Pathogenesis
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
Diagnosis
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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