Mitral regurgitation history and symptoms
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [2]; Varun Kumar, M.B.B.S.; Lakshmi Gopalakrishnan, M.B.B.S.; Rim Halaby, M.D. [3]
Overview
Acute and decompensated mitral regurgitation (MR) is associated with symptoms of congestive heart failure including dyspnea, paroxysmal nocturnal dyspnea, orthopnea, and exercise intolerance. Individuals with chronic compensated MR may be asymptomatic, with a normal exercise tolerance and no evidence of heart failure.
History
Patients with suspected or confirmed MR should be inquired about the acuity of the symptoms. The knowledge of the onset of the symptoms helps in the classification of MR into acute and chronic.
In addition, the patient should be asked about the symptoms of diseases that might have lead to primary MR, such as recent ST elevation myocardial infarction, infective endocarditis, connective tissue disease, mitral valve prolapse, and rheumatic heart disease. In addition, the history of the patient should include information about coronary artery disease or any other conditions that might have caused heart failure in order to rule out secondary ischemic MR and functional MR respectively. Exposure to radiation to the chest should also be reported.
Symptoms
Acute or Decompensated Mitral Regurgitation
The symptoms associated with acute or decompensated MR are due to the acute volume overload with subsequent pulmonary congestion in addition to the decreased cardiac output. Symptoms include:
- Shortness of breath
- Orthopnea
- Paroxysmal nocturnal dyspnea
- Exercise intolerance
- Fatigue
- Lightheadedness
- Cough
- Palpitations (related to increased contractility and onset of atrial fibrillation)
Cardiovascular collapse with shock (cardiogenic shock) may be seen in individuals with acute mitral regurgitation due to papillary muscle rupture or rupture of a chordae tendineae.
Chronic Compensated Mitral Regurgitation
Individuals with chronic compensated MR may be asymptomatic, with a normal exercise tolerance and no evidence of heart failure. These individuals may be sensitive to small shifts in their intravascular volume status, and are prone to develop volume overload (congestive heart failure).
Palpiatations might occur in these patients due to the dilatation of the left atrium.