Mitral regurgitation

Diagnosis

• Most common cause is papillary / chordae rupture after MI
  • Day 2-7
• MI, Endocarditis, Trauma
• Severe dyspnea, tachycardia, pulmonary edema
• Suspect if new-onset pulm edema + normal heart size
• Cardiogenic shock may develop
• S4, apical systolic murmur

Important to note; Clinical evaluation may be misleading leading to underestimation of mitral regurgitation severity. The classic holosystolic murmur can be much reduced in intensity. The tachycardia may make the murmur difficult to even appreciate. Even transthoracic echocardiography with color Doppler may be inadequate and underestimate the degree of regurgitation.

Treatment

Medical therapy is simply a measure to aid hemodynamic stabilization before surgery. The following measures may help to achieve hemodynamic stabilization before surgery.

• • oxygen
  • Nitrates and diuresis may improve filling pressures and treat edema
  • Increase forward flow
  • Decrease afterload
  • Nitroprusside can be considered in normotensive patients to increase cardiac output and decrease MR
  • Inotropes may be required in hypotension
  • Intra aortic balloon pump may decrease afterload, increase forward cardiac output and reduce regurgitation

• • • • Consult Cards/CT Surgery!
• Only real treatment is emergency surgery

See Also

• Valvular Emergencies
• Heart Murmurs

Source

• Tintinalli
• Kosowsky JM: Infective Endocarditis and Valvular Heart Disease, in Marx JA, Hockberger RS, Walls RM, et al (eds): Emergency Medicine: Concepts and Clinical Practice, ed. 7. St. Louis, Mosby, Inc., 2010, (Ch) 81: p.1072-1074.

2) Ahmed MI et al. Mitral Regurgitation, Current Problems in Cardiology