• Mitral Regurgitation (most common)!

    by  • 08/10/2013 • Cardiology

    Definition

    mitral valve does not close properly when the heart pumps out blood. MR is the most common form of valve disease

    Secondary mitral regurgitation is due LVH, causing stretching of the mitral valve annulus and displacement of the papillary muscles.

    Presenting complaint

    1. p/c: compensated, decompensated (=LHF = SOB, pulmonary oedema, decreased exercise tolerance, PND, orthopnoea, low CO and ejection fraction),

     

    Murmur: pansystolic murmur which is high pitched and radiates to the axilla, may have S3.

    1. Patients with mitral valve prolapse (MVP) often have a mid-to-late systolic click and a late systolic murmur

    Diagnostic tools/investigations

    1. ECG (LVH/AF)
    2. CXR
    3. Echo/USS
    4. TOE – to detect severity of MR

     

    Aetiology: Marfans, RF, hypertrophic CMP, myxamatous degeneration (degen of connective tissues in heart) which often = MVP = MR.

    Treatment and management (conservative/medical/surgical)

    1. Acute = repair damage/valve replacement

     

    If the individual with acute mitral regurgitation is normotensive, vasodilators may be of use to decrease the afterload seen by the left ventricle and thereby decrease the regurgitant fraction. The vasodilator most commonly used is nitroprusside

    1. Chronic = ACE inhibitors and hydralazine s/e: lupus (smooth muscle relaxant) 
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