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Acute mitral regurgitation in adults

Catherine M Otto, MD
Section Editor
William H Gaasch, MD
Deputy Editor
Susan B Yeon, MD, JD, FACC


Patients with acute mitral regurgitation (MR) are often gravely ill with significant hemodynamic abnormalities that require urgent medical and usually surgical treatment [1].

The pathophysiology, clinical features, and management of acute MR will be reviewed here. The changes that occur in chronic MR are discussed separately. (See "Pathophysiology of chronic mitral regurgitation" and "Clinical manifestations and diagnosis of chronic mitral regurgitation".)


Although there are many causes of acute mitral regurgitation (MR), many of which can, under other circumstances, also cause chronic MR, there are only three basic mechanisms of acute native valve MR (figure 1):

Ruptured mitral chordae tendineae (flail leaflet) due to myxomatous disease (mitral valve prolapse) [2], infective endocarditis, or trauma [3], rheumatic heart disease (acute rheumatic fever [4] or chronic rheumatic mitral valve disease), or spontaneous rupture [5,6]. This complication has also been reported with a mechanical circulatory support device due to device displacement [7].

Papillary muscle rupture due to acute myocardial infarction or trauma or papillary muscle displacement due to myocardial infarction or ischemia. (See "Mechanical complications of acute myocardial infarction" and "Management and prognosis of chronic secondary mitral regurgitation".)


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Literature review current through: Sep 2016. | This topic last updated: Oct 21, 2015.
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