Mitral Regurgitation, Acute

Cardiovascular System


Clinicals - History

Fact Explanation
{"ops":[{"insert":"Acute heart failure"},{"insert":"\n"}]}
{"ops":[{"insert":"Acute mitral insufficiency results in acute heart failure. Symptoms include a cough, severe exertional dyspnea, orthopnea, and ankle swelling.\n\nThese symptoms are due to the rapid change in the valvular architecture. Blood is forced back into the left atrium, which dilates to accomodate the increased volume. The elevated left atrial pressure causes pulmonary vascular congestion. Cardiac output is also reduced, as a portion of the blood pumped is redirected back into the left atrium.\n\nFurthermore, the left ventricle has to rapidly adjust to a large increase in preload from the dilated left atrium, while the right side of the heart has to work against a greater afterload. This causes fluid to accumulate in the peripheral tissues."}]}
{"ops":[{"insert":"Infective endocarditis"},{"insert":"\n"}]}
{"ops":[{"insert":"Patients with infective endocarditis can be asymptomatic, or manifest only subtle symptoms such as fever, lethargy and weight loss. Less often, symptoms may occur secondary to complications of septic embolism, e.g., discitis, pneumonia, or cerebral abscesses.\n\nAcute mitral insufficiency can be caused by infective endocarditis, most often due to rupture of affected chordae tendinae. Note that infective endocarditis is more common in valves which are already abnormal. Therefore, it is not always clear if the valvular dysfunction preceeded the infection or was caused by it."}]}
{"ops":[{"insert":"Rheumatic fever"},{"insert":"\n"}]}
{"ops":[{"insert":"Symptoms of acute rheumatic fever include fever, arthritis, chorea, and a rash.\n\nWhile rheumatic fever typically gives rise to chronic mitral regurgitation over a period of months to years, acute mitral regurgitation can also occur following rupture of the chordae."}]}
{"ops":[{"insert":"Myocardial infarction"},{"insert":"\n"}]}
{"ops":[{"insert":"Patients may have experienced a recent myocardial infarction (MI), or have manifested anginal symptoms. Note that acute mitral regurgitation typically occurs in the first week after an infarction; it is rare after two weeks post-infarction.\n\nWhere the myocardium has been recently damaged, there is a risk of papillary muscle rupture. As the valve leaflets are tethered to these muscles, this results in mitral regurgitation."}]}
{"ops":[{"insert":"Mitral valve prolapse"},{"insert":"\n"}]}
{"ops":[{"insert":"Mitral valve prolapse (MVP) occurs when one or more of the mitral leaflets move into the atrium during systole. This is a risk factor for chordal rupture and thus, acute mitral regurgitation.\n\nThe most common cause of MVP is myxomatous degeneration, a non-inflammatory loss of leaflet structure due to changes in the collagen within the valve. It is unclear why this occurs, but there is a degree of inheritability. MVP is also more common in connective tissue disorders such as Marfan syndrome and Ehlers-Danlos syndrome."}]}
{"ops":[{"insert":"Connective tissue disease"},{"insert":"\n"}]}
{"ops":[{"insert":"Systemic lupus erythematosus (SLE) can affect the valves of the heart; this is termed Libman-Sacks endocarditis. Thrombi form on the valve, leading to progressive thickening, edema and scarring. Similar changes can occur antiphospholipid syndrome.\n\nThese degenerative changes can lead to rupture of the chordae tendinae, leading to acute mitral insufficiency."}]}
{"ops":[{"insert":"Blunt chest trauma"},{"insert":"\n"}]}
{"ops":[{"insert":"Blunt chest trauma can give rise to mitral regurgitation. Unfortunately, these patients often have multiple injuries, complicating the clinical picture.\n\nThe atrioventricular valves appear to be particularly susceptible to blunt injury, with papillary muscle avulsion, tearing of the chordae, and perforation of leaflets being potential sequlae."}]}
{"ops":[{"insert":"Acute heart failure"},{"insert":"\n"}]}
{"ops":[{"insert":"Acute mitral insufficiency results in acute heart failure. Symptoms include a cough, severe exertional dyspnea, orthopnea, and ankle swelling.\n\nThese symptoms are due to the rapid change in the valvular architecture. Blood is forced back into the left atrium, which dilates to accomodate the increased volume. The elevated left atrial pressure causes pulmonary vascular congestion. Cardiac output is also reduced, as a portion of the blood pumped is redirected back into the left atrium.\n\nFurthermore, the left ventricle has to rapidly adjust to a large increase in preload from the dilated left atrium, while the right side of the heart has to work against a greater afterload. This causes fluid to accumulate in the peripheral tissues."}]}
{"ops":[{"insert":"Infective endocarditis"},{"insert":"\n"}]}
{"ops":[{"insert":"Patients with infective endocarditis can be asymptomatic, or manifest only subtle symptoms such as fever, lethargy and weight loss. Less often, symptoms may occur secondary to complications of septic embolism, e.g., discitis, pneumonia, or cerebral abscesses.\n\nAcute mitral insufficiency can be caused by infective endocarditis, most often due to rupture of affected chordae tendinae. Note that infective endocarditis is more common in valves which are already abnormal. Therefore, it is not always clear if the valvular dysfunction preceeded the infection or was caused by it."}]}
{"ops":[{"insert":"Rheumatic fever"},{"insert":"\n"}]}
{"ops":[{"insert":"Symptoms of acute rheumatic fever include fever, arthritis, chorea, and a rash.\n\nWhile rheumatic fever typically gives rise to chronic mitral regurgitation over a period of months to years, acute mitral regurgitation can also occur following rupture of the chordae."}]}
{"ops":[{"insert":"Myocardial infarction"},{"insert":"\n"}]}
{"ops":[{"insert":"Patients may have experienced a recent myocardial infarction (MI), or have manifested anginal symptoms. Note that acute mitral regurgitation typically occurs in the first week after an infarction; it is rare after two weeks post-infarction.\n\nWhere the myocardium has been recently damaged, there is a risk of papillary muscle rupture. As the valve leaflets are tethered to these muscles, this results in mitral regurgitation."}]}
{"ops":[{"insert":"Mitral valve prolapse"},{"insert":"\n"}]}
{"ops":[{"insert":"Mitral valve prolapse (MVP) occurs when one or more of the mitral leaflets move into the atrium during systole. This is a risk factor for chordal rupture and thus, acute mitral regurgitation.\n\nThe most common cause of MVP is myxomatous degeneration, a non-inflammatory loss of leaflet structure due to changes in the collagen within the valve. It is unclear why this occurs, but there is a degree of inheritability. MVP is also more common in connective tissue disorders such as Marfan syndrome and Ehlers-Danlos syndrome."}]}
{"ops":[{"insert":"Connective tissue disease"},{"insert":"\n"}]}
{"ops":[{"insert":"Systemic lupus erythematosus (SLE) can affect the valves of the heart; this is termed Libman-Sacks endocarditis. Thrombi form on the valve, leading to progressive thickening, edema and scarring. Similar changes can occur antiphospholipid syndrome.\n\nThese degenerative changes can lead to rupture of the chordae tendinae, leading to acute mitral insufficiency."}]}
{"ops":[{"insert":"Blunt chest trauma"},{"insert":"\n"}]}
{"ops":[{"insert":"Blunt chest trauma can give rise to mitral regurgitation. Unfortunately, these patients often have multiple injuries, complicating the clinical picture.\n\nThe atrioventricular valves appear to be particularly susceptible to blunt injury, with papillary muscle avulsion, tearing of the chordae, and perforation of leaflets being potential sequlae."}]}

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