Mitral Regurgitation

Features

• It is a condition characterized by retrograde blood flow into t left atrium during systole. Acute MR presents with symptoms of pulmonary edema, hypotension and cardiogenic shock.
• Chronic MR may be asymptomatic for years ( or for life ).
• Severe mitral regurgitation may cause left - sided heart failure

On examination

• Apex beat is forceful and displaced with thrill. There is pan - systolic ( holosystolic ) murmur , which radiate to the axilla and increases with expiration
• In patients with mitral prolapse and severe mitral regurgitation earlier surgery is indicated if mitral repair can be performed successfully with a high degree of certainty.
• Patients with functional mitral regurgitation may improve with biventricular pacing. Some may also benefit from surgical intervention or percutaneous repair

Investigations

• ECG may show P - mitrale (due to left atrial hypertrophy) & LVH.
• CXR show enlarged LA and LV, Pulmonary venous congestion and pulmonary edema (acute).
• Echocardiography is the best initial (diagnostic) test and cardiac catheterization is the most accurate test.

Management

• Diuretics
• ACE inhibitors decrease the rate of progression.
• Digoxin if AF is present
• Valve replacement is indicated:
• Ejection fraction is < 60 %
• Left - ventricular end systolic diameter is > 40 mm (4.0 cm)