Retrograde flow from LV to LA in systole due to leaflet, chordal, papillary muscle, or annular dysfunction.
Causes
- • Degenerative (prolapse)
- • Functional (LV dilation)
- • Rheumatic
- • Endocarditis
- • Papillary muscle rupture post-MI
Clinical features
- • Dyspnoea, fatigue
- • Palpitations (AF)
- • Acute MR: pulmonary oedema, shock
Examination
- • Apex displaced, hyperdynamic
- • Pansystolic murmur radiating to axilla
- • S3
Investigations
- • ECG, CXR (cardiomegaly, pulmonary congestion)
- • TTE/TOE — severity, mechanism, EF, LA size
Management
- • Acute severe: IABP, vasodilator, urgent surgery
- • Chronic primary: surgery if symptoms OR EF ≤60 OR LVESD ≥40 mm OR new AF / PASP >50
- • Functional: optimise HF therapy, consider MitraClip
Complications
- • AF, pulmonary hypertension, heart failure
References
- • ESC Valvular Heart Disease 2021
Educational — verify locally.
