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Cardio Exam
 
 

Mitral Regurgitation

 
 
 
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Overview

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
  • 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
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