Mitral regurgitation

 

Disease:

Cause

·      Dilated left ventricle

·      Degeneration

·      Infective endocarditis

·      Connective tissue disease

Complications

·      Left heart failure

·      Atrial enlargement

·      Atrial tachyarrhythmias

·      Pulmonary hypertension

·      Right heart failure

Diagnosis

·      History

·      Examination: displaced apex, pansystolic murmur -> axilla

·      ECG: P-mitrale, ↑QRS amplitude

·      TTE: regurgitation!

Grading

Indirect:

·      Size of LV

·      Size of LA

·      PA pressure

Direct:

·      Size of jet

·      Size of orifice (vena contracta)

·      Size of convergence zone (PISA shell radius)

Goals

·      “Full, fast, forward”

·      Euvolaemia

·      High/normal heart rate

·      Low/normal afterload

Management

·      General good (↓SVR)

·      Regional good (↓SVR)

·      Opioids good (↓SVR) and bad (↓HR)

·      Vasopressors bad (↑SVR)

 

 

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