Cardiovascular Medicine Book

http://www.fpnotebook.com/

Mitral Regurgitation

Advertisement

  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
    3. Bonow (1998) Circulation 98:1949
    4. Carabello (1997) N Engl J Med 337(1):32
    5. Shipton (2001) Am Fam Physician 63(11):2201

Mitral Valve Insufficiency (C0026266)

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.
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)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.
ConceptsDisease or Syndrome (T047)
MSHD008944
EnglishMI - Mitral incompetence, Mitral Incompetence, Mitral Insufficiency, MITRAL REGURGITATION, Mitral Valve Incompetence, Mitral Valve Insufficiency, Mitral Valve Regurgitation, MR - Mitral regurgitation
Spanishincompetencia de la valvula mitral, insuficiencia de la valvula mitral, insuficiencia mitral
Parent ConceptsValvular regurgitation (C0042300), Heart valve disease (C0018824), Mitral Valve Insufficiency (C0026266), Diseases of mitral valve (C0026265), Heart valve regurgitation (C0264879)
SourcesCOSTAR, CSP, CST, DXP, LCH, MSH, MTH, NCI, NDFRT, OMIM, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)



Navigation Tree