“Abnormal systolic backflow of blood from LV into LA through a leaky valve”

Risk Factors
  • Intrinsic Valve Disease:
    • Myxomatous degeneration → Mitral valve prolapse
    • Rheumatic heart disease
    • Infective endocarditis
  • Disease of the valve-related apparatus:
    • Chordal rupture
    • Post-MI: papillary muscle dysfunction/rupture
  • Secondary causes :
    • Stretching of the valve ring when the left ventricle is dilated – HF
    • Aging → Annular calcification → contraction (elderly)
Aetiology

Blood regurgitates during ventricular contraction → early systolic murmur

Pathophysiology

Left Ventricle (LV) vol & pressure overload (pumps blood into aorta + regurgitated blood) → dysfunctional LV with increased pressure → less drainage of blood from lungs → pulmonary congestion

Clinical Presentation
  • Symptoms
    • Asymptomatic for many years
    • Damaged LV:  breathlessness, effort intolerance and fatigue
    • AF: palpitations + emboli
    • Pulmonary congestion: HTN + oedema
  • Signs
    • Loud pansystolic murmur at apex: heard on left 5th intercostal space, midclavicular line & radiates to axilla
    • Displaced apex beat
Investigations
  • Bloods:
    • FBC, U+E, glucose, lipids
  • Imaging:
    • Chest X-Ray – See if in heart failure
    • Echocardiogram – assess the severity
  • Special:
    • ECG – LV hypertrophy / Atrial Fibrillation
Management
  • Conservative: n/a
  • Medical:
    • Statins
    • Anti-hypertensives
    • Anti-coagulants and rate control if AF
    • ACE-i/b-blockers/diuretics to decrease afterload
  • Surgical:
    • Mitral valve repair or replacement
Complications
  • Increase in atrial size

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