Mitral Regurgitation

Mitral Regurgitation


Damage to valve leading to regurgitant flow into Left atrium and increased Left Atrial and Ventricular pressures and reduction in cardiac output


Annulus: LV dilatation, mitral annular calcification, endocarditis

Leaflets: Congenital, Marfan’s Syndrome, endocarditis, rheumatic heart disease,

collagen vascular disease

Chordae Tendineae: Trauma/tear, Marfan’s Syndrome, endocarditis, acute MI

Papillary Muscles & LV: Ischaemia, infarction, rupture, aneurysm, HOCM


Hyperdynamic, displaced apex beat due to LVH, soft S1, pansystolic murmur radiating to axilla, 3rd heart sound, pulmonary oedema


Dyspnoea, fatigue, orthopnoea, paroxysmal nocturnal dyspnoea


ECG: Right Atrial Enlargement (Peaked P Wave), Left Ventricular Hypertrophy

Chest X-Ray: Left Ventricular Hypertrophy, Right Atrial Enlargement, Pulmonary Hypertension

Echo: Assess for leaflet abnormalities, severity of regurgitation, LV function

Cardiac catheterisation


Medical: Asymptomatic – serial echocardiograms to monitor progress

Symptomatic - reduce preload (diuretics) and reduce afterload (ACEI)

Surgical: Mitral valve replacement.


Severe disease has a poor outlook, Heart failure, AF, Infective endocarditis

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