ECHOCARDIOLOGIST IN GANGAMMA CIRCLE
A regurgitant mitral valve allows part of the left ventricular stroke volume to regurgitate into
the left atrium, imposing a volume load on both the left atrium and the left ventricle.
Symptoms: Dyspnoea (increased left atrial pressure); fatigue (decreased cardiac
General signs: Tachypnoea.
The pulse: Normal, or sharp upstroke due to rapid left ventricular decompression;
atrial fibrillation is relatively common.
Palpation: The apex beat may be displaced, diffuse and hyperdynamic if left ventricular
enlargement has occurred; a pansystolic thrill may be present
at the apex; a parasternal impulse (due to left atrial enlargement behind
the right ventricle—the left atrium is often larger in mitral regurgitation
than in mitral stenosis and can be enormous). All these signs suggest
severe mitral regurgitation.
Auscultation Soft or absent S1 (by the end of diastole, atrial and ventricular pressures
have equalised and the valve cusps have drifted back together);
left ventricular S3, due to rapid left ventricular filling in early diastole;
pansystolic murmur maximal at the apex and usually radiating towards
Causes of chronic
(i) Degenerative; (ii) rheumatic; (iii) mitral valve prolapse; (iv) papillary
muscle dysfunction, due to left ventricular failure or ischaemia.