MITRAL REGURGITATION AND PROLAPSE


I. Pathophysiology:

II. Clinical presentation:

III. Mnemonic for causes of MR: "PRIESTS' CAPS"

P apillary musc. problems (rupture or fibrosis, 2? to ischemia, LV dilatation, bact. endocarditis)

Rheumatic heart disease (40% of cases of MR, more common result of RHD in males; females get more MS)

I HSS (on echo, see ant. motion of the mitral valve during systole)

E ndocarditis, infective (due to direct involv. of valve or chorae tendinae; also Endocardial cushion defects)

S LE & other collagen-vast. disorders, esp. RA (not so common)

T ransposition of the great vessels, corrected

S pondylitis, ankylosing (3% of pts get MR; same amount get AR)

C alcified mitral annulus (us. in elderly, causes very MILD MR)

A neurysm of LV (changes pap. mm. configuration)

P rolapse of mitral valve (us. very MILD MR, but increased incidence of endocarditis and arrhythmias)

S ingle papillary m. (congenital, aka "parachute mitral valve"; valve may be regurgitant, stenotic, or neither)

IV. Treatment

V. Mitral valve prolapse
  1. Definition = displacement of any portion of the valve into the left atrium during systole
  2. Prevalence = 1-2.5%
  3. Can be associated with excess leaflet tissue ("Barlow's syndrome"), particularly in young patients
  4. In elderly patients usually caused by deficiency in fibroelastic tissue
  5. More common in women than men
  6. Clinical features
    1. Asucultatory findings: Mid-systolic click and late-systolic murmur
    2. Usually asymptomatic
    3. Not associated with increased mortality
    4. Some patients with MVP have other symtpoms such as dizziness and palpitations, but causal relationship to MVP is unclear
    5. 5-10% progress to frank mitral regurgitation
(Sources include Core Content Review of Family Medicine, 2012)