Aidan at 11:10, 3 August 2020

2020-08-03T11:10:39Z

Aidan: Text replacement - "Clinical Presentation" to "Clinical Manifestations"

2020-07-19T12:17:26Z

Text replacement - "Clinical Presentation" to "Clinical Manifestations"

← Older revision		Revision as of 12:17, 19 July 2020
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	** Otherwise		** Otherwise

	== Clinical ~~Presentation~~ ==		== Clinical Manifestations ==

	=== Physical Examination ===		=== Physical Examination ===

Maintenance script: Imported from text file

2020-07-04T01:17:45Z

Imported from text file

New page

== Definition ==

* Incompetent mitral valve allowing backflow across the annulus
* Can be ''primary'', from myxomatous degeneration or senescence, or ''secondary'', from LV dilatation and functional regurgitation

== Etiology ==

* Inflammatory
** Rheumatic heart disease
** Lupus
** Scleroderma
** Rheumatoid arthritis
* Degenerative
** Myxomatous degeneration (MVP)
** Marfan syndrome
** Ehlers-Danlos syndrome
* Infective endocarditis, after healing
* Structural
** Ruptured chordae tendinae (spontaneous, post-MI, MVP, trauma, IE)
** Ruptured or dysfunctional papillary muscle (MI)
** Mitral annular dilatation from LV dysfunction (also called secondary MR)
** Hypertrophic cardiomyopathy (due to systolic anterior motion of the MV; SAM)
** Paravalvular leak of prosthetic valve
* Congenital
** MV cleft or fenestration
** Parachute mitral valve

== Pathophysiology ==

* LV compensates by eccentric hypertrophy (increased LV end-diastolic volume)
* LVEF supra-normal >60%
* LA dilates to compensate for MR and maintain normal LA pressure

== Grading ==

* Severe
** Central jet >40% of LA
** Holosystolic eccentric jet of MR
** Vena contracta ≥0.7cm
** Regurgitant volume ≥60ml
** Regurgitant fraction ≥50%
** ERO ≥0.4cm2
** Other findings: LA enlargement and high RVSP
* Secondary MR
* Severe
** ERO ≥0.2
** Regurgitant volume ≥30ml
** Regurgitant fraction ≥50%
* Progressive
** Otherwise

== Clinical Presentation ==

=== Physical Examination ===

* Palpation
** PMI is prominent and displaced left
** Systolic expansion of LA may be palpable in RSB
* Auscultation
** Soft S1
** Widely split S2 (A2 occurs early because decreased forward flow over the aortic valve)
** Holosystolic, blowing, high-pitched murmur at the apex
** May hear S3

== Investigations ==

* Consider TEE if severity or mechanism is unclear fro TEE, especially if eccentric jet
* Consider cardiac MRI if volumes are unclear from TTE
* Consider exercise echo if discrepancy between severity on TTE and symptoms

== Management ==

* ACEi, beta blocker, MRA for HFrEF if surgery not planned
* Don't use vasodilators unless hypertensive
* Surgery: repair preferred to replacement when possible
** Symptomatic severe LVEF >30%
** Asymptomatic severe with LVEF ≤060% or LVESD ≥40mm
** Undergoing another cardiac surgery
** Asymptomatic chronic severe with normal LVEF and dimesion in whome likelihood of successful repair iss >95% and expected mortality <1%
** Asymptomatic severe with new AFib or resting pHTN
* Secondary MR
** Treat the LV first per heart failure guidelines
** Consider CRT (cardiac resynchronization therapy) before valvular intervention
** Surgery if
*** Undergoing another cardiac surgery like CABG and AVR
*** Consider for severe symptomatic patients

[[Category:Cardiology]]

Mitral regurgitation - Revision history

Aidan at 11:10, 3 August 2020

Aidan: Text replacement - "Clinical Presentation" to "Clinical Manifestations"

Maintenance script: Imported from text file