THE CONTEXT
Mitral regurgitation produces characteristic auscultatory findings and may arise from leaflet prolapse, altered ventricular geometry or endocarditis.
Auscultation and echocardiography
•
The first heart sound is normal or soft and merges with a pansystolic murmur extending to the second heart sound.
•
A third heart sound occurs with severe mitral regurgitation.
•
The illustrated transoesophageal echocardiogram shows mitral valve prolapse with one leaflet bulging towards the left atrium; colour Doppler demonstrates a resulting regurgitant jet.
Functional and acute mitral regurgitation
•
Mitral valve function depends on the chordae tendineae and their papillary muscles. Left ventricular dilatation can distort their geometry and cause regurgitation.
•
Dilated cardiomyopathy and heart failure from coronary artery disease are common causes of functional mitral regurgitation.
•
Endocarditis is an important cause of acute mitral regurgitation.