Summary
Definition
History and exam
Key diagnostic factors
- dyspnea on exertion
- decreased exercise tolerance
- lower extremity edema
- holosystolic murmur
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
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
Diagnostic tests
1st tests to order
- transthoracic echo
- ECG
Tests to consider
- flow convergence method or proximal isovelocity surface area
- color Doppler flow
- transesophageal echocardiogram
- cardiac catheterization
- cardiac magnetic resonance imaging (CMR)
Treatment algorithm
acute severe MR
chronic severe primary MR: asymptomatic
chronic severe primary MR: symptomatic
chronic severe secondary MR
Contributors
Authors
Prakash P. Punjabi, FRCS, FESC, MS, MCh, FCCP, FFSTEd, Diplomate NBE
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.
Acknowledgements
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
Matthew Czarny, MD
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
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.
Differentials
- Acute coronary syndrome (ACS)
- Infective endocarditis
- Mitral stenosis
More DifferentialsGuidelines
- 2023 ESC guidelines for the management of infective endocarditis
- 2021 ESC/EACTS guidelines for the management of valvular heart disease
More GuidelinesVideos
Mitral regurgitation (severe)
Third heart sound gallop
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