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Mitral regurgitation

Last reviewed: 5 Apr 2025
Last updated: 24 Jan 2025

Summary

Definition

History and exam

Key diagnostic factors

  • dyspnea on exertion
  • decreased exercise tolerance
  • lower extremity edema
  • holosystolic murmur
Full details

Other diagnostic factors

  • fatigue
  • displaced point of maximal impulse
  • orthopnea
  • paroxysmal nocturnal dyspnea
  • palpitations
  • diaphoresis
  • pulmonary closure is louder than aortic closure
  • S3 heart sound
  • diminished S1 heart sound
Full details

Risk factors

  • mitral valve prolapse
  • history of rheumatic heart disease
  • infective endocarditis
  • history of cardiac trauma
  • history of myocardial infarction
  • history of congenital heart disease
  • history of ischemic heart disease
  • left ventricular systolic dysfunction
  • hypertrophic cardiomyopathy
  • anorectic/dopaminergic drugs
  • elevated systolic blood pressure
Full details

Diagnostic tests

1st tests to order

  • transthoracic echo
  • ECG
Full details

Tests to consider

  • flow convergence method or proximal isovelocity surface area
  • color Doppler flow
  • transesophageal echocardiogram
  • cardiac catheterization
  • cardiac magnetic resonance imaging (CMR)
Full details

Treatment algorithm

ACUTE

acute severe MR

ONGOING

chronic severe primary MR: asymptomatic

chronic severe primary MR: symptomatic

chronic severe secondary MR

Contributors

Authors

Professor

National Heart and Lung Institute

Imperial College London

Consultant Cardiothoracic Surgeon

Department of Cardiothoracic Surgery

Hammersmith Hospital

Imperial College Healthcare NHS Trust

London

UK

Disclosures

PPP is an author of references cited in this topic. PPP declares that he has no competing interests.

Dr Prakash P. Punjabi would like to gratefully acknowledge Dr Samir Kapadia and Dr Mehdi H. Shishehbor, previous contributors to this topic.

Disclosures

SK and MHS declare that they have no competing interests.

Peer reviewers

Assistant Professor of Medicine

Department of Cardiovascular Medicine

Johns Hopkins University School of Medicine

Baltimore

MD

Disclosures

MC is a paid consultant to Medtronic and receives research grants to the institution as a site principal investigator for clinical trials for Medtronic, MedAlliance, and Abbott and a sub-investigator for clinical trials for Edwards Lifesciences. All of these companies manufacture devices used in the transcatheter treatment of structural heart and/or coronary artery disease.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

De Bonis M, Al-Attar N, Antunes M, et al. Surgical and interventional management of mitral valve regurgitation: a position statement from the European Society of Cardiology Working Groups on Cardiovascular Surgery and Valvular Heart Disease. Eur Heart J. 2016 Jan 7;37(2):133-9.Full text  Abstract

Otto CM, Nishimura RA, Bonow RO, et al. 2020 ACC/AHA guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2021 Feb 2;143(5):e72-227.Full text  Abstract

Vahanian A, Beyersdorf F, Praz F, et al. 2021 ESC/EACTS guidelines for the management of valvular heart disease. Eur Heart J. 2022 Feb 12;43(7):561-632.Full text  Abstract

Bonow RO, O'Gara PT, Adams DH, et al. 2020 focused update of the 2017 ACC expert consensus decision pathway on the management of mitral regurgitation: a report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol. 2020 May 5;75(17):2236-70.Full text  Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
  • Mitral regurgitation images
  • Differentials

    • Acute coronary syndrome (ACS)
    • Infective endocarditis
    • Mitral stenosis
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  • Guidelines

    • 2023 ESC guidelines for the management of infective endocarditis
    • 2021 ESC/EACTS guidelines for the management of valvular heart disease
    More Guidelines
  • Videos

    Mitral regurgitation (severe)

    Third heart sound gallop

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