Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content ++ Mitral valve regurgitationMitral valve insufficiencyLeft atrial overload ++ 394.1 Rheumatic mitral insufficiency424.0 Mitral valve disorders746.6 Congenital mitral insufficiency ++ I05.1 Rheumatic mitral insufficiencyI34.0 Nonrheumatic mitral (valve) insufficiencyQ23.3 Congenital mitral insufficiency ++ 6D: Impaired aerobic capacity/endurance associated with cardiovascular pump dysfunction or failure1 +++ Description ++ Mitral valve does not close properly during systolic contraction of left ventricleCauses backflow and fluid overload in left atriumFluid overload in left atrium can lead to weakening of left atrial wallFluid overload in left atrium can also cause pooling and clotting in left atriumMR is most common type of valvular heart disease +++ Essentials of Diagnosis ++ Stethoscope for auscultation systolic murmur in mitral positionEKG/ECG2Echocardiogram +++ General Considerations ++ Patients with significant MR can show signs and symptoms of congestive heart failureStrenuous activity should be limited for symptomatic MRSigns and symptoms should be monitoredCan lead to sudden cardiac death, arrhythmias, embolic events, and coronary diseasePatients can develop bacterial endocarditisValve problems can develop 5 to 10 years after rheumatic feverIschemic heart disease, rheumatic fever, and Marfan syndrome are also associated with MR +++ Demographics ++ MR can be congenital, present from birthMore common in women and with advanced age +++ Signs and Symptoms ++ Symptoms depend on degree of valvular dysfunction.Mild-to-moderate regurgitation generally does not cause symptomsDeviation of heartbeat or point of maximal impulse (PMI)Cardiovascular collapse or shockAudible systolic murmur at left 4th intercostal space, mid-clavicular lineAngina pectorisSyncopeCongestive heart failureDyspnea on exertionShortness of breathAnginal chest pain that increases with exerciseOrthopneaFatigue weaknessFainting, dizziness with activityPalpitationsPalpable heaves/thrills over precordiumArrhythmias, particularly atrial fibrillationEndocarditis +++ Functional Implications ++ Severe MR causes progressive shortness of breath and signs of congestive heart failureMinimal functional implications and patients may be unaware of reduced cardiovascular capacity until it becomes severeMR can cause syncope, chest pain, and heart failure if untreated +++ Possible Contributing Causes ++ Acute rheumatic feverMVP: most common cause of MR is mitral valve prolapse (MVP) due to weakening of connective tissueCoronary artery diseaseDiabetes mellitusHyperlipoproteinemiaHypertensionMarfan syndromeOlder age +++ Differential Diagnosis ++ Acute coronary syndromeAortic regurgitationAortic stenosisMVPMitral stenosisMyocardial infarction dysfunctionShock, hypovolemiaHeart failureChest x-ray evidence of pulmonary edemaSigns and symptoms of right and left heart failureMarkedly decreased exercise toleranceDecreased systolic BP during exerciseEF < 30 to 40%Disability +++ Imaging ++ EchocardiographyMRI of the heartChest x-rayECG +... Your MyAccess profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. Please click ‘Continue’ to continue the affiliation switch, otherwise click ‘Cancel’ to cancel signing in. Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Username? Forgot Password? Sign in via OpenAthens Sign in via Shibboleth