Mitral regurgitation causes
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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
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 | 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 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). Papillary muscle rupture or dysfunction that is associated with ST elevation myocardial infarction [4], 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 | No underlying causes. |
| 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 | No underlying causes. |
| 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, rheumatoid disease, systemic lupus erythematosus (SLE) [4], polychondritis.
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| Sexual | No underlying causes. |
| Trauma | Trauma to the heart (stab wound). |
| Urologic | No underlying causes. |
| Miscellaneous | Chromosomal abnormalities such as turner syndrome, Congenital (present from birth) mitral regurgitation is most often part of a more complex heart defect or syndrome (atrial septal defect (ostium primum), 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. |
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.
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 drug.
- Chromosomal abnormalities.
- Cohen syndrome.
- Collagen vascular diseases.
- Contractural Arachnodactyly.
- Dilatation of the left ventricle.
- Dilated cardiomyopathy.
- Ehlers-Danlos syndrome.
- Endocarditis [4].
- Endocardial cushion defect.
- Endomyocardial fibrosis.
- Familial hypertrophic cardiomyopathy
- Fabry disease.
- Fenfluramine drug.
- Heart tumors.
- High blood pressure.
- Ischemic heart disease (Coronary artery disease).
- Marfan's syndrome [4].
- Mendelian inherited conditions.
- Methysergide drug.
- Mitral valve prolapse.
- Osteogenesis Imperfecta
- Pergolide drug.
- Polychondritis.
- Polycystic kidney disease-adult (autosomal dominant type).
- Pseudoxanthoma elasticum.
- Rheumatic heart disease.
- Rheumatoid disease.
- Swelling of the left lower heart chamber.
- Systemic Lupus Erythematosus.
- Syphilis (rare).
- 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 4.7 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.