Mitral Regurgitation (MR)

Introduction

Mitral regurgitation (MR) is a condition where the mitral valve does not close properly, allowing blood to flow backward into the left atrium of the heart. This can lead to various complications, including heart failure and arrhythmias.

Causes

MR can be classified into two types: primary (organic) MR and secondary (functional) MR.

• Primary MR: Caused by structural abnormalities of the mitral valve (e.g., mitral valve prolapse, rheumatic heart disease, infective endocarditis, congenital defects).
• Secondary MR: Due to left ventricular dysfunction (e.g., ischemic heart disease, dilated cardiomyopathy).

Symptoms

MR may be asymptomatic in mild cases, but as it progresses, symptoms may include: - Shortness of breath (especially during exertion or while lying down) - Fatigue - Palpitations (due to atrial fibrillation) - Swelling in the legs - Pulmonary congestion in severe MR

Diagnosis

Diagnosis is based on clinical examination and imaging tests, such as: - Echocardiography (the gold standard for MR evaluation) - Electrocardiogram (ECG) (to detect arrhythmias) - Chest X-ray (may show signs of heart enlargement) - Cardiac MRI (for detailed structural assessment)

Treatment

Treatment depends on the severity of MR:

• Mild Cases: Regular monitoring and management of risk factors such as hypertension.
• Moderate-to-Severe Cases:
  • Medications: Diuretics (to reduce fluid overload), beta-blockers (if heart failure or arrhythmias are present).
  • Surgical Interventions:
    • Mitral Valve Repair (preferred if feasible)
    • Mitral Valve Replacement (if repair is not possible)
  • Transcatheter Mitral Valve Repair (MitraClip): An option for patients who are high-risk surgical candidates.

Prognosis

The prognosis depends on the severity and timely intervention. Early detection and appropriate treatment can significantly improve quality of life and survival.

Conclusion

Mitral regurgitation is a serious but manageable condition. Regular follow-up with a cardiologist, lifestyle modifications, and appropriate treatment are key to maintaining heart health.

Source recommendations

1. 2021 ESC/EACTS Guidelines for the Management of Valvular Heart Disease

1. https://academic.oup.com/eurheartj/article/43/7/561/6358470
2. https://pubmed.ncbi.nlm.nih.gov/34453165/
3. https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Valvular-Heart-Disease-Guidelines
4. https://www.jacc.org/doi/10.1016/j.jacc.2023.05.061
5. https://www.eacts.org/clinical-practice-guideline/esc-eacts-guidelines-for-the-management-of-valvular-heart-disease/

2. 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease

1. https://www.ahajournals.org/doi/10.1161/CIR.0000000000000923
2. https://pubmed.ncbi.nlm.nih.gov/33332149/
3. https://www.ahajournals.org/doi/10.1161/CIR.0000000000000932
4. https://pubmed.ncbi.nlm.nih.gov/33342586/
5. https://www.acc.org/Latest-in-Cardiology/ten-points-to-remember/2020/12/16/21/58/2020-ACC-AHA-VHD-GL-Pt-1-GL-VHD