Mitral Regurgitation

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Definition Aetiology Pathophysiology Risk factor Sign and Symptoms Investigations Management

A medical condition known as mitral regurgitation (MR) occurs when the heart's mitral valve does not seal completely. Blood starts to flow back into the left atrium as a result of this. Consequently, the heart can't pump blood as efficiently, which results in symptoms like fatigue, breathlessness, and palpitations.

The causes of MR can be separated into structural and function-related reasons:

• Functional MR is brought about by modifications to the "mechanical" characteristics of the heart, such as an expansion of the left ventricle. Dilated cardiomyopathy, ischemic heart disease, and hypertension are common causes.

• Physical modifications : mitral prolapse, stenosis, or ruptures, are the main cause of structural MR. Rheumatic fever, infectious endocarditis, Marfan syndrome, and mitral annular calcification are common causes.

• Congenital heart abnormalities, trauma, or recent surgery are other possible causes of MR.

During MR the left ventricle has to compensate by increasing blood output in the body. The pressure inside the left atrium rises as a result of this process, which may result in an expansion of the atrium. This compensatory mechanism eventually results in a drop in cardiac output and a reduction in blood supply to other organs and tissues.

The increased pressure in the left atrium leads to pulmonary hypertension and eventually heart failure.

• Age: People who are older have a higher risk of having MR.

• Gender: MR affects women more frequently than it does males.

• Family history: One's risk of having MR is increased if there is a history of MR or other heart valve diseases in the patient's family.

• High blood pressure: High blood pressure can put more stress on the heart and raise the risk of MR.

• Cardiovascular disease: MR risk can be increased by a history of ischemic heart disease, dilated cardiomyopathy, or other cardiovascular disorders.

• Infectious endocarditis: MR is a frequent side effect of this condition.

• Rheumatic fever:  is a rare but deadly strep throat condition that can result in MR.

• Heart abnormalities that are present at birth can put some persons at higher risk of getting MR.

• Trauma or prior surgery: Some persons get MR as a result of heart or chest surgery or trauma.

• Obesity: Obesity can make MR more likely to occur.

• Breathlessness: This can happen either when exercising or while at rest and is brought on by the heart's failure to adequately pump blood to the body's organs and tissues.

• Fatigue: People with MR may experience fatigue or weakness as a result of their heart's failure to adequately pump blood to their body's tissues and organs.

• Palpitations: Some MR patients may experience palpitations or a speeding heartbeat.

• Edema: Leg, ankle, and foot swelling can be brought on by MR's elevated pressure in the left atrium.

• Cough: The increased pressure in the lungs brought on by MR may cause coughing.

• Chest pain: Some MR patients may have chest pain, especially when exercising.

• Reduced capacity for exercise: People with MR may find it difficult to maintain their typical levels of physical activity because of exhaustion and shortness of breath.

Some common investigations include:

• Physical examination: a holosystolic murmur with propagation to the left axilla is referred to as mitral valve regurgitation. This murmur is most audible near the cardiac apex.

• Echocardiography: a technique for visualising the heart via sound waves. can be used to measure the disease's size, shape, and severity of MR. 

• Cardiac magnetic resonance imaging (MRI): a magnetic field and radio waves are used in this examination to provide precise pictures of the heart. It can be used to assess the mitral valve's structure, as well as the structures around.

• Cardiac computed tomography (CT): This examination produces finely detailed images of the heart and blood arteries using X-rays and computer technology. 

• Cardiac catheterization: it involves passing a tiny tube to the heart through a blood artery. It can be used to gauge heart pressure and assess the mitral valve's performance.

• Electrocardiogram (ECG)

• Blood tests: the degree of heart failure brought on by MR can be assessed by blood tests like those for B-type natriuretic peptide (BNP).

Some common treatment options include:

• Medications: the symptoms of MR can be controlled, and the disease's progression can be slowed, with the help of medications such ACE inhibitors and beta-blockers. To decrease fluid accumulation in the legs and lungs, diuretics can be taken.

• Surgery: Surgery can be used to repair or replace the mitral valve.

• Monitor: When MR is modest and the patient shows no symptoms, a cautious waiting strategy could be advised. To guarantee that the situation does not worsen, regular monitoring and follow-up sessions would be necessary.