Mitral regurgitation is a leakage of blood from the left ventricle (LV) to the left atrium (LA) during systole due to an incompetent mitral valve.
- Most Common Cause: Rheumatic Heart Disease (RHD)
- Mnemonic: "MR = Mitral Regurgitation = Murmur Returns (to LA)"
CAUSES OF MITRAL
REGURGITATION
1. Chronic Causes
(Slowly Developing MR)
• Rheumatic Heart Disease (Most Common).
• Mitral Valve Prolapse (MVP).
• Ischemic Heart Disease (Post-Heart Attack).
• Dilated Cardiomyopathy (Enlarged Heart).
• Marfan Syndrome (Connective Tissue Disorder).
Mnemonic: "R.M.I.D.M." (RHD, MVP, Ischemia, Dilated Heart, Marfan's)
2. Acute Causes
(Sudden MR – Medical Emergency!)
• Chordae Tendineae Rupture (Valve Support Damage).
• Papillary Muscle Rupture (After MI).
• Infective Endocarditis (Bacterial Valve Infection).
Mnemonic: "C.P.I." (Chordae, Papillary, Infection)
PATHOPHYSIOLOGY
OF MR
- LV Contraction (Systole) → Blood Leaks Back into LA Instead of Going to Aorta.
- Left Atrium Overloads → Dilates & Hypertrophies (Giant Left Atrium).
- Left Ventricle Enlarges to Compensate for Extra Volume.
- Late Stage → Heart Failure Due to Overload.
Mnemonic: "L.A.V.E." (Leak → Atrium Enlarges → Ventricle Dilates → Ends in Heart Failure)
SYMPTOMS OF
MITRAL REGURGITATION
• Early Stage (Asymptomatic for Years).
• Fatigue & Weakness (Low Forward Blood Flow).
• Palpitations (Due to Atrial Fibrillation).
• Breathlessness on Exertion (Late Sign of Heart Failure).
• Right Heart Failure (Edema, Liver Congestion in Severe Cases).
Mnemonic: "F.P.B.R." (Fatigue, Palpitations, Breathless, Right Heart Signs)
SIGNS & HEART
SOUNDS IN MR
- Apex Beat: Displaced left & downward (LV Enlargement).
- Murmur: Holosystolic (Pansystolic) Murmur → Best heard at the Apex, Radiates to Axilla.
- Heart Sounds:
- Soft S1 (Weak Mitral Closure).
- Wide Split S2 (Delayed Pulmonary Valve
Closure).
- S3 Gallop (LV Overload).
Mnemonic: "M.A.S.H." (Murmur Apex, Soft S1, Holosystolic, Axilla Radiation)
DIAGNOSIS OF
MITRAL REGURGITATION
ECG:
- Left Atrial Enlargement (P Mitrale).
- Left Ventricular Hypertrophy (LVH).
Chest X-ray:
- Cardiomegaly (Enlarged LV & LA).
- Pulmonary Congestion in Late Stage.
Echocardiography (Best Test!)
- Confirms MR Severity.
- Color Doppler Shows Regurgitant Jet.
Mnemonic: "E.C.E." (ECG, CXR, Echo – Best Test)
TREATMENT OF
MITRAL REGURGITATION
1. MEDICAL
TREATMENT (For Mild-Moderate Cases)
- Diuretics (Reduce Fluid Overload).
- Beta-Blockers (Slow Down Heart, Reduce Workload).
- ACE Inhibitors (Reduce LV Dilatation).
- Anticoagulants (For Atrial Fibrillation – Prevent Stroke).
Mnemonic: "D.B.A.A." (Diuretics, Beta-Blockers, ACEI, Anticoagulants)
2. SURGICAL
TREATMENT (For Severe MR)
- Mitral Valve Repair (Preferred Over Replacement).
- Mitral Valve Replacement (Mechanical or Bioprosthetic Valve).
Mnemonic: "R&R" (Repair & Replace – Only for Severe Cases)
COMPLICATIONS OF
MR
• Heart Failure (LV Weakens Over Time).
• Atrial Fibrillation (Due to LA Enlargement).
• Pulmonary Hypertension (If Untreated for Long Time).
• Endocarditis (Valve Infection Risk).
Mnemonic: "H.A.P.E." (Heart Failure, AFib, Pulmonary HTN, Endocarditis)
DIFFERENTIAL
DIAGNOSIS (CONDITIONS THAT MIMIC MR)
- Tricuspid Regurgitation (TR): Murmur Increases on Inspiration (Unlike MR).
- Ventricular Septal Defect (VSD): Murmur at Lower Sternal Border.
- Aortic Stenosis (AS): Crescendo-Decrescendo Murmur (Not Holosystolic).
Mnemonic: "T.V.A." (Tricuspid, VSD, Aortic Stenosis)
PREVENTION OF
MITRAL REGURGITATION
- Early Treatment of Rheumatic Fever (Penicillin).
- Regular Follow-up for Valve Disease.
- Avoid Excessive IV Fluid in Weak Heart Patients.
Mnemonic: "P.R.A." (Penicillin, Regular Follow-up, Avoid Fluid Overload)
FINAL REVISION WITH MNEMONICS
- Definition = "MR = Mitral Regurgitation = Murmur Returns (to LA)"
- Causes = "R.M.I.D.M." (RHD, MVP, Ischemia, Dilated Heart, Marfan's)
- Pathophysiology = "L.A.V.E." (Leak → Atrium Enlarges → Ventricle Dilates → Ends in Heart Failure)
- Symptoms = "F.P.B.R." (Fatigue, Palpitations, Breathless, Right Heart Signs)
- Signs & Murmurs = "M.A.S.H." (Murmur Apex, Soft S1, Holosystolic, Axilla Radiation)
- Diagnosis = "E.C.E." (ECG, CXR, Echo – Best Test)
- Medical Treatment = "D.B.A.A." (Diuretics, Beta-Blockers, ACEI, Anticoagulants)
- Surgical Treatment = "R&R" (Repair & Replace – Only for Severe Cases)
- Complications = "H.A.P.E." (Heart Failure, AFib, Pulmonary HTN, Endocarditis)
- Differential Diagnosis = "T.V.A." (Tricuspid, VSD, Aortic Stenosis)
- Prevention = "P.R.A." (Penicillin, Regular Follow-up, Avoid Fluid Overload)
