Skip to Main Content

++

CONDITION/DISORDER SYNONYMS

++

  • Left atrial overload

  • Mitral valve regurgitation

  • Mitral valve insufficiency

++

ICD-9-CM CODES

++

  • 394.1 Rheumatic mitral insufficiency

  • 424.0 Mitral valve disorders

  • 746.6 Congenital mitral insufficiency

++

ICD-10-CM CODES

++

  • I05.1 Rheumatic mitral insufficiency

  • I34.0 Nonrheumatic mitral (valve) insufficiency

  • Q23.3 Congenital mitral insufficiency

++

PREFERRED PRACTICE PATTERN

++

  • 6D: Impaired Aerobic Capacity/Endurance Associated With Cardiovascular Pump Dysfunction or Failure1

++

PATIENT PRESENTATION

A 65-year-old female, with a history of mitral valve prolapse (MVP) and an irregular heartbeat, presents with shortness of breath on walking. Vitals are: Pulse: 92, Respirations: 24, Blood Pressure: 132/80, and SpO2% of 97%. On physical examination there are bounding arterial pulses bilaterally and a leftward displacement of the apical impulse. Cardiac auscultation reveals a holosystolic murmur over the apex of the heart. EKG readings are nonspecific and the echocardiogram shows an enlarged left ventricle, enlarged left atria, and a regurgitant volume into the left atria of 65 mL.

++

KEY FEATURES

++
Description
++

  • Mitral valve does not close properly during systolic contraction of left ventricle.

    • Causes backflow and fluid overload in left atrium.

  • Fluid overload in left atrium can lead to weakening of left atrial wall.

  • Fluid overload in left atrium can also cause pooling and clotting in left atrium.

  • Mitral regurgitation (MR) is the most common type of valvular heart disease.

++
Essentials of Diagnosis
++

  • Stethoscope for auscultation systolic murmur in mitral position

  • EKG/ECG2

  • Echocardiogram

++
FIGURE 13-1

Continuous wave tracing of mitral regurgitation with calculation of dP/dt (apical transducer position). The time period between velocities of 1 and 3 m/s is 0.07 second, the calculated dP/dt is approximately 460 mm Hg/s. (From Fuster V, Walsh RA, Harrington RA. Hurst’s The Heart, 13th ed. www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

Graphic Jump Location
++
General Considerations
++

  • Patients with significant MR can show signs and symptoms of congestive heart failure.

  • Strenuous activity should be limited for symptomatic MR.

  • Signs and symptoms should be monitored.

  • Can lead to sudden cardiac death, arrhythmias, embolic events, and coronary disease.

  • Patients can develop bacterial endocarditis.

  • Valve problems can develop 5 to 10 years after rheumatic fever.

  • Ischemic heart disease, rheumatic fever, and Marfan syndrome are also associated with MR.

++
Demographics
++

  • MR can be congenital, present from birth.

  • More common in women and with advanced age.

++

CLINICAL FINDINGS

++

SIGNS AND SYMPTOMS

  • Symptoms depend on the degree of valvular dysfunction

  • Mild-to-moderate regurgitation generally does not cause symptoms

  • Deviation of heartbeat or point of maximal impulse (PMI)

  • Cardiovascular collapse or shock

  • Audible systolic murmur at left fourth intercostal space, midclavicular line

  • Angina ...

Want remote access to your institution's subscription?

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.

Ok

About MyAccess

If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.

Subscription Options

AccessPhysiotherapy Full Site: One-Year Subscription

Connect to the full suite of AccessPhysiotherapy content and resources including interactive NPTE review, more than 500 videos, Anatomy & Physiology Revealed, 20+ leading textbooks, and more.

$595 USD
Buy Now

Pay Per View: Timed Access to all of AccessPhysiotherapy

24 Hour Subscription $34.95

Buy Now

48 Hour Subscription $54.95

Buy Now

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.