(판) 폐쇄부전
Croatian MITRALNA INSUFICIJENCIJA
Polish Wada mitralna, Niedomykalność zastawki mitralnej, Niedomykalność zastawki dwudzielnej
Hungarian Mitralis incompetentia, Mitralis regurgitatio, Mitralis insufficientia, Mitralis billentyű incompetentia
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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