Mitral regurgitation - Revision history

Rossdonaldson1: /* Disposition */

2024-11-13T17:17:58Z

Disposition

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	==Disposition==		==Disposition==
	*Admit		*Admit for severe presentations

	==See Also==		==See Also==

Rossdonaldson1: /* Background */

2024-11-13T17:13:58Z

Background

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	==Background==		==Background==
			[[File:Blausen 0645 MitralValve Regurgitation.png\|thumb]]
	[[File:Mitral Regurgitation scheme1.png\|thumb\|Schematic drawing of mitral regurgitation. During systole, contraction of the left ventricle causes abnormal backflow (arrow) into the left atrium. 1) Mitral valve; 2) Left ventricle; 3) Left atrium; 4) Aorta.]]		[[File:Mitral Regurgitation scheme1.png\|thumb\|Schematic drawing of mitral regurgitation. During systole, contraction of the left ventricle causes abnormal backflow (arrow) into the left atrium. 1) Mitral valve; 2) Left ventricle; 3) Left atrium; 4) Aorta.]]
	*Annual incidence of degenerative Mitral Valve (MV) disease causing MR ~3% in industrialized countries<ref>Kouchoukos NT. Problems in mitral valve replacement. In: Kirklin TW. eds. Advances in Cardiovascular Surgery. Grune & Stratton, New York,1973:205-16.</ref>		*Annual incidence of degenerative Mitral Valve (MV) disease causing MR ~3% in industrialized countries<ref>Kouchoukos NT. Problems in mitral valve replacement. In: Kirklin TW. eds. Advances in Cardiovascular Surgery. Grune & Stratton, New York,1973:205-16.</ref>

Rossdonaldson1: /* Background */

2024-11-13T17:11:46Z

Background

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	==Background==		==Background==
			[[File:Mitral Regurgitation scheme1.png\|thumb\|Schematic drawing of mitral regurgitation. During systole, contraction of the left ventricle causes abnormal backflow (arrow) into the left atrium. 1) Mitral valve; 2) Left ventricle; 3) Left atrium; 4) Aorta.]]
	*Annual incidence of degenerative Mitral Valve (MV) disease causing MR ~3% in industrialized countries<ref>Kouchoukos NT. Problems in mitral valve replacement. In: Kirklin TW. eds. Advances in Cardiovascular Surgery. Grune & Stratton, New York,1973:205-16.</ref>		*Annual incidence of degenerative Mitral Valve (MV) disease causing MR ~3% in industrialized countries<ref>Kouchoukos NT. Problems in mitral valve replacement. In: Kirklin TW. eds. Advances in Cardiovascular Surgery. Grune & Stratton, New York,1973:205-16.</ref>
	*Other etiologies of MR:		*Other etiologies of MR:

Rossdonaldson1: /* Disposition */

2024-11-13T17:09:22Z

Disposition

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	==Disposition==		==Disposition==
			*Admit

	==See Also==		==See Also==

Rossdonaldson1: /* Management */

2024-11-13T17:08:59Z

Management

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	**[[Dobutamine]] pressor of choice as α agonism and increased afterload minimal compared to beta agonism<ref>Sonoda M et al. Effects of Dobutamine Infusion on Mitral Regurgitation. Echocardiography. 1998 Jan;15(1):13-20.</ref>		**[[Dobutamine]] pressor of choice as α agonism and increased afterload minimal compared to beta agonism<ref>Sonoda M et al. Effects of Dobutamine Infusion on Mitral Regurgitation. Echocardiography. 1998 Jan;15(1):13-20.</ref>
	**Avoid [[beta-blockers]] as mild to moderate tachycardia allows less time for LV to backfill		**Avoid [[beta-blockers]] as mild to moderate tachycardia allows less time for LV to backfill
	*'''Consult Cardiology or Cardiothoracic Surgery'''		*'''Consult Cardiology or Cardiothoracic Surgery for definitive management'''

	==Disposition==		==Disposition==

Rossdonaldson1: /* ManagementDiSandro D et al. Acute Mitral Regurgitation Treatment & Management. eMedicine. Dec 28, 2015. http://emedicine.medscape.com/article/758816-treatment. */

2024-11-13T17:08:33Z

ManagementDiSandro D et al. Acute Mitral Regurgitation Treatment & Management. eMedicine. Dec 28, 2015. http://emedicine.medscape.com/article/758816-treatment.

← Revisión anterior		Revisión del 17:08 13 nov 2024
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	**Mitral valve anatomy and scalloping much better appreciated in TEE over TTE		**Mitral valve anatomy and scalloping much better appreciated in TEE over TTE

	==Management<ref>DiSandro D et al. Acute Mitral Regurgitation Treatment & Management. eMedicine. Dec 28, 2015. http://emedicine.medscape.com/article/758816-treatment.</ref>==		==Management==
	*'''Consult Cardiology or Cardiothoracic Surgery'''		*Supportive measures until definitive surgery<ref>DiSandro D et al. Acute Mitral Regurgitation Treatment & Management. eMedicine. Dec 28, 2015. http://emedicine.medscape.com/article/758816-treatment.</ref>
	*Supportive measures until definitive surgery
	*Appropriate treatment if [[myocardial infarction]] must include catheterization or [[thrombolysis]]		*Appropriate treatment if [[myocardial infarction]] must include catheterization or [[thrombolysis]]
	*Pulmonary edema		*[[Pulmonary edema]]
	**[[Oxygen]]		**[[Oxygen]]
	**[[nitroglycerin\|Nitrates]] and [[diuretics\|diuresis]] may improve filling pressures and treat edema		**[[nitroglycerin\|Nitrates]] and [[diuretics\|diuresis]] may improve filling pressures and treat edema
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	**[[Nitroprusside]] can be considered in normotensive patients to increase cardiac output and decrease MR		**[[Nitroprusside]] can be considered in normotensive patients to increase cardiac output and decrease MR
	**Intra aortic balloon pump may decrease afterload, increase forward cardiac output and reduce regurgitation		**Intra aortic balloon pump may decrease afterload, increase forward cardiac output and reduce regurgitation
	*Inotropes		*[[Inotropes]]
	**[[Dobutamine]] pressor of choice as α agonism and increased afterload minimal compared to beta agonism<ref>Sonoda M et al. Effects of Dobutamine Infusion on Mitral Regurgitation. Echocardiography. 1998 Jan;15(1):13-20.</ref>		**[[Dobutamine]] pressor of choice as α agonism and increased afterload minimal compared to beta agonism<ref>Sonoda M et al. Effects of Dobutamine Infusion on Mitral Regurgitation. Echocardiography. 1998 Jan;15(1):13-20.</ref>
	**Avoid beta-blockers as mild to moderate tachycardia allows less time for LV to backfill		**Avoid [[beta-blockers]] as mild to moderate tachycardia allows less time for LV to backfill
			*'''Consult Cardiology or Cardiothoracic Surgery'''

	==Disposition==		==Disposition==

Rossdonaldson1 at 16:59, 13 November 2024

2024-11-13T16:59:27Z

← Revisión anterior		Revisión del 16:59 13 nov 2024
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	==Background==		==Background==
	*Annual incidence of degenerative Mitral Valve (MV) disease causing MR ~3% in industrialized countries<ref>Kouchoukos NT. Problems in mitral valve replacement. In: Kirklin TW. eds. Advances in Cardiovascular Surgery. Grune & Stratton, New York,1973:205-16.</ref>		*Annual incidence of degenerative Mitral Valve (MV) disease causing MR ~3% in industrialized countries<ref>Kouchoukos NT. Problems in mitral valve replacement. In: Kirklin TW. eds. Advances in Cardiovascular Surgery. Grune & Stratton, New York,1973:205-16.</ref>
	~~[[File:MV anatomy.jpg\|thumbnail\|MV Anatomy in PSS]]~~
	~~[[File:MV anatomy PSL.jpg\|thumbnail\|MV Anatomy in PSL]]~~
	~~[[File:MV anatomy Apical.jpg\|thumbnail\|MV Anatomy in Apical]]~~
	*Other etiologies of MR:		*Other etiologies of MR:
	**Cardiac ischemia		**Cardiac ischemia
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	==Evaluation==		==Evaluation==
			[[File:MV anatomy.jpg\|thumbnail\|MV Anatomy in PSS]]
			[[File:MV anatomy PSL.jpg\|thumbnail\|MV Anatomy in PSL]]
			[[File:MV anatomy Apical.jpg\|thumbnail\|MV Anatomy in Apical]]
	*Clinical history and exam		*Clinical history and exam
	**[[Myocardial infarction]], [[endocarditis]], trauma		**[[Myocardial infarction]], [[endocarditis]], trauma

Rossdonaldson1: /* Clinical Features */

2024-11-13T16:33:01Z

Clinical Features

← Revisión anterior		Revisión del 16:33 13 nov 2024
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	==Clinical Features==		==Clinical Features==
			[[File:Phonocardiograms from normal and abnormal heart sounds.svg\|thumb\|Phonocardiograms of common cardiac murmurs.]]
	*[[Heart failure]] symptoms		*[[Heart failure]] symptoms
	*Atrial dilatation and [[atrial fibrillation]]		*Atrial dilatation and [[atrial fibrillation]]

Blsimpso at 01:44, 2 July 2021

2021-07-02T01:44:35Z

← Revisión anterior		Revisión del 01:44 2 jul 2021
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	*[[Valvular Emergencies]]		*[[Valvular Emergencies]]
	*[[Heart Murmurs]]		*[[Heart Murmurs]]

			==External Links==
			*[http://www.emdocs.net/acute-valvular-emergencies-pearls-pitfalls/ emDocs - Acute Valvular Emergencies: Pearls and Pitfalls]

	==References==		==References==

ClaireLewis at 15:40, 25 September 2019

2019-09-25T15:40:49Z

← Revisión anterior		Revisión del 15:40 25 sep 2019
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	**[[Rheumatic disease]]		**[[Rheumatic disease]]
	**[[SLE]], [[scleroderma]], [[amyloidosis]], [[sarcoidosis]]		**[[SLE]], [[scleroderma]], [[amyloidosis]], [[sarcoidosis]]
	**Connective tissue disease (myxomatous degeneration, Marfan, Ehlers-Danlos)		**[[Connective tissue disease]] (myxomatous degeneration, [[Marfan syndrome\|Marfan]], [[Ehlers-Danlos syndrome\|Ehlers-Danlos]])
	**[[HOCM]]		**[[HOCM]]
	**Dilated cardiomyopathy		**[[Dilated cardiomyopathy]]
	**[[Mitral valve prolapse]]		**[[Mitral valve prolapse]]
	**Congenital disorders		**Congenital disorders
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	==Clinical Features==		==Clinical Features==
	*Heart failure symptoms		*[[Heart failure]] symptoms
	*Atrial dilatation and [[atrial fibrillation]]		*Atrial dilatation and [[atrial fibrillation]]
	*[[Pulmonary hypertension]]		*[[Pulmonary hypertension]]
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	**Dysfunction of ventricular wall leads to papillary muscle dysfunction or chordae rupture		**Dysfunction of ventricular wall leads to papillary muscle dysfunction or chordae rupture
	**Posterior papillary muscle and supporting ventricular wall most commonly affected		**Posterior papillary muscle and supporting ventricular wall most commonly affected
	***Dyspnea, tachycardia, pulmonary edema (especially if new, and no cardiomegaly)		***[[Dyspnea]], [[tachycardia]], [[pulmonary edema]] (especially if new, and no cardiomegaly)
	***S4 heart sound		***S4 heart sound
	***Apical systolic murmur		***Apical systolic [[murmur]]

	==Differential Diagnosis==		==Differential Diagnosis==
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	**S4, apical systolic murmur		**S4, apical systolic murmur
	**Clinical evaluation with auscultation may underestimate MR severity<ref>Mitral Regurgitation, Ahmed MI, McGiffin DC, O'Rourke RA, Dell Italia LJ. Current Problems in Cardiology Volume 34, Issue 3, March 2009, Pages 93–136</ref>		**Clinical evaluation with auscultation may underestimate MR severity<ref>Mitral Regurgitation, Ahmed MI, McGiffin DC, O'Rourke RA, Dell Italia LJ. Current Problems in Cardiology Volume 34, Issue 3, March 2009, Pages 93–136</ref>
	*~~Echo~~ grading		*[[Echocardiography]] grading
	**Traditional grading is different from ischemic MR grading		**Traditional grading is different from ischemic MR grading
	***Eyeball grading of color jet from 1+ to 4+, set to color gain that minimizes background noise		***Eyeball grading of color jet from 1+ to 4+, set to color gain that minimizes background noise
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	*Appropriate treatment if [[myocardial infarction]] must include catheterization or [[thrombolysis]]		*Appropriate treatment if [[myocardial infarction]] must include catheterization or [[thrombolysis]]
	*Pulmonary edema		*Pulmonary edema
	**Oxygen		**[[Oxygen]]
	**Nitrates and diuresis may improve filling pressures and treat edema		**[[nitroglycerin\|Nitrates]] and [[diuretics\|diuresis]] may improve filling pressures and treat edema
	**Early intubation for impending respiratory failure		**Early intubation for impending respiratory failure
	*Decrease afterload		*Decrease afterload
	**Nitroprusside can be considered in normotensive patients to increase cardiac output and decrease MR		**[[Nitroprusside]] can be considered in normotensive patients to increase cardiac output and decrease MR
	**Intra aortic balloon pump may decrease afterload, increase forward cardiac output and reduce regurgitation		**Intra aortic balloon pump may decrease afterload, increase forward cardiac output and reduce regurgitation
	*Inotropes		*Inotropes
	**Dobutamine pressor of choice as α agonism and increased afterload minimal compared to beta agonism<ref>Sonoda M et al. Effects of Dobutamine Infusion on Mitral Regurgitation. Echocardiography. 1998 Jan;15(1):13-20.</ref>		**[[Dobutamine]] pressor of choice as α agonism and increased afterload minimal compared to beta agonism<ref>Sonoda M et al. Effects of Dobutamine Infusion on Mitral Regurgitation. Echocardiography. 1998 Jan;15(1):13-20.</ref>
	**Avoid beta-blockers as mild to moderate tachycardia allows less time for LV to backfill		**Avoid beta-blockers as mild to moderate tachycardia allows less time for LV to backfill