Mitral regurgitation causes
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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 [1], infection of the heart valve (infective endocarditis) [1], mitral valve prolapse (accounts for 45% of cases in the western world [2], 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), 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 [3], causing stretching of the mitral valve annulus and displacement of the papillary muscles ( causes include dilated cardiomyopathy, aortic insufficiency and Takotsubo cardiomyopathy [4][5]). |
| Chemical / poisoning | No underlying causes. |
| Dermatologic | No underlying causes. |
| Drug Side Effect | Certain forms of medication (e.g. fenfluramine) can cause mitral regurgitation. |
| 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 [1]) 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 and Marfan's syndrome [1]. |
| 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:
- balloon valvuloplasty of the mitral valve.
- Infective endocarditis [1].
- Papillary muscle rupture [1].
- ST elevation myocardial infarction.
- Trauma.
Differential Diagnosis of the Causes of Chronic Mitral Regurgitation
In alphabetical order:
- Mitral valve prolapse.
- Ischemic heart disease, Coronary artery disease.
- Rheumatic heart disease.
- Heart tumors.
- High blood pressure.
- Swelling of the left lower heart chamber.
- Dilatation of the left ventricle.
- Dilated cardiomyopathy.
- Aortic insufficiency.
- Takotsubo cardiomyopathy.
- syphilis (rare).
- Endocarditis [1].
References
- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 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.
- ↑ 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)