Epidemiology

Etiology

• Primary MR (organic): mitral regurgitation caused by direct involvement of the valve leaflets or chordae tendinae
  • Degenerative mitral valve disease (mitral valve prolapse, mitral annular calcification, ruptured chordae tendinae)
  • Rheumatic fever
  • Infective endocarditis
• Secondary MR (functional): caused by changes of the left ventricle that lead to valvular incompetence
  • Coronary artery disease or prior myocardial infarction causing papillary muscle involvement
    • This results in hypokinesis and outward displacement of the papillary muscle, creating increased tension on the attached chordae tendineae and preventing complete closure of the corresponding mitral valve cusp.
  • Dilated cardiomyopathy (e.g., peripartum cardiomyopathy) and left-sided heart failure

Pathophysiology

Clinical features

• Auscultation
  • S3 heart sound in advanced stages of disease
    • Indication of severity
    • vs S2-opening snap interval in Mitral stenosis, also a indication of severity
  • Holosystolic murmur (high-pitched, blowing)
    • Radiates to the left axilla and heard best over the apex (5th intercostal space at the left midclavicular line)
    • Intensity can be increased by increasing preload (e.g., leg raise) or afterload (e.g., handgrip) due to increased regurgitation.

Diagnostics

Treatment