Mitral valve disease

Medicine > Cardiovascular

Background knowledge 🧠

Overview

The mitral valve controls blood flow between the left atrium and left ventricle of the heart.
Common mitral valve pathologies include mitral stenosis and mitral regurgitation.

Aetiology

Rheumatic heart disease: can lead to both mitral stenosis and mitral regurgitation.
Congential malformation: is a cause of mitral stenosis.
Calcification with ageing: is the most common cause of mitral stenosis.
Mitral valve prolapse, endocarditis, myocardial infarction and cardiomyopathy: are all causes of mitral regurgitation.

Types

Mitral regurgitation: Backflow of blood from the left ventricle to the left atrium.
Mitral stenosis: Narrowing of the mitral valve orifice.

Clinical Features 🌡️

Symptoms

Dyspnoea: common in both stenosis and regurgitation.
Fatigue: associated with both stenosis and regurgitation.
Palpitations: associated with both stenosis and regurgitation.
Orthopnoea: may occur in aortic regurgitation.
Cough: can occur in aortic stenosis.
Aortic stenosis can also lead to atrial fibrillation or heart failure.

Signs

Mitral regurgitation: associated with a pansystolic murmur that radiates to the axilla.
Mitral stenosis: associated with an opening snap, and mid-diastolic murmur.

Investigations 🧪

Tests

Electrocardiogram (ECG): May show atrial fibrillation, left atrial enlargement.
Echocardiogram: Gold standard for assessing valve structure and function.
Chest X-ray: Might show enlarged heart, signs of pulmonary congestion.
Cardiac catheterisation: Detailed assessment of valve and coronary arteries.

Management 🥼

Management

Mitral regurgitation: Valve repair or replacement, medications for heart failure (if present).
Mitral stenosis: Valve repair or replacement, balloon valvuloplasty.

Complications

Heart failure.
Atrial fibrillation.
Pulmonary hypertension.
Thromboembolism.
Endocarditis.

Prevention

Antibiotic prophylaxis for patients with mitral valve disease undergoing certain procedures to prevent endocarditis.

Key Points

Dyspnoea, fatigue and palpitations are common clinical features of both mitral stenosis and regurgitation.
Echocardiography is the gold standard method for assessing the valve structure and function.
Common complications include heart failure and atrial fibrillation.
Management may include both pharmacological and surgical interventions (e.g., valve replacement)

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