| Mitral insufficiency | |
|---|---|
| Other names | Mitral incompetence, mitral regurgitation, mitral valve insufficiency |
 | |
| During contraction of the left ventricle there is backflow (arrow) into the left atrium. (1) Mitral valve (2) Left ventricle (3) Left atrium (4) Aorta | |
| Specialty | Cardiology |
| Symptoms | Sudden onset: Severe shortness of breath, low blood pressure[1] Gradual onset: Few symptoms initially, may develop shortness of breath, palpitations, chest pain, leg swelling[2] |
| Complications | Heart failure, pulmonary hypertension[2] |
| Types | Acute, chronic[2] |
| Causes | Sudden onset: Infectious endocarditis, rupture of the papillary muscle Gradual onset: Degenerative changes with mitral valve prolapse, rheumatic heart disease, infectious endocarditis, cardiomyopathy, heart failure, atrial fibrillation[2] |
| Diagnostic method | Suspected based on a systolic murmur, confirmed by echocardiography[2] |
| Differential diagnosis | Acute coronary syndrome, aortic stenosis, tricuspid regurgitation, pulmonic stenosis, ventricular septal defect[2] |
| Treatment | Watchful waiting, surgery[2] |
| Prognosis | Variable[2] |
| Frequency | 175 million[2] |
Mitral insufficiency, also known as mitral regurgitation (MR), is a type of valvular heart disease in which there is backward flow of blood from the left ventricle, through the mitral valve, into the left atrium, when the heart contracts.[2] It may be sudden or gradual in onset.[2] Cases of sudden onset may present with severe shortness of breath and low blood pressure.[2][1] Cases of gradual onset may have few symptoms, though may develop shortness of breath, palpitations, chest pain, or leg swelling.[2] Complications can include heart failure.[2]
Cases of sudden onset may occur due to infectious endocarditis or rupture of the papillary muscle as a result of a heart attack, trauma, or Marfan's syndrome.[2] Cases of gradual onset may occur due to degenerative changes with mitral valve prolapse, rheumatic heart disease, infectious endocarditis, cardiomyopathy, heart failure, or atrial fibrillation.[2] Diagnosis may be suspected based on a systolic murmur and confirmed by echocardiography.[2]
Cases of sudden onset generally require urgent surgery.[2] Some may require vasopressors, an intra-aortic balloon pump, and mechanical ventilation to stabilize them before surgery.[2] For cases of gradual onset, only if it becomes severe is surgery potentially recommended.[2] The type of surgery may be an mitral valve replacement or an mitral valve repair.[2] Outcomes are variable.[2]
Globally about 175 million people are affected.[2] It affects less than 1% of people under 45 and 11% of people over 75 years old.[2] The chronic form is more common than the acute form.[3] It is the most common form of valvular heart disease.[4] The murmur of mitral insufficiency was first described in 1818 by Rene T. Laennec.[5] Surgery for the mitral valve became available in the late 1950s and early 1960s.[6]
References edit
- ^ a b Watanabe, Nozomi (May 2019). "Acute mitral regurgitation". Heart. 105 (9): 671–677. doi:10.1136/heartjnl-2018-313373.
- ^ a b c d e f g h i j k l m n o p q r s t u v w x Chaudhari, SS; Chokkalingam Mani, B (January 2020). "Mitral Valve Insufficiency". PMID 32491821.
{{cite journal}}: Cite journal requires|journal=(help) - ^ FCCM, Joseph E. Parrillo, MD; MS, R. Phillip Dellinger, MD (2013). Critical Care Medicine: Principles of Diagnosis and Management in the Adult. Elsevier Health Sciences. p. 562. ISBN 978-0-323-08929-6.
{{cite book}}: CS1 maint: multiple names: authors list (link) - ^ Otto, Catherine M.; Bonow, Robert O. (2009). Valvular Heart Disease: A Companion to Braunwald's Heart Disease E-Book. Elsevier Health Sciences. p. 357. ISBN 978-1-4377-2147-8.
- ^ Hajar, R (July 2016). "Rheumatic Fever and Rheumatic Heart Disease a Historical Perspective". Heart views : the official journal of the Gulf Heart Association. 17 (3): 120–126. doi:10.4103/1995-705X.192572. PMID 27867464.
{{cite journal}}: CS1 maint: unflagged free DOI (link) - ^ Savage, Edward Bruce; Bolling, Steven F.; Bolling, Steven (2006). Atlas of Mitral Valve Repair. Lippincott Williams & Wilkins. p. 2. ISBN 978-0-7817-4692-2.