Epidemiology
Etiology
- Primary MR (organic): mitral regurgitation caused by direct involvement of the valve leaflets or chordae tendinae
- 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