Patients may be asymptomatic or may have manifestations like fatigue caused by reduced cardiac output, tachypnea or dyspnea, orthopnea, paroxysmal nocturnal dyspnea and hemoptysis due to pulmonary hypertension [1]. When atrial fibrillation due to left atrium dilatation occurs, most patients experience palpitations. In children, failure to thrive is an important hallmark of almost all serious heart conditions.

When mitral regurgitation happens abruptly, being caused by an acute accident like chordal or papillary muscle rupture due to myocardial infarction, compensatory mechanisms do not have time to install and symptoms are dramatic, as patients present with pulmonary edema or cardiogenic shock. In chronic severe mitral regurgitation, patients slowly progress to congestive heart failure and pulmonary edema [2].

• Fatigue

  Most people with mitral valve prolapse have no symptoms, however, those who do commonly complain of symptoms may experience: Fatigue is the most common symptom of mitral valve prolapse, although the reason for fatigue is not understood. [medicinenet.com]

  They include: A racing or irregular heartbeat (arrhythmia) Dizziness or feeling lightheaded Shortness of breath Fatigue Chest pain Mitral valve stenosis For some, the primary and often only symptom of mitral stenosis is shortness of breath. [heartvalvedisease.nm.org]

  It can provoke symptoms such as breathlessness and fatigue and lead to atrial fibrillation or heart failure. To continue reading this article, you must login. [health.harvard.edu]

  We ask about general symptoms (anxious mood, depressed mood, fatigue, pain, and stress) regardless of condition. Last updated: January 31, 2019 [patientslikeme.com]

• Pain

  Remember when you were 18 years old and you started having left-sided chest pains? Your pains felt as if someone was stabbing you. They were very painful and at one time you may even have screamed with pain. [chd-uk.co.uk]

  Symptoms of mitral valve stenosis may include: Shortness of breath Cough due to fluid on the lungs (pulmonary edema) A rapid, fluttering heartbeat (palpitations) Dizziness or lightheadedness Swollen feet or legs Blood clots Chest pain [heartvalvedisease.nm.org]

  Sharp chest pains, which can be prolonged. Unlike angina and chest pain, rarely, mitral valve prolapse occurs during or after exercise ,and may not respond to nitroglycerin. [medicinenet.com]

  You may have blocked arteries with claudication, which is leg pain while walking or exercising. The pain tends to first appear as a cramping in the calf. You may have blocked arteries with severe problems. [uvmhealth.org]

• Congestive Heart Failure

  If the condition persists, the patient can also develop atrial fibrillation and potentially congestive heart failure, leading to shortness of breadth, dizziness, chest pain, and fatigue. [myocor.com]

  failure: importance of left ventricular diastolic function and right ventricular systolic function. 61 54 Troughton RW...Klein AL 15013124 2004 23 [Autoantibodies: new upstream targets of paroxysmal atrial fibrillation in patients with congestive heart [malacards.org]

  Complications congestive heart failure pulmonary hypertension mass-effect from left atrial enlargement (e.g. [radiopaedia.org]

• Weakness

  Mitral regurgitation is caused by damage or weakness of the mitral valve. [drugs.com]

  The valve or its supporting structures can be damaged by a heart attack, coronary artery disease, or weakness in the tissues of these structures (myxomatous degeneration). [msdmanuals.com]

  Some surgeons might not be comfortable operating on weak hearts because they feel they might not recover well after surgery. [heartsurgeryinfo.com]

  Symptoms of acute mitral valve regurgitation including severe shortness of breath, fast heart rate, lightheadedness, weakness, confusion, and chest pain. [uofmhealth.org]

  Another cause is functional mitral regurgitation, or a weak heart muscle that's not strong enough to adequately close the valve. This often occurs because of heart injury from a heart attack. [uvahealth.com]

• Streptococcal Infection

  Rheumatic fever — An illness that sometimes follows a streptococcal infection of the throat. Ventricle — One of the two lower chambers of the heart. [medical-dictionary.thefreedictionary.com]

  Genetic weakness of the mitral valve tissue (myxomatous degeneration) and heart attack are the most common causes of mitral regurgitation except in places where antibiotics are not readily available to treat streptococcal infections and prevent rheumatic [msdmanuals.com]

• Cough

  In acute or chronic decompensated MR, pulmonary edema and pulmonary hypertension often cause dyspnea, coughing, jugular venous distention, and pitting edema. [amboss.com]

  This may produce symptoms ranging from shortness of breath during exertion, coughing, congestion around the heart and lungs, swelling of the legs and feet. [cardiomyopathy.org]

  Symptoms of mitral valve stenosis may include: Shortness of breath Cough due to fluid on the lungs (pulmonary edema) A rapid, fluttering heartbeat (palpitations) Dizziness or lightheadedness Swollen feet or legs Blood clots Chest pain [heartvalvedisease.nm.org]

  You may be at risk if you experience these symptoms: Difficulty breathing, especially during exercise or when lying flat Awakening short of breath in the middle of the night Fatigue Sensation of rapid or irregular heartbeat Cough with exertion or when [uvahealth.com]

• Dyspnea

  The patients were referred to our cardiovascular department because of exertional dyspnea. Echocardiography showed severe mitral valve insufficiency resulting from leaflet flail or prolapse and normal left ventricular function. [ncbi.nlm.nih.gov]

  Symptoms such as palpitations or dyspnea appear late in the course of chronic compensated MR in which cardiac output can still be maintained. [amboss.com]

  Patients may be asymptomatic or may have manifestations like fatigue caused by reduced cardiac output, tachypnea or dyspnea, orthopnea, paroxysmal nocturnal dyspnea and hemoptysis due to pulmonary hypertension. [symptoma.com]

  Loop diuretics such as furosemide are helpful in patients with exertional or nocturnal dyspnea. Digoxin may reduce symptoms in patients with AF or those in whom valve surgery is not appropriate. [msdmanuals.com]

• Orthopnea

  Patients may be asymptomatic or may have manifestations like fatigue caused by reduced cardiac output, tachypnea or dyspnea, orthopnea, paroxysmal nocturnal dyspnea and hemoptysis due to pulmonary hypertension. [symptoma.com]

  急性二尖瓣闭锁不全因未及产生代偿作用，因此会产生较严重的症状，且症状类似郁血性心衰竭，包含呼吸困难、肺水肿（英语：pulmonary edema）、端坐呼吸（英语：orthopnea），以及阵发性夜间呼吸困难（英语：paroxysmal nocturnal dyspnea）等等[3]。另外由于循环血容量骤降，会产生心因性休克（英语：cardiogenic shock）的症状，如休息时呼吸困难。 [zh.m.wikipedia.org]

  Symptoms include dyspnea, fatigue (due to heart failure), orthopnea, and palpitations (often due to atrial fibrillation). Rarely, patients present with endocarditis (eg, fever, weight loss, embolic phenomena). [msdmanuals.com]

  […] coronary artery disease and acute myocardial infarction (typically, inferior myocardial infarction, which may lead to papillary muscle dysfunction), significant acute MR is accompanied by symptoms of impaired LV function, such as dyspnea, fatigue, and orthopnea [emedicine.medscape.com]

• Hemoptysis

  Patients may be asymptomatic or may have manifestations like fatigue caused by reduced cardiac output, tachypnea or dyspnea, orthopnea, paroxysmal nocturnal dyspnea and hemoptysis due to pulmonary hypertension. [symptoma.com]

  Other less common symptoms include hemoptysis, thromboembolism or symptoms of infectious endocarditis. Acute mitral regurgitation presents with dramatic symptoms. Syncope can occur from sudden hypotension related to cardiogenic shock. [healio.com]

• Dry Cough

  In acute or chronic decompensated MR, pulmonary edema and pulmonary hypertension often cause dyspnea, coughing, jugular venous distention, and pitting edema. [amboss.com]

  Symptoms Dry cough Difficulty breathing Stagnation of blood vessels in the lungs Heart palpitations Irregular heartbeat Upheavals in the left side of the chest Patients with insufficient mitral valve can also feel dizziness in the morning or before the [bookinghealth.com]

• Failure to Thrive

  In children, failure to thrive is an important hallmark of almost all serious heart conditions. [symptoma.com]

• Heart Disease

  Clinically severe TR has been reported in 23% to 37% of patients after MVR for rheumatic heart disease ( 7,8 ). In 14%, TR occurred in the absence of significant left heart disease, pulmonary hypertension, or obvious organic TV disease ( 7 ). [content.onlinejacc.org]

  Always tell your provider and dentist if you have a history of heart valve disease or congenital heart disease before treatment. Some people may need antibiotics before dental procedures or surgery. References Carabello BA. Valvular heart disease. [mountsinai.org]

  Epidemiology Frequency United States Previously, chronic rheumatic heart disease was the most common cause of acquired mitral valve disease in the Western world. [emedicine.medscape.com]

• Mitral Valve Prolapse

  Mitral valve prolapse definition and facts Mitral valve prolapse (mitral valve prolapse) is the most common heart valve abnormality. Most people with mitral valve prolapse have no symptoms and require no treatment. [medicinenet.com]

  Mitral valve stenosis Mitral valve stenosis, nonrheumatic Mtral valve prolapse Non-rheumatic mitral regurgitation Nonrheumatic mitral valve prolapse Non-rheumatic mitral valve prolapse Nonrheumatic mitral valve regurgitation Nonrheumatic mitral valve [icd9data.com]

  Post Mitral Valve Prolapse - Symptoms What symptoms did you experience with your mitral valve prolapse? Post View 22 Comments Mitral Valve Prolapse - Experience Please share your experience with mitral valve prolapse. [emedicinehealth.com]

  Mitral Valve Prolapse Mitral valve prolapse is defined as the displacement of one or both of the leaflets of the mitral valve beyond the annulus into the left atrium during systole.1 Historically a mitral valve prolapse syndrome has been described as [acc.org]

• Palpitations

  Palpitations are sensations of fast or irregular heart beats. In most people with mitral valve prolapse, palpitations are harmless. [medicinenet.com]

  Symptoms of mitral valve stenosis may include: Shortness of breath Cough due to fluid on the lungs (pulmonary edema) A rapid, fluttering heartbeat (palpitations) Dizziness or lightheadedness Swollen feet or legs Blood clots Chest pain [heartvalvedisease.nm.org]

  Mitral Valve Prolapse Symptom - Heart Palpitations Heart palpitations are one symptom of a heart condition called mitral valve prolapse (a very common heart valve abnormality). [emedicinehealth.com]

  Symptoms such as palpitations or dyspnea appear late in the course of chronic compensated MR in which cardiac output can still be maintained. [amboss.com]

• Heart Murmur

  When to see a doctor If your doctor hears a heart murmur when listening to your heart with a stethoscope, he or she may recommend that you visit a cardiologist and get an echocardiogram. [mayoclinic.org]

  To ensure proper cardiac function, please remember to get regular, annual check-ups if you have been diagnosed with a heart murmur, a mitral valve prolapse or mitral valve regurgitation. [heart-valve-surgery.com]

  Mitral valve regurgitation signs and symptoms can include: Blood flowing turbulently through the heart (heart murmur) Shortness of breath, especially with exertion or when lying down Fatigue, especially during times of increased activity Lightheadedness [columbiasurgery.org]

• Systolic Murmur

  Forty-five patients had a pan-systolic murmur and 37 had a late-systolic murmur on auscultation that was verified by timing of onset of regurgitant turbulence by cine magnetic resonance imaging. [ncbi.nlm.nih.gov]

  Systolic Murmurs - Mitral Regurgitation You are listening to a typical example of a murmur caused by mitral valve regurgitation. [med.ucla.edu]

  Mitral prolapse has often been termed the “click-murmur” syndrome because of the physical findings it produces, i.e., a mid-systolic click followed by a late systolic murmur. [thecardiologyadvisor.com]

• Dizziness

  Symptoms of mitral valve stenosis may include: Shortness of breath Cough due to fluid on the lungs (pulmonary edema) A rapid, fluttering heartbeat (palpitations) Dizziness or lightheadedness Swollen feet or legs Blood clots Chest pain [heartvalvedisease.nm.org]

  […] practitioner if the pulse rate is outside the parameters dietary restrictions, including the need to maintain low salt intake prescribed medications, such as diuretics and ACE inhibitors and potential adverse effects, such as orthostatic hypotension, dizziness [quizlet.com]

  Symptoms include evidence of a heart rhythm disorder, such as dizziness, blackout, or fainting spell, or a continuing and uncomfortable feeling that the heart is fluttering or racing. Chest pain does not go away. [emedicinehealth.com]

  If the condition persists, the patient can also develop atrial fibrillation and potentially congestive heart failure, leading to shortness of breadth, dizziness, chest pain, and fatigue. [myocor.com]

• Akinesia

  Ischemic MR is characterized by restrictive mitral leaflet mobility due to dyskinesia or even akinesia of the ventricular wall which bears one or both papillary muscles, thus, extending the distance between the ventricular wall and the leaflets. [ncbi.nlm.nih.gov]

A clinical examination reveals a left atrial lift caused by the left atrium filling with blood during systole. The first heart sound is normal or diminished, while the second heart sound is split into early stages of the disease because the aortic valve closes early. The splitting interval diminishes as pulmonary hypertension starts [1]. A third sound caused by increased ventricular filling may also appear, while the pulmonary component of the second heart sound is accentuated if pulmonary hypertension has begun. Mitral valve prolapse is accompanied by an ejection systolic click.

The murmur caused by mitral regurgitation is best heard at the apex and radiates towards the axilla and subscapular area. It is usually pansystolic, but may also be presystolic in acute settings or telesystolic in mitral valve prolapse or papillary muscle dysfunction. The intensity decreases as the left ventricle dysfunction advances [2].

Peripheral pulse is sharp but has a small volume; atrial fibrillation presents late in the course of the disease and the characteristic pulse abnormality is noted. The dilated left atrium may compress the left main bronchus, leading to wheezing and, rarely, lung atelectasis and hyperinflation.

The postero-anterior radiography may show a normal aspect of the heart or enlarged left atrium and left atrial appendage; if mitral regurgitation begins abruptly, the X-ray shows signs of pulmonary edema with normal sized left atrium. The pulmonary edema might be more prominent in the right upper lobe [3]. Cardiomegaly is present in chronic regurgitations.

Echocardiography is the most valuable tool in assessing mitral regurgitation. Two-dimensional (2D) echocardiography is useful in measuring heart dimensions and characterizing the mitral apparatus while trying to identify the cause of the disease and associated abnormalities. Color flow echocardiography describes the direction of the flow [4]. Quantitative and semi-quantitative measurement methods should be used in evaluating disease severity [5].

Spectral Doppler (pulse and continuous) is useful in calculating the severity of the regurgitation (by measuring parameters such as vena contracta, proximal isovelocity surface area, and regurgitant fraction) and evaluating a possible concomitant mitral stenosis [5]. If doubt about severity persists, stress echocardiography and exercise testing should be performed [2].

Transesophageal echocardiography and heart catheterization are indicated in cases where heart anatomy is uncertain [6], whereas cardiac magnetic resonance imaging (MRI) is more accurate in determining ventricular function and size. Catheterization is also useful in grading the regurgitation [7].

Electrocardiography shows rhythm and conduction abnormalities, left atrial enlargement and right ventricular hypertrophy if pulmonary hypertension is present.

Brain natriuretic peptide has prognostic value in severe mitral regurgitation and can be used in risk stratification [8].

• P Mitrale

  Also, it may detect a dilated left atrium and ventricle and decreased left ventricular function.MOHAMMAD ALADAM 23.  Electrocardiography: P mitrale is broad, notched P waves in several or many leads with a prominent late negative component to the P wave [slideshare.net]

  Electrocardiography[edit] P mitrale is broad, notched P waves in several or many leads with a prominent late negative comp[[mb b [[]]]]onent to the P wave in lead V1, and may be seen in MR, but also in mitral stenosis, and, potentially, any cause of overload [en.wikipedia.org]

  The most common finding is left atrial enlargement (P mitrale), but this finding disappears if the patient enters atrial fibrillation. Right heart strain may produce findings of right axis deviation and right ventricular hypertrophy on ECG. [healio.com]

• Left Ventricular Hypertrophy

  In ICD-10-CM, the code for left ventricular hypertrophy is I51.7 Cardiomegaly. The heart is divided into right and left sides by a septum (a muscular wall). [aapc.com]

  Eventually, these patients develop eccentric left ventricular hypertrophy and worsened contractility. EF can fall below 50% and regurgitant volume can exceed forward volume in severe MR. [openanesthesia.org]

  The chronic compensated phase results in eccentric left ventricular hypertrophy. The combination of increased preload and hypertrophy produces increased end-diastolic volumes, which, over time, result in left ventricular muscle dysfunction. [emedicine.medscape.com]

We found that although percutaneous treatment was effective at reducing mitral regurgitation, surgical treatment was more effective, as graded by an echocardiographic core laboratory. [nejm.org]

Mitral Valve Regurgitation Treatment The goals of treatment for mitral regurgitation are to limit or eliminate the leakage of your valve while providing symptom relief and improving the quality and longevity of your life. [upmc.com]

Treatment Treatment will depend on what symptoms you have, what condition caused the mitral valve regurgitation, how well the heart is working, and if the heart has become enlarged. [mountsinai.org]

The prognosis of these patients is good; however, sudden death, endocarditis, and progressive regurgitation occur rarely. [emedicine.medscape.com]

Mitral Valve Regurgitation Prognosis Prognosis for mitral valve regurgitation varies based on its severity, whether it be major or mild mitral valve regurgitation. Medication can ease symptoms, but cannot reverse mitral valve regurgitation. [baptisthealth.com]

Mitral regurgitation Summary Etiology Pathophysiology Clinical features Diagnostics Treatment Complications Acute management checklist [amboss.com]

Most of these patients had an ischemic etiology (75%, regurgitation ≥2/4) and prolapse of both leaflets. Only 1 patient with isolated posterior leaflet prolapse presented 2/4 grade regurgitation on follow-up. [revespcardiol.org]

Etiology of MR Patients with primary MR should be grouped according to the Carpentier classification, which is useful for understanding etiology as well as therapeutic approaches (Central Illustration). [imaging.onlinejacc.org]

— Adult — Cardiac Surgical Procedures/methods — Child — Child Preschool — Chordae Tendineae/surgery — Cohort Studies — Echocardiography Transesophageal — Female — Follow-Up Studies — Humans — Male — Mitral Valve/surgery — Mitral Valve Insufficiency/etiology [archive-ouverte.unige.ch]

Etiology is a major determinant of outcome in cardiac surgical patients. Medical and Surgical Treatment Medical treatment may include digoxin, diuretics, and/or vasodilators—including ACE inhibitors. [openanesthesia.org]

Working Group on Epidemiology and Prevention of Cardiovascular Diseases: Meeting of the Working Group of the European Society of Cardiology on Epidemiology and Prevention of Cardiovascular Diseases 9,Suppl.=1 von: Weltgesundheitsorganisation. [zdb-katalog.de]

Epidemiology Frequency United States Previously, chronic rheumatic heart disease was the most common cause of acquired mitral valve disease in the Western world. [emedicine.medscape.com]

The pathophysiology and operative strategy for these patients are discussed. [ncbi.nlm.nih.gov]

Mitral regurgitation Summary Etiology Pathophysiology Clinical features Diagnostics Treatment Complications Acute management checklist [amboss.com]

PATHOPHYSIOLOGY Echocardiographic studies of functional MR have shown that regurgitant flow varies during systole: there is an early systolic peak, a midsystolic decrease, and a late, smaller late systolic peak [ 4,5 ]. [web.archive.org]

Although the pathophysiology resulting from mitral regurgitation (MR) (mitral valve insufficiency) is similar throughout all age groups, the specific cause of mitral regurgitation differs with age. [emedicine.medscape.com]

After mitral valve repair, a single-chamber cardioverter-defibrillator was implanted for secondary prevention of sudden cardiac death. [ncbi.nlm.nih.gov]

Atrial fibrillation, if present, may require treatment, including use of anticoagulants to prevent clots. [msdmanuals.com]

To prevent blood clots from forming, the patient will need to take drugs that prevent abnormal blood clotting (anticoagulants). [medical-dictionary.thefreedictionary.com]

Treat strep infections quickly to prevent rheumatic fever. Always tell your provider and dentist if you have a history of heart valve disease or congenital heart disease before treatment. [mountsinai.org]

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2. Vahanian A, Alfieri O, Andreotti F, et al. Guidelines on the management of valvular heart disease (version 2012): The Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2012;33(19):2451-2496.
3. Schnyder PA, Sarraj AM, Duvoisin BE, et al. Pulmonary edema associated with mitral regurgitation: prevalence of predominant involvement of the right upper lobe. AJR Am J Roentgenol. 1993;161(1): 33-36.
4. Little SH, Pirat B, Kumar R, et al. Three-dimensional color Doppler echocardiography for direct measurement of vena contracta area in mitral regurgitation: in vitro validation and clinical experience. JACC Cardiovasc Imaging. 2008;1(6):695-704.
5. Zoghbi WA, Enriquez-Sarano M, Foster E et al. Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography. J Am Soc Echocardiogr 2003;16(7):777-802.
6. Calafiore AM, Gallina S, Iaco AL, et al. Mitral valve surgery for functional mitral regurgitation: should moderate-or-more tricuspid regurgitation be treated? a propensity score analysis. Ann Thorac Surg. 2009;87(3):698-703.
7. Bonow RO, Carabello BA, Kanu C, et al. ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing committee to revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): developed in collaboration with the Society of Cardiovascular Anesthesiologists: endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons. Circulation. 2006;114(5):e84-231.
8. Pizarro R, Bazzino OO, Oberti PF, et al. Prospective validation of the prognostic usefulness of brain natriuretic peptide in asymptomatic patients with chronic severe mitral regurgitation. J Am Coll Cardiol. 2009;54(12):1099-1106.