Ischemic mitral regurgitation

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Overview

Ischemic mitral regurgitation can occur as a complication of either ST elevation myocardial infarction (MI) and acute myocardial ischemia. If mitral regurgitation occurs as a complication of MI it is permanent while if it occurs as a result of ischemia, it is transient and resolves with resolution of ischemia.

Pathophysiology

Ischemic Mitral Regurgitation can be due to :

• Papillary muscle rupture secondary to acute MI.
• Most often Ischemic Mitral Regurgitation is “functional” and due to “papillary muscle displacement” involving a left ventricular-wall motion abnormality as well as alteration in left ventricular geometry.

Diagnosis

Symptoms

The clinical presentation of Ischemic mitral regurgitation reflects the state of Left ventricular-dysfunction more than the state of mitral valve.

• Asymptomatic detected by Echocardiography or Angiography
• Weakness, fatigue
• Exercise Intolerance

Signs

• Approximately one half have holosystolic murmur
• Decreased cardiac output
• Exercise produces severe regurgitation in patients with mild ischemic mitral regurgitation.
• Severe cases present with pulmonary edema

Exercise Echocardiography

• Effective regurgitant orifice (ERO) area increase with exercise is associated with increased risk for acute pulmonary edema
• Exercise induced ERO ≥13 mm2 is an independent predictor of cardiac death.

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Treatment

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Prognosis

Independent of left ventricular function, MR is associated with higher mortality .