Overview
Definition
Abnormal reversal of blood flow from the left ventricle into the left atrium during systole.
Epidemiology
Very common; mild MR is often an incidental finding. Severe MR requires intervention.
Etiology & Risk Factors
- Primary: Mitral valve prolapse (most common), Rheumatic heart disease, Endocarditis
- Secondary: Left ventricular dilation (ischemia, cardiomyopathy) stretching the valve annulus
Clinical Symptoms
- Fatigue
- Dyspnea on exertion
- Orthopnea
- Palpitations (if A-fib develops)
Clinical Approach
Diagnosis
- Echocardiogram (diagnostic)
- Auscultation: Holosystolic murmur at the apex, radiating to the axilla
- Chest X-ray (Left atrial enlargement, pulmonary edema)
Management
- Medical: Afterload reduction (ACEI/ARB/Nitro) in acute severe MR, Diuretics for heart failure symptoms
- Surgical: Mitral valve repair (preferred) or replacement (MVR) for severe symptomatic MR or LVEF < 60%
Complications
- Atrial fibrillation
- Heart failure
- Pulmonary hypertension