Mitral regurgitation history and symptoms

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [2]; Varun Kumar, M.B.B.S.; Lakshmi Gopalakrishnan, M.B.B.S.; Rim Halaby, M.D. [3]: Yamuna Kondapally, M.B.B.S [4]

Overview

Acute and decompensated mitral regurgitation (MR) is associated with symptoms of congestive heart failure including dyspnea, paroxysmal nocturnal dyspnea, orthopnea, and exercise intolerance. Individuals with chronic compensated MR may be asymptomatic, with a normal exercise tolerance and no evidence of heart failure.

Patients with suspected or confirmed MR should be inquired about the acuity of the symptoms. The knowledge of the onset of the symptoms helps in the classification of MR into acute and chronic.
In addition, the patient should be asked about the symptoms of diseases that might have lead to primary MR, such as recent ST elevation myocardial infarction, infective endocarditis, connective tissue disease, mitral valve prolapse, and rheumatic heart disease.
The history of the patient should include information about coronary artery disease or any other conditions that might have caused heart failure in order to rule out secondary ischemic MR and functional MR respectively. Exposure to radiation to the chest should also be reported.

The symptoms associated with acute or decompensated MR are due to the acute volume overload with subsequent pulmonary congestion in addition to the decreased cardiac output. Symptoms include:^[1]^[2]^[3]
- Shortness of breath
- Orthopnea
- Paroxysmal nocturnal dyspnea
- Exercise intolerance
- Fatigue
- Lightheadedness
- Cough
- Palpitations (related to increased contractility and onset of atrial fibrillation)
Cardiovascular collapse with shock (cardiogenic shock) may be seen in individuals with acute MR due to papillary muscle rupture or rupture of a chordae tendineae.

Individuals with chronic compensated MR may be asymptomatic, with a normal exercise tolerance and no evidence of heart failure. These individuals may be sensitive to small shifts in their intravascular volume status, and are prone to develop volume overload (congestive heart failure).
Palpitations might occur in these patients due to the dilatation of the left atrium.^[4]^[5]^[6]

↑ Enriquez-Sarano M, Akins CW, Vahanian A (2009). “Mitral regurgitation”. Lancet. 373 (9672): 1382–94. doi:10.1016/S0140-6736(09)60692-9. PMID 19356795.
↑ Birnbaum Y, Chamoun AJ, Conti VR, Uretsky BF (2002). “Mitral regurgitation following acute myocardial infarction”. Coron Artery Dis. 13 (6): 337–44. PMID 12436029.
↑ Iung B (2003). “Management of ischaemic mitral regurgitation”. Heart. 89 (4): 459–64. PMC 1769268. PMID 12639884.
↑ Madesis A, Tsakiridis K, Zarogoulidis P, Katsikogiannis N, Machairiotis N, Kougioumtzi I; et al. (2014). “Review of mitral valve insufficiency: repair or replacement”. J Thorac Dis. 6 Suppl 1: S39–51. doi:10.3978/j.issn.2072-1439.2013.10.20. PMC 3966162. PMID 24672698.
↑ Sparano DM, Ward RP (2012). “Management of asymptomatic, severe mitral regurgitation”. Curr Treat Options Cardiovasc Med. 14 (6): 575–83. doi:10.1007/s11936-012-0207-4. PMID 22961273.
↑ Mokadam NA, Stout KK, Verrier ED (2011). “Management of acute regurgitation in left-sided cardiac valves”. Tex Heart Inst J. 38 (1): 9–19. PMC 3060740. PMID 21423463.