Mitral Regurgitation

Outline

Background 

• Mitral valve is common- 5% of community and 10% of cardiology inpatients

• 
  

Assessment

History

• Asymptomatic (chronic)

• Acute decompensated HF (see acute below)

• Connective tissue disorders: Marfan's Syndrome, Ehlers Danlos syndrome (EDS)  

Examination

• Pansystolic murmur- loudest at apex, on expiration, radiating to auxilla

• Atrial Fibrillation (AF) +- bruising; 

• Tricuspid Regurgitation (TR) with prominent v waves in JVP; in 40%

• Dynamic displaced apex beat (from 5th intercostal space, midclavicular line to auxilla)

Investigations

• ECHO

• ECG

• CXR / BNP ? decompensated HF

Diagnosis

Diagnostic criteria: ECHO findings

Differentials (systolic murmur):

• Aortic Stenosis - pansystolic

• Tricuspid Regurgitation (TR), Pulmonary Stenosis - inspiration

• Ventricular Septal Defect (VSD) - nil radiation

• HOCM (Hypertrophic obstructive cardiomyopathy) - nil radiation, loudest left sternal edge, young

Management

Conservative: 

• Smoking cessation, diet, exercise, wellbeing

• Cardiology valvular MDT- cardiology, PT, OT, dieticians, 

Medical 

Management

• Open Heart surgery

• Mitral clip

Acute MR (post MI)

Background 

• Acute mitral regurgitation is one of the complications of acute myocardial infarction. 

Assessment

History:

• Sob,  presyncope

Examination:

• Left sided HF: pulmonary oedema

• Pansystolic murmur radiating to auxilla (new)

Investigations

• ECHO, ECG, CXR, BNP

Diagnosis

Diagnostic criteria: ECHO 

Differentials

• Ventricle septal defect (VSD)

• Ventricle rupture

Management

 Medical: 

1. Vasodilators- gtn,

2. Inotropes- dobutamine,

3. Intra-aortic pumps,

Surgical:

• Cardiothoracic input re: repair. 

Links

Links

• Body System: Cardiovascular

• Specialty: Cardiology

• Examination: Cardiovascular Exam 

Page written in 2026.