Introduction 

-Mitral regurgitation (MR) occurs due to the inability of the mitral valve to close adequately to prevent blood from returning back to the left atrium from the left ventricle during systole 

-Most common cause is mitral valve prolapse 

-Acute: papillary muscle rupture

-Chronic: Rheumatic fever, mitral valve prolapse 

Symptoms & Signs 

symptoms in proportion to  increase in left atrial pressure and pulmonary hypertension

– fatigue, exhaustion, atypical chest pain, progressive dyspnea, congestive heart failure, paroxysmal nocturnal dyspnea, orthopnea, pleural effusion, edema, increased jugular pressure

-A holosystolic murmur best heard at the apex, with radiation to the axilla 

-Handgrip exercise increases the intensity of the murmur 

Diagnosis 

ECG: left atrial abnormality, left ventricular hypertrophy 

Chest X-ray: can show LV enlargement, left atrial enlargement, and pulmonary edema 

Echocardiography: the diagnostic test of choice; can show mitral valve regurgitation, size of left atrium, left ventricle, pulmonary pressure 

Treatment 

Medications: Diuretics, ACE inhibitors Surgical: Mitral valve repair or replacement

Mitral Regurgitation 

Introduction 

-Mitral regurgitation (MR) occurs due to the inability of the mitral valve to close adequately to prevent blood from returning back to the left atrium from the left ventricle during systole 

-Most common cause is mitral valve prolapse 

-Acute: papillary muscle rupture

-Chronic: Rheumatic fever, mitral valve prolapse 

Symptoms & Signs 

symptoms in proportion to  increase in left atrial pressure and pulmonary hypertension

– fatigue, exhaustion, atypical chest pain, progressive dyspnea, congestive heart failure, paroxysmal nocturnal dyspnea, orthopnea, pleural effusion, edema, increased jugular pressure

-A holosystolic murmur best heard at the apex, with radiation to the axilla 

-Handgrip exercise increases the intensity of the murmur 

Diagnosis 

ECG: left atrial abnormality, left ventricular hypertrophy 

Chest X-ray: can show LV enlargement, left atrial enlargement, and pulmonary edema 

Echocardiography: the diagnostic test of choice; can show mitral valve regurgitation, size of left atrium, left ventricle, pulmonary pressure 

Treatment 

Medications: Diuretics, ACE inhibitors 

Surgical: Mitral valve repair or replacement

Introduction 

-The mitral valve has two leaflets, anterior and posterior

-Mitral stenosis is a condition where the mitral valve area is reduced, causing obstruction of blood flow from the left atrium into the left ventricle during left ventricular diastole

-MS can cause elevated left atrial pressure resulting in pulmonary hypertension, pulmonary edema, and right heart failure. 

-the most common cause of mitral valve stenosis: Rheumatic heart disease 

-Other causes include congenital, SLE, RA, myxoma 

Symptoms & signs 

-Rosy cheeks (mitral facies), Fatigue, exertional dyspnea, orthopnea, heart failure, atrial fibrillation, pulmonary hypertension, right-sided heart failure (ascites, pedal edema, weight gain), hemoptysis, hoarseness of voice (Ortner syndrome), systemic embolization 

-Accentuated first heart sound, an opening snap following the second heart sound, mid-diastolic low-pitched rumbling murmur best heard at the apex with the patient in the left lateral position 

Diagnosis 

ECG: tall peaked P waves, broad bifid P waves (P mitrale), right axis deviation,  LA abnormality, atrial fibrillation 

Echocardiography: thickened mitral valve leaflets, fish-mouth appearance of mitral valve, “hockey-stick” motion of the anterior leaflet, enlarged left atrium 

Chest x-ray: Left atrial enlargement, horizontal lines in the regions of the costophrenic angles representing interstitial edema (Kerley A and B lines) 

Treatment 

Asymptomatic: no treatment 

Symptomatic: Balloon valvuloplasty or valve replacement

Medications: diuretics, beta blockers,calcium channel blockers, anticoagulants