Mitral regurgitation
Diagnosis
- Most common cause is papillary / chordae rupture after MI[1]
- 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. [2]
Treatment
- Decrease pulmonary edema
- O2, nitrates, diuretics
- Increase forward flow
- Decrease afterload
- Consider nitroprusside in normotensive pts
- Dobutamine
- Consult Cards/CT Surg
- Intra-aortic balloon pump, emergency surgery
See Also
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
- ↑ 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.
- ↑ 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