MITRIAL REGURGITATION

2005-04-09T15:52:00.000-07:00

This article has been published by the International Biopharmaceutical Association www.ibpassociation.org . Please note this article does not give any medical advice.

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Mitrial regurgitation is an insufficiency of the mitrial valve to preventback-flow of blood from the left ventricle to the left atrium. Etiology: Rheumatic heart disease (50%), mitrial valve prolapse (rupturedtendinae), papillary muscle dysfunction due to ischemic heart disease,endocarditis, left ventricular dilation, annular calcification,hypertrophic cardiomyopathy and congenital.Pathophysiology: Regurgitation of blood from the left ventricle into theleft atrium results in a low cardiac output, and increased left atrialpressure. At first, the atrium can not sustain the hi blood volume andresults in back-flow to the pulmonary system and pulmonary congestion.The left atrium will later comply and expand allowing for the greatervolume and then hypertrophy along with the left ventricle to produce agreater ejection fraction. Eventually, left ventricular dysfunction willoccur.Manifestations: Generally, left-sided heart failure symptoms of dyspnea,orthopnea, paroxysmal nocturnal dyspnea will appear. Pulmonary congestionwill result in severe cases exhibiting hemoptysis and perhaps right-sidedfailure, as well. This will cause typical right-sided heart failuresymptoms. If atrial enlargement and hypertrophy result in atrialfibrillation, atrial fibrillation may occur and followed by the risk ofsystemic emboli.Physical examination will reveal a holo-systolic apical murmur, radiatingto the axilla. A thrill may be palpable. Atrial hypertrophy will oftencause S3 to be heard. Left ventricular hypertrophy will laterallydisplace the PMI. Other signs include a soft S1 heart sound, wide S2split, left ventricular lift, and carotid upstroke (water hammer pulse). Diagnosis: Left sided enlargement will be seen on ECG. Chest X-ray willreveal this and pulmonary congestion, as well. Echocardiography willprovide sufficient view of enlarged chambers, a ruptured corda tendinae, amitrial valve prolapse, and vegetations in endocarditis. Doppler willreveal abnormal blood flow and the degree of regurgitation. Cardiaccatheterization may provide more precise measurements than echocardiogram.Management: Valve replacement or repair should be performed as early aspossible. The latter has fewer complications, and both must be performedbefore heart failure begins.Symptoms may be relieved with certain drug treatments. Diuretics areuseful in treating congestion and reducing ejection resistance.Vasodilators (ACE-Inhibitors, Nitroprusside IV, Hydralazine) may reduceafterload, as well and thus help reduce hypertrophy of the ventricle.Digitalis may be used to control fibrillation, and for inotropicstimulation, though should not be used in later stages. Prophylactictreatment against emboli (anticoagulants) and endocarditis should beadministered.

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MITRIAL REGURGITATION