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Condition/Disorder Synonyms

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  • Mitral valve regurgitation

  • Mitral valve insufficiency

  • Left atrial overload

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ICD-9-CM Codes

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  • 394.1 Rheumatic mitral insufficiency

  • 424.0 Mitral valve disorders

  • 746.6 Congenital mitral insufficiency

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ICD-10-CM Codes

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  • I05.1 Rheumatic mitral insufficiency

  • I34.0 Nonrheumatic mitral (valve) insufficiency

  • Q23.3 Congenital mitral insufficiency

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Preferred Practice Pattern

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Key Features

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Description

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  • 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

  • MR is most common type of valvular heart disease

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Essentials of Diagnosis

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  • Stethoscope for auscultation systolic murmur in mitral position

  • EKG/ECG 2

  • Echocardiogram

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General Considerations

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  • 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

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Demographics

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  • MR can be congenital, present from birth

  • More common in women and with advanced age

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Clinical Findings

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Signs and Symptoms

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  • Symptoms depend on 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 4th intercostal space, mid-clavicular line

  • Angina pectoris

  • Syncope

  • Congestive heart failure

  • Dyspnea on exertion

  • Shortness of breath

  • Anginal chest pain that increases with exercise

  • Orthopnea

  • Fatigue weakness

  • Fainting, dizziness with activity

  • Palpitations

  • Palpable heaves/thrills over precordium

  • Arrhythmias, particularly atrial fibrillation

  • Endocarditis

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Functional Implications

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  • Severe MR causes progressive shortness of breath and signs of congestive heart failure

  • Minimal functional implications and patients may be unaware of reduced cardiovascular capacity until it becomes severe

  • MR can cause syncope, chest pain, and heart failure if untreated

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Possible Contributing Causes

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  • Acute rheumatic fever

  • MVP: most common cause of MR is mitral valve prolapse (MVP) due to weakening of connective tissue

  • Coronary artery disease

  • Diabetes mellitus

  • Hyperlipoproteinemia

  • Hypertension

  • Marfan syndrome

  • Older age

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Differential Diagnosis

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  • Acute coronary syndrome

  • Aortic regurgitation

  • Aortic stenosis

  • MVP

  • Mitral stenosis

  • Myocardial infarction dysfunction

  • Shock, hypovolemia

  • Heart failure

    • Chest x-ray evidence of pulmonary edema

    • Signs and symptoms of right and left heart failure

    • Markedly decreased exercise tolerance

    • Decreased ...

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