Mitral Regurgitation

Common causes: HTN, CHF, IHD, RF

occurs more commonly in men

O/E-

hyperdynamic and displaced LV impulse

Carotid upstroke diminished in volume but brisk

PSM radiating to axilla and often acompanied by a thrill

(Soft, low-pitched, decrescendo systolic murmur heard best at lower-left sternal border in acute MR)

S3 heard with a soft S1 and widely split S2

Distended neck veins when severe or acute

Chronic MR causes volume overload of LV and LV chamber enlargement. This leads to an increase in LV contractility and total stroke volume via the Frank-Starling mechanism.

As a result, patients with chronic MR who have normal ventricular function will actually have an increased LVEF. Conversely, a normal LVEF in a patient with severe MR suggests significant ventricular dysfunction.

Chronic AR response a bit similar but they tend to maintain a normal LVEF and forward cardiac output.

INVx

ECG - signs of LVH and left atrial enlargement

CXR - cardiomegaly, vascular congestion, features of heart failure

Echo

Catheterization is the single most accurate test