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Structural Heart Disease

Mitral Regurgitation



    • Causes of Mitral Regurgitation

    • Acute

    • Acute myocardial infarction
    • Infective endocarditis
    • Trauma
    • Chronic

    • Mitral annular calcification
    • Mitral valve prolapse
    • Rheumatic heart disease
    • Papillary muscle dysfunction
    • Connective tissue disease - systemic lupus erythematosus, rheumatoid arthritis


  • Mitral regurgitation examines as a pan-systolic murmur best heard over the apex with a volume-loaded heart, soft S1 and present S3 with or without evidence of left ventricular failure.
    • Signs of Mitral Regurgitation

    • Peripheral Signs

    • Small volume pulse
    • Central Signs

    • Apical thrill (palpable murmur)
    • Soft or absent first heart sound (S1)
    • Presence of a fourth heart sound (S4)
    • Volume-loaded apex beat -  displaced apex with forceful, non-sustained impulses
    • Pansystolic murmur heard greatest over the apex on expiration
    • Radiation to the left sternal edge and neck - suggests posterior mitral valve leaflet prolapse
    • Radiation to the axilla - suggests anterior mitral valve leaflet prolapse
    • Signs of Complications

    • Evidence of pulmonary hypertension - elevated JVP, parasternal heave, loud / palpable P2
    • Evidence of left ventricular failure - pulsus alternans, presence of S3, pulmonary crepitations
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