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  • Mitral valve regurgitation
  • Mitral valve insufficiency
  • Left atrial overload

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  • 394.1 Rheumatic mitral insufficiency
  • 424.0 Mitral valve disorders
  • 746.6 Congenital mitral insufficiency

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  • I05.1 Rheumatic mitral insufficiency
  • I34.0 Nonrheumatic mitral (valve) insufficiency
  • Q23.3 Congenital mitral insufficiency

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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/ECG2
  • 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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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 systolic BP during exercise
    • EF < 30 to 40%
    • Disability

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Imaging

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Diagnostic Procedures

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