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Mitral Regurgitation

by | 20 May, 2020

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Introduction

Mitral regurgitation refers to leaking of the mitral valve during systole such that blood returns to the left atrium from the left ventricle.

Murmur

Sound: Pansystolic murmur

Loudest region: Mitral area (5th intercostal space, mid-clavicular line)

Radiation: Axilla

Accentuation: Expiration

midsystolic murmur
Pansystolic murmur

Pansystolic murmur. Source: University of Michigan Murmur library

Causes

Acute disease

Chronic disease

  • Rheumatic fever
  • Connective tissue disease
  • Mitral valve prolapse
  • Congenital abnormality

Functional disease

Functional regurgitation occurs due to a left ventricular abnormality, such as abnormal shape, rather than mitral valve pathology.

Differential diagnosis

Investigations

  • Echocardiogram
  • ECG: may show atrial fibrillation and p-mitrale (broad, bifid P waves)
  • Chest x-ray
  • Blood cultures, if considering infective endocarditis

Management

Medically manage underlying heart failure and atrial fibrillation.

Surgical management should be offered to symptomatic patients or those with a reduced ejection fraction.

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