Mitral regurgitation causes: Difference between revisions
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*Papillary muscle rupture. | *Papillary muscle rupture. | ||
*ST elevation myocardial infarction. | *ST elevation myocardial infarction. | ||
*Infective endocarditis. | |||
*Trauma. | |||
==Differential Diagnosis of the Causes of Chronic Mitral Regurgitation== | ==Differential Diagnosis of the Causes of Chronic Mitral Regurgitation== | ||
Revision as of 13:49, 16 September 2011
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]; Varun Kumar, M.B.B.S.; Lakshmi Gopalakrishnan, M.B.B.S.; Mohammed A. Sbeih, M.D. [3]
Overview
Regurgitation means leaking from a valve that doesn't close all the way. It is caused by diseases that weaken or damage the valve or its supporting structures. Mitral regurgitation becomes chronic when the condition persists rather than occurring for only a short time period. The causes of chronic mitral regurgitation should be distinguished from the acute mitral regurgitation causes.
Common Causes of Mitral Regurgitation
- Acute Mitral Regurgitation.
- Dysfunction or injury to the mitral valve following a heart attack. Papillary muscle rupture or dysfunction that is associated with ST elevation myocardial infarction.
- Infection of the heart valve (infective endocarditis). These conditions may rupture the valve or surrounding structures, leaving an opening for blood to move backwards.
- Trauma.
- Chronic Mitral Regurgitation.
- Mitral valve prolapse now accounts for 45% of cases in the Western world.
- Ischemic heart disease / Coronary artery disease.
- Rheumatic heart disease, in the past, this was the most common cause of MR in the Western world. In developing countries, rheumatic heart disease remains the most common cause.
Complete Differential Diagnosis of the Causes of Mitral Regurgitation
(By organ system)
| Cardiovascular | Dysfunction or injury to the mitral valve following a heart attack, papillary muscle rupture or dysfunction that is associated with ST elevation myocardial infarction, infection of the heart valve (infective endocarditis), mitral valve prolapse (accounts for 45% of cases in the western world), ischemic heart disease (coronary artery disease), rheumatic heart disease (this was the most common cause of MR in the western world), balloon valvuloplasty of the mitral valve, heart tumors, high blood pressure and swelling of the left lower heart chamber.
Dilatation of the left ventricle, causing stretching of the mitral valve annulus and displacement of the papillary muscles ( causes include dilated cardiomyopathy, aortic insufficiency and Takotsubo cardiomyopathy [1][2]). |
| Chemical / poisoning | No underlying causes |
| Dermatologic | No underlying causes |
| Drug Side Effect | No underlying causes |
| Ear Nose Throat | No underlying causes |
| Endocrine | No underlying causes |
| Environmental | No underlying causes |
| Gastroenterologic | No underlying causes |
| Genetic | No underlying causes |
| Hematologic | No underlying causes |
| Iatrogenic | No underlying causes |
| Infectious Disease | Infective endocarditis (the predominant organism is S. aureus, but varies depending upon the patient [3]) and untreated syphilis (rare). |
| Musculoskeletal / Ortho | No underlying causes |
| Neurologic | No underlying causes |
| Nutritional / Metabolic | No underlying causes |
| Obstetric/Gynecologic | No underlying causes |
| Oncologic | No underlying causes |
| Opthalmologic | No underlying causes |
| Overdose / Toxicity | No underlying causes |
| Psychiatric | No underlying causes |
| Pulmonary | No underlying causes |
| Renal / Electrolyte | No underlying causes |
| Rheum / Immune / Allergy | Collagen vascular diseases; SLE, Marfan's syndrome, |
| Sexual | No underlying causes |
| Trauma | Trauma to the heart (stab wound). |
| Urologic | No underlying causes |
| Miscellaneous | Congenital (present from birth) mitral regurgitation is most often part of a more complex heart defect or syndrome, |
Differential Diagnosis of the Causes of Acute Mitral Regurgitation
In alphabetical order:
- Papillary muscle rupture.
- ST elevation myocardial infarction.
- Infective endocarditis.
- Trauma.
Differential Diagnosis of the Causes of Chronic Mitral Regurgitation
In alphabetical order:
Diseases Causing Mitral Regurgitation
Primary mitral regurgitation is due to any disease process that affects the mitral valve apparatus itself. The causes of primary mitral regurgitation include:
- Mitral valve prolapse now accounts for 45% of cases in the Western world
- Ischemic heart disease / Coronary artery disease
- Rheumatic heart disease In the past, this was the most common cause of MR in the Western world. In developing countries, rheumatic heart disease remains a major cause.
- Infective endocarditis
- Collagen vascular diseases (ie: SLE, Marfan's syndrome)
- Trauma
- Balloon valvuloplasty of the mitral valve
- Certain forms of medication (e.g. fenfluramine)
Secondary mitral regurgitation is due to the dilatation of the left ventricle, causing stretching of the mitral valve annulus and displacement of the papillary muscles. This dilatation of the left ventricle can be due to:
- Any cause of dilated cardiomyopathy including aortic insufficiency,
- Non-ischemic dilated cardiomyopathy,
- Non-compaction Cardiomyopathy and
- As a complication of Takotsubo cardiomyopathy[1][2]. A recent study[4] revealed mitral valve tethering and systolic anterior motion of mitral valve have independent mechanisms with different pathophysiology in causing acute MR in patients with Takotsubo cardiomyopathy.
Causes of chronic mitral regurgitation include:
- Primary diseases of the valve leaflets such as mitral valve prolapse. MVP is a common cause. However, most patients with MVP do not develop severe mitral regurgitation. Older age, male gender, and auscultatory evidence of severe MR are prognostic clues that identify patients with mitral valve prolapse who are at a relatively high risk of complications.
- Rheumatic heart disease. One out of three cases of chronic mitral regurgitation are caused by rheumatic heart disease, a complication of untreated strep throat that is becoming less common.
- Coronary artery disease and heart attacks.
- cardiomyopathy.
- Endocarditis.
- Heart tumors.
- High blood pressure.
- Marfan syndrome.
- Swelling of the left lower heart chamber.
- Untreated syphilis (rare).
- Congenital (present from birth) mitral regurgitation is most often part of a more complex heart defect or syndrome.
Chronic Mitral Regurgitation
- Developed World: Mitral valve prolapse (MVP).[5]
- Developing World: Rheumatic heart disease
- Ischemic mitral regurgitation: Ischemic heart disease causes mitral regurgitation by the combination of ischemic dysfunction of the papillary muscles, the abnormal motion of the underlying wall, and the dilatation of the left ventricle that is present in ischemic heart disease, with the subsequent displacement of the papillary muscles and the dilatation of the mitral valveannulus.
- Secondary mitral regurgitation due to the dilatation of the left ventricle, caused by stretching of the mitral valve annulus and displacement of the papillary muscles. This dilatation of the left ventricle can be due to any cause of dilated cardiomyopathy, including aortic insufficiency, nonischemic dilated cardiomyopathy and Noncompaction Cardiomyopathy. It is also called functional mitral regurgitation, because the papillary muscles, chordae, and valve leaflets are usually normal.[6]
- Marfan's syndrome [3]
Acute Mitral Regurgitation
- Acute bacterial endocarditis. The predominant organism is S. aureus, but varies depending upon the patient.[3]
- Papillary muscle rupture or dysfunction,[3] associated with ST elevation myocardial infarction.
References
- ↑ 1.0 1.1 Haghi D, Röhm S, Suselbeck T, Borggrefe M, Papavassiliu T (2010). "Incidence and clinical significance of mitral regurgitation in Takotsubo cardiomyopathy". Clinical Research in Cardiology : Official Journal of the German Cardiac Society. 99 (2): 93–8. doi:10.1007/s00392-009-0078-1. PMID 19774331. Retrieved 2011-04-16. Unknown parameter
|month=ignored (help) - ↑ 2.0 2.1 Brunetti ND, Ieva R, Rossi G, Barone N, De Gennaro L, Pellegrino PL, Mavilio G, Cuculo A, Di Biase M (2008). "Ventricular outflow tract obstruction, systolic anterior motion and acute mitral regurgitation in Tako-Tsubo syndrome". International Journal of Cardiology. 127 (3): e152–7. doi:10.1016/j.ijcard.2007.04.149. PMID 17692942. Retrieved 2011-04-16. Unknown parameter
|month=ignored (help) - ↑ 3.0 3.1 3.2 3.3 Elizabeth D Agabegi; Agabegi, Steven S. (2008). Step-Up to Medicine (Step-Up Series). Hagerstwon, MD: Lippincott Williams & Wilkins. ISBN 0-7817-7153-6. Chapter 1: Diseases of the Cardiovascular system > Section: Valvular Heart Disease
- ↑ http://circimaging.ahajournals.org/content/early/2011/04/15/CIRCIMAGING.110.962845.abstract
- ↑ Kulick, Daniel. "Mitral Valve Prolapse (MVP)". MedicineNet.com. MedicineNet, Inc. Retrieved 2010-01-18.
- ↑ Functional mitral regurgitation By William H Gaasch, MD. Retrieved on Jul 8, 2010