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Mitral regurgitation: Difference between revisions
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(Created page with "'''Mitral regurgitation''' (MR) refers to when the mitral valve closes incompletely during systole, causing blood to flow back from the left ventricle into the left atrium. It’s a common valvular heart disease. MR can be primary, due to direct involvement of the valve itself or the chorda tendinae, or secondary, due to changes in the dimensions of the left ventricle, making it impossible for the anatomically normal mitral valve to close properly. It can also be ei...") |
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* Secondary | * Secondary | ||
** [[Dilated cardiomyopathy]] | ** [[Dilated cardiomyopathy]] | ||
** [[ | ** [[Acute myocardial infarction|Myocardial infarction]] (ischaemia of the papillary muscles) | ||
== Pathophysiology == | |||
Mitral regurgitation causes a backward pressure increase to the left atricle and from there to the pulmonary vasculature, which causes the dyspnoea. The lungs respond by increasing pulmonary vascular resistance, which in turn increases the afterload of the right ventricle, which may cause dilation of the right ventricle. | |||
The pressure load on the left atrium may also cause it to dilate, which may trigger [[atrial fibrillation]]. AFib may worsen the symptoms as they suddenly lose the atrial contraction needed to fill the left ventricle in diastole. | |||
== Clinical features == | == Clinical features == | ||
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== Diagnosis and evaluation == | == Diagnosis and evaluation == | ||
[[Echocardiography]] allows for assessment of the mitral valve motion during systole, and it can visualise regurgitated blood flow. [[Coronary angiography]] can be used to assess the degree of [[coronary artery disease]]. | [[Echocardiography]] allows for assessment of the mitral valve motion during systole, and it can visualise regurgitated blood flow. [[Coronary angiography]] can be used to assess the degree of [[coronary artery disease]] if valvular surgery is indicated. | ||
Coronary catheterisation used to be the gold standard for evaluation of mitral valve disease, as one can directly measure the pressure in the right heart, left atrium, and pulmonary vasculature, but nowadays echocardiography can estimate these well enough that catheterisation is rarely necessary. | |||
If the left ventricle has dilated, a wide and bifid P-wave may be seen on the [[ECG]]. | |||
== Treatment == | == Treatment == | ||
Surgery, either valve repair or replacement, is the definitive treatment for MR. In case of acute primary MR, urgent surgery is indicated. In case of chronic primary MR, surgery is indicated if the <abbr>LVEF</abbr> is decreased or the patient is symptomatic. However, if the LVEF is severely decreased (<30%), surgery is not recommended due to high mortality rate and low likelihood of improvement. | Surgery, either valve repair or replacement, is the definitive treatment for MR. In case of acute primary MR, urgent surgery is indicated. In case of chronic primary MR, surgery is indicated if the <abbr>LVEF</abbr> is decreased or the patient is symptomatic. However, if the LVEF is severely decreased (<30%), surgery is not recommended due to high mortality rate and low likelihood of improvement. | ||
While waiting for surgery, pharmacological therapy for [[heart failure]] is required. | While waiting for surgery, pharmacological therapy for [[heart failure]] is required, if present. Even if there is no overt heart failure, [[RAAS inhibitors]] may decrease peripheral vascular resistance and therefore improve symptoms. | ||
[[Category:Cardiology]] | [[Category:Cardiology]] | ||