Mitral regurgitation causes: Difference between revisions
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*[[Endocarditis]] <ref name=agabegi2nd-ch1>{{cite book|author=Elizabeth D Agabegi; Agabegi, Steven S. |title=Step-Up to Medicine (Step-Up Series) |publisher=Lippincott Williams & Wilkins |location=Hagerstwon, MD |year=2008 |pages=|isbn=0-7817-7153-6 |oclc= |doi= |accessdate=}} Chapter 1: Diseases of the Cardiovascular system > Section: Valvular Heart Disease</ref> | *[[Endocarditis]] <ref name=agabegi2nd-ch1>{{cite book|author=Elizabeth D Agabegi; Agabegi, Steven S. |title=Step-Up to Medicine (Step-Up Series) |publisher=Lippincott Williams & Wilkins |location=Hagerstwon, MD |year=2008 |pages=|isbn=0-7817-7153-6 |oclc= |doi= |accessdate=}} Chapter 1: Diseases of the Cardiovascular system > Section: Valvular Heart Disease</ref> | ||
*[[Endocardial cushion defect]] | *[[Endocardial cushion defect]] | ||
*Endomyocardial fibrosis | *[[Endomyocardial fibrosis]] | ||
*[[Fabry disease]] | *[[Fabry disease]] | ||
*[[Fenfluramine]] | *[[Fenfluramine]] | ||
*[[Heart tumors]] | *[[Heart tumors]] | ||
*[[Hypertension]] | *[[Hypertension]] | ||
*[[Hypertrophic obstructive cardiomyopathy]] ([[HOCM]]) | |||
*[[Ischemic heart disease]] ([[Coronary artery disease]]) | *[[Ischemic heart disease]] ([[Coronary artery disease]]) | ||
*Left ventricular dilation | |||
*[[Marfan's syndrome]] | *[[Marfan's syndrome]] | ||
*[[Methysergide]] | *[[Methysergide]] | ||
Revision as of 22:22, 15 April 2012
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Mohammed A. Sbeih, M.D. [2]; Cafer Zorkun, M.D., Ph.D. [3]; Varun Kumar, M.B.B.S.; Lakshmi Gopalakrishnan, M.B.B.S.
Overview
Mitral regurgitation is due to either perforation or prolapse of the leaflets, dilation of the mitral annulus or rupture of the papillary muscles or chordae tendineae. There are several phases of mitral regurgitation (acute, chronic compensated, and chronic decompensated).
Mechanical Basis of Mitral Regurgitation
The mechanical basis underlying mitral regurgitation includes the following:
- Anterior mitral leaflet prolapse
- Posterior mitral leaflet prolapse
- Bileaflet prolapse
- Restricted mitral leaflets
- Apical tethering
- Papillary muscle rupture
- Ischemic papillary muscle rupture
- Mitral leaflet perforation
- Rupture or tear of the chordae tendineae
- Dilation of the mitral annulus
- "Functional MR" due to dilation of the heart itself
Common Causes of Mitral Regurgitation
Acute Mitral Regurgitation
- Heart attack or acute MI: Dysfunction or injury to the mitral valve following a heart attack. Papillary muscle rupture or dysfunction that is associated with ST elevation myocardial infarction.
- Endocarditis: The infaction may cause perforation of the leaflet, erosion of the surrounding structures, or a vagetation may not permit the leaflets to coapt.
- Trauma
Chronic Mitral Regurgitation
- Mitral valve prolapse: This disorder now accounts for 45% of cases of mitral regurgitation in the Western world.
- Ischemic heart disease / Coronary artery disease: This can be due to either papillary muscle dysfunction or left ventricular dilation and functional mitral regurgitation. Ischemia is responsible for 3% to 25% of MR cases.
- 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 | Atrial septal defect (ostium primum), balloon valvuloplasty of the mitral valve, dilatation of the left ventricle, causing stretching of the mitral valve annulus and displacement of the papillary muscles [1](causes include aortic insufficiency,dilated cardiomyopathy and Takotsubo cardiomyopathy [2][3]), dysfunction or injury to the mitral valve following a heart attack,
endomyocardial fibrosis, endocardial cushion defect, familial hypertrophic cardiomyopathy, heart tumors, high blood pressure, infection of the heart valve (infective endocarditis) [4], ischemic heart disease (coronary artery disease), mitral annular calcification, mitral valve prolapse (accounts for 45% of cases in the western world [5], 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), myxomatous degeneration. Papillary muscle rupture or dysfunction that is associated with ST elevation myocardial infarction [4], prosthetic valve dysfunction, rheumatic heart disease (this was the most common cause of MR in the western world) and swelling of the left lower heart chamber. |
| Chemical / poisoning | No underlying causes. |
| Dermatologic | No underlying causes. |
| Drug Side Effect | Certain forms of medication can cause mitral regurgitation such as cabergoline, fenfluramine, methysergide and pergolide. |
| Ear Nose Throat | No underlying causes. |
| Endocrine | No underlying causes. |
| Environmental | No underlying causes. |
| Gastroenterologic | No underlying causes. |
| Genetic | Chromosomal abnormalities such as turner syndrome, mendelian inherited conditions: Autosomal dominant conditions such as contractural arachnodactyly, familial hypertrophic cardiomyopathy, osteogenesis imperfecta and polycystic kidney disease-adult, autosomal recessive conditions such as cohen syndrome and pseudoxanthoma elasticum, X-linked inherited conditions such as fabry disease. |
| Hematologic | No underlying causes. |
| Iatrogenic | No underlying causes. |
| Infectious Disease | Infective endocarditis (the predominant organism is S. aureus [4], but varies depending upon the patient) and untreated syphilis (rare). |
| Musculoskeletal / Ortho | Contractural arachnodactyly. |
| Neurologic | No underlying causes. |
| Nutritional / Metabolic | No underlying causes. |
| Obstetric/Gynecologic | No underlying causes. |
| Oncologic | Heart tumors. |
| Opthalmologic | No underlying causes. |
| Overdose / Toxicity | No underlying causes. |
| Psychiatric | No underlying causes. |
| Pulmonary | No underlying causes. |
| Renal / Electrolyte | Polycystic kidney disease-adult (autosomal dominant type). |
| Rheum / Immune / Allergy | Ankylosing spondylitis, collagen vascular diseases such as marfan's syndrome, ehlers-danlos syndrome and osteogenesis imperfecta, rheumatic Heart Disease, rheumatoid arthritis, systemic lupus erythematosus (SLE) [4], polychondritis. |
| 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 (atrial septal defect (ostium primum). |
Differential Diagnosis of the Causes of Acute Mitral Regurgitation
In alphabetical order:
- Balloon valvuloplasty of the mitral valve
- Infective endocarditis [4]
- Papillary muscle rupture [4]
- ST elevation myocardial infarction
- Trauma with disruption of the chordae tendineae
Differential Diagnosis of the Causes of Chronic Mitral Regurgitation
In alphabetical order:
- Atrial septal defect (Ostium primum)
- Ankylosing spondylitis
- Aortic insufficiency
- Autosomal recessive conditions
- Cabergoline
- Collagen vascular diseases
- Contractural arachnodactyly
- Dilatation of the left ventricle
- Dilated cardiomyopathy
- Ehlers-danlos syndrome
- Endocarditis [4]
- Endocardial cushion defect
- Endomyocardial fibrosis
- Fabry disease
- Fenfluramine
- Heart tumors
- Hypertension
- Hypertrophic obstructive cardiomyopathy (HOCM)
- Ischemic heart disease (Coronary artery disease)
- Left ventricular dilation
- Marfan's syndrome
- Methysergide
- Mitral valve prolapse
- Osteogenesis imperfecta
- Pergolide
- Polychondritis
- Polycystic kidney disease-adult (autosomal dominant type)
- Pseudoxanthoma elasticum
- Rheumatic heart disease
- Rheumatoid disease
- Systemic lupus erythematosus (SLE)
- Syphilis
- Takotsubo cardiomyopathy
- Turner syndrome
- X-linked inherited conditions such as fabry disease
References
- ↑ Functional mitral regurgitation By William H Gaasch, MD. Retrieved on Jul 8, 2010
- ↑ 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) - ↑ 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) - ↑ 4.0 4.1 4.2 4.3 4.4 4.5 4.6 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
- ↑ Kulick, Daniel. "Mitral Valve Prolapse (MVP)". MedicineNet.com. MedicineNet, Inc. Retrieved 2010-01-18.