Mitral regurgitation

Epidemiology

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Etiology

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• Acute: Papillary muscle rupture (post-MI), Infective Endocarditis (IE), Chordae tendineae rupture (MVP, trauma).
• Chronic Primary: Mitral Valve Prolapse (MVP - most common in US) c, Rheumatic Heart Disease (developing countries), Myxomatous degeneration.
• Chronic Secondary (Functional): LV dilatation (HFrEF), Ischemic cardiomyopathy (tethers leaflets).
  • 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. t

Pathophysiology

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Clinical features

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• 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

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Treatment

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