Mitral Regurgitation
Not yet clinically reviewed
This protocol was migrated from the earlier Pharmapedia and Ward Guide apps for educational use. Follow your hospital's own policies and consult seniors when in doubt.
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)