Mitral incompetence

From Ganfyd

Pathophysiology

The two leaflets of the valve are stiff, misshapen, or incorrectly supported, and thus do not seal. Ventricular systole results in blood refluxing back into the left atrium through the incompetent valve therefore reducing forward flow and so cardiac output.

Causes

• Rheumatic heart disease
• Functional owing to heart enlargement
• Destruction of the valve owing to infective endocarditis
• Congenital associated with ASD "Endocardial cushion defects" (Seen in Trisomy 21)

Symptoms

• Heart failure with breathlessness

Signs

• Atrial fibrillation (emboli)
• Pansystolic murmur

Investigations

Radiology

• Cardiomegaly
• Heart failure

ECG

• Atrial fibrillation

Echocardiography

Management

• Standard Treatment of heart failure. Aim to reduce afterload to encourage forward flow.
• Anticoagulate if in AF and digoxin
• Mitral valve repair
• Mitral valve replacement