Mitral regurgitation

The most common cause is: Rheumatic heart disease

Other causes include:

Degenerative mitral valve disease

Left ventricular dilatation

Mitral valve prolapse

Papillary muscle dysfunction

Infective endocarditis

Hypertrophic cardiomyopathy

Connective tissue disease

Congenital

Symptoms

1. Dyspnoea
2. Fatigue
3. Palpitation
4. Odema/ascites

Signs

1. AF/atrial flutter
2. Apical PSM+thrills
3. Soft S1 ,apical S3
4. Pul venous congestion
5. Pul hypertension
6. Jerky pulse

Investigation

1-ECG

AF

Left atrial hypertrophy

Left ventricular hypertrophy

2-CXR

Enlarge left atrium

Enlarge left ventricle

Pul venous congestion

Pul odema

3-echo

Dilated LA/LV

Dynamic LV

Structural abnormality of the mitral valve

Management

Medical:

Duretics

Vasodilator

Warfarin/digoxin

Antibiotic prophylaxis

Surgical:

Signs of progressive left ventricular dilatation.

1-moderate to severe symptoms despite medical therapy provided left ventricular function is adequate

2-ejection fraction <55%

3-Left ventricular end diastolic dimension >45mm, even in absence of symptoms.

Signs of severity

1-dilated left ventricular→displaced thrusting apex

2-S3→indicator of poor prognosis

3-Rt vent function reduced