MDNotes: Cardiology: Mitral Regurgitation

Cardiology: Mitral Regurgitation

Causes – rule of two’s

Signs

Pansystolic murmur best heard in the mitral area, radiating to the axilla.
Heave
Displaced Apex Beat
Possible signs of:
- Heart failure / pulmonary hypertension: crackles at the lung bases, pink frothy sputum, oedema etc
- AF – irregularly irregular pulse

Hang on a minute! – the blood in mitral regurg is flowing away from the axilla – why does the sound radiate to the axilla?

Well, the sound comes from the valve itself, and is not related to the direction of flow of blood. Due to the location of the mitral valve, any sound it produces (whether from regurg or stenosis) will radiate to the axilla.

Symptoms

Investigations

ECG – P Mitrale – ‘bifid’ (two-peaks) P waves due to atrial hypertrophy
Trans-Oesophageal Ultrasound – TOE – used to asses the level of valve damage, to check if suitable for valve repair / replacement
Doppler-Echo – assesses the site and size of the regurgitant jet
Cardiac catheterisation – may be used to confirm the diagnosis, and to assess the level of underlying CAD (coronary artery disease)

Management

Conservative – lifestyle advice (e.g. avoidance of RFs for underlying cause)
Medical –control the signs and symptoms; e.g. diuretics if heart failure is a component, treat AF
Surgical –patients may require valve replacement or repair.
- Patients should be placed on antibiotics to prevent bacterial endocarditis

Valve replacements

Prosthetic – last about 10 years, after which time, may require another replacement. No need for long term anticoagulant therapy.
Metal –last a life time, but require anticoagulant therapy for life. Also noisy (often make a loud ‘click’ sound). There are three types of metal valve
- Tilting disc
- Double tilting disc
- Ball in a cage

Notes by Tom Leach

MDNotes