Mitral Valve Regurgitation

Mitral Valve Regurgitation Definition Mitral valve regurgitation is the leakage of blood from the left ventricle into he left atrium due to incomplete closure of mitral valve during diastole. Note: during systole the mitral valve closes so that blood can be ejected out of the aorta into the systemic circulation. But during the diastole it opens so the ventricles can fill up. Aetiology • • • • • • Mitral valves prolapse Rheumatic fever Ineffective endocarditis Papillary muscle rupture Coronary artery disease Dilated cardiomyopathy Pathophysiology • • • • Mitral valves prolapse -> LV contracts -> pressure generated -> blood pumped out of the aortic valve -> connective tissue disorder -> myxomatous degeneration -> weak chordae tendae -> increased chordae tendae -> rupture -> inability to keep valve from prolapsing -> blood leaks into atria Papillary muscle damage from heart attack -> unable to anchor tendae chordae -> blood goes from LV to RV (because RV has lower pressure, as the LV has higher pressure and thicker muscle wall) Left heart failure -> LV dilation -> mitral valve stretches Rheumatic fever -> inflammation -> impact heart tissue -> chronic rheumatic fever -> leaflets no longer form seal -> blood leak Signs and Symptoms • • • • • • • • • Palpitations Chest pain Increased heart rate Blood leakage -> prevent heart from pumping blood effectively -> shortness pf breath and fatigue More blood held in -> cardiac hypertrophy and increased thickness Blood backs up in legs -> edema Blood pumped into pulmonary circulation -> pulmonary veins -> pulmonary capillaries > extra blood in capillaries -> pulmonary hypertension -> increase in hydrostatic pressure -> fluid pushed into intestinal space of the lungs -> pulmonary edema and dilation of pulmonary vessels Increased blood pressure and blood volume: - Compressed oesophagus -> dysphagia - Extra blood -> pulmonary hypertension Holosystolic murmur (high-pitched, blowing) • • • • Elevated jugular venous pressure Symptoms of left heart failure Quite S1 sound S3 in advanced stages of disease Diagnosis • • • • • • • Echocardiogram: - Assesses the function of the left atrium and ventricle Cardiac MRI - Heart size Coronary angiogram - To rule of vessel obstruction diseases Physical exam for heart murmurs: - Patient in squatting position: ✓ While in this position there is an increased venous return -> ventricle filled with more blood -> increased ventricle size -> more space left for leaflets to hang out -> as the ventricle contracts it gets smaller -> it takes longer for leaflets to get forced into atrium -> murmur comes in later and is shorter ✓ While in standing position -> there is a decreased venous return > less blood gets into the ventricle -> less room for ventricles and blood -> leaflets forced earlier -> murmur appears earlier and is longer ECG: - Acute: ✓ Normal sinus rhythm ✓ Sinus tachycardia ✓ Dagger like Q waves ✓ ST and T wave abnormalities ✓ Atrial fibrillation - Chronic: ✓ Left ventricular hypertrophy (may be found in 50% of patients with this condition) ✓ Atrial fibrillation ✓ P mitrale (signs of left atrium enlargement) ✓ Signs of right heart failure X-ray - LV and LA enlargement Lab results - Troponin T: indicates that MI is also present and maybe the actual cause of MVR Treatment • • • • Blood thinners Heart rate decreasing meds Mitral valve repair - Reconnection of leaflets Mitral valve replacement Complications • • • • • Heart failure Pulmonary edema Cardiogenic shock Atrial emboli Endocarditis