Clinical manifestations and diagnosis of chronic mitral regurgitation
- Catherine M Otto, MD
Catherine M Otto, MD
- Editor-in-Chief — Cardiovascular Medicine
- Section Editor — Cardiac Evaluation; Valvular Disease
- Professor of Medicine
- University of Washington
- Section Editors
- William H Gaasch, MD
William H Gaasch, MD
- Section Editor — Valvular Disease
- Professor of Medicine
- University of Massachusetts Medical School
- Tufts University School of Medicine
- Senior Consultant in Cardiology
- Lahey Clinic
- Warren J Manning, MD
Warren J Manning, MD
- Section Editor — Noninvasive Cardiac Imaging and Stress Testing
- Professor of Medicine and Radiology
- Harvard Medical School
Mitral regurgitation (MR) is a common valvular disorder that can arise from abnormalities of any part of the mitral valve apparatus. These include the valve leaflets, annulus, chordae tendineae, and papillary muscles (table 1 and figure 1). The left atrium and ventricle are also integrally involved with mitral valve function.
The etiology and clinical manifestations of chronic MR will be reviewed here. Issues related to acute MR, pathophysiology of chronic MR and management of chronic MR are discussed separately. (See "Acute mitral regurgitation in adults" and "Pathophysiology of chronic mitral regurgitation" and "Management of chronic primary mitral regurgitation" and "Management and prognosis of chronic secondary mitral regurgitation".)
Mitral regurgitation (MR) may be due to a primary abnormality (often referred to organic MR) of one or more components of the valve apparatus (leaflets, chordae tendineae, papillary muscles, and/or annulus) or may be secondary (previously referred to as functional MR) to another cardiac disease (such as coronary heart disease or a cardiomyopathy) (table 1). (See "Pathophysiology of chronic mitral regurgitation", section on 'Causes and mechanisms'.)
The causes of primary (also known as organic) MR include:
●Degenerative mitral valve disease (including mitral valve prolapse) is the most common cause of primary MR in developed countries. It includes a spectrum of disease ranging from myxomatous mitral valve disease (also known as myxomatous degeneration, with redundancy of anterior and posterior mitral leaflets and the chordae), seen primarily in younger populations, and fibroelastic deficiency disease, seen primarily in older populations. It is not clear if these are two distinct disease processes or manifestations of a single disease. (See "Definition and diagnosis of mitral valve prolapse" and "Nonarrhythmic complications of mitral valve prolapse".)
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- CLINICAL MANIFESTATIONS
- Physical examination
- - Heart sounds
- - Effect of diagnostic maneuvers
- Chest radiograph
- DIAGNOSIS AND EVALUATION
- Approach to diagnosis and evaluation
- - Identifying mitral regurgitation and its severity
- - Identifying hemodynamic consequences
- - Identifying the cause of mitral regurgitation
- - Echocardiogram
- - Cardiovascular magnetic resonance
- - Cardiac catheterization
- - Stress testing
- DIFFERENTIAL DIAGNOSIS
- SERIAL MONITORING
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS