Mitral regurgitation (MR)

Aetiology:

• Rheumatic fever (50% of cases)
• Prolapsed mitral valve
• Any disease that causes LV dilatation;
• Aortic valve disease
• Myocarditis
• Dilated cardiomyopathy
• Hypertensive heart disease
• IHD

• IE
• Connective tissue disorders (e.g. SLE)
• Marfan’s syndrome

Symptoms:

• Asymptomatic for many years
• Palpitations (due to the increased SV)
• Dyspnoea/orthopnoea owing to pulmonary HT
• Fatigue/lethargy due to the reduced cardiac output
• In the late stages of the disease, the symptoms of right-heart failure also occur, culminating in congestive cardiac failure
• Cardiac cachexia may develop
• Subacute IE is quite common

Signs:

Pulse: Sinus rhythm or AF

Apex: Thrusting, displaced, systolic thrill

Sound: Soft S1, S3

Murmur: Pansystolic

Investigations:

CXR:

• Left atrial/ventricle enlargement
• Cardiomegaly

ECG:

• P mitrale (left atrial delay)
• Left ventricular hypertrophy:
• Left axis deviation

• AF may be present

Echocardiography

Treatment:

• Asymptomatic, mild MR can be managed conservatively by following the pt with serial echocardiograms
• Antibiotic prophylaxis against IE is required
• Any evidence of progressive cardiac enlargement generally warrants early surgical intervention, by either mitral valve repair or replacement
• For those patients who are not considered appropriate for surgical intervention, or in whom surgery will be considered at a later date:
• ACEIs
• Diuretics
• Anticoagulants (possibly)