Mitral Incompetence Overview

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Questions and Answers

What is a primary consequence of left ventricular dilatation in chronic mitral incompetence?

Increased contractility of the left ventricle

Reduced left atrial pressure

Inhibition of blood regurgitation to the left atrium

Decreased blood flow to the aorta (correct)

Eccentric hypertrophy is characterized by which of the following?

Dilatation of the left ventricular chamber (correct)

Reduced overall size of cardiomyocytes

Combination of thickening and dilatation

Increased left ventricular wall thickness

What typically causes pulmonary congestion in patients with mitral incompetence?

Stagnant blood in the left atrium

Decreased blood flow from the aorta

Increased pulmonary venous pressure (correct)

Thrombus formation in the left atrium

In mitral stenosis, why does thrombus formation occur?

Due to accumulation of stagnant blood Signup and view all the answers

Which type of hypertrophy occurs in response to volume overload from dilated left ventricles?

Eccentric hypertrophy Signup and view all the answers

What is primarily affected during systole due to regurgitation in mitral incompetence?

Cardiac output Signup and view all the answers

What distinguishes compensated heart failure from decompensated heart failure?

Stabilization of cardiac output Signup and view all the answers

What characterizes compensated mitral incompetence?

Eccentric hypertrophy of the left ventricle Signup and view all the answers

Which condition is most likely to result from decompensated mitral incompetence?

Increased filling pressures in the left ventricle Signup and view all the answers

What is the most significant change in the left atrium during the chronic compensated phase?

Enlargement of the left atrium Signup and view all the answers

Which of the following symptoms may be present in compensated mitral incompetence?

Palpitations Signup and view all the answers

Which statement is true regarding the progression from compensated to decompensated mitral incompetence?

Decreased stroke volume leads to increased pulmonary congestion. Signup and view all the answers

What primarily occurs in the left ventricle during decompensated mitral incompetence?

Dilatation of the left ventricle Signup and view all the answers

Which factor contributes to the symptoms of congestive heart failure in decompensated mitral incompetence?

Increased end-systolic volume Signup and view all the answers

What role does eccentric hypertrophy play in compensated mitral incompetence?

Helps manage the larger than normal stroke volume Signup and view all the answers

Which condition indicates a high likelihood of decompensated mitral incompetence?

Presence of heart failure symptoms Signup and view all the answers

What is a key characteristic of compensated mitral incompetence?

Left atrial dilatation accommodating regurgitant blood Signup and view all the answers

Which of the following is NOT a cause of mitral incompetence?

Coronary artery disease Signup and view all the answers

What occurs during the systole phase in mitral regurgitation?

Blood leaks backwards from the left ventricle to the left atrium Signup and view all the answers

Which condition is characterized by left atrial dilatation without pulmonary congestion?

Compensated mitral incompetence Signup and view all the answers

What is the primary issue that leads to thrombosis in mitral stenosis compared to mitral incompetence?

Stasis in the left atrium due to decreased blood flow Signup and view all the answers

What effect does left ventricular dilation have on the mitral valve?

It results in functional incompetence of the mitral valve. Signup and view all the answers

What is the significance of systolic pulsations of the left atrium in chronic mitral incompetence?

They help prevent stasis and thrombosis in the left atrium. Signup and view all the answers

How does mitral valve prolapse contribute to mitral incompetence?

By allowing backward flow of blood during systole Signup and view all the answers

What is one of the most common clinical outcomes associated with chronic mitral incompetence?

Atrial fibrillation Signup and view all the answers

Study Notes

Mitral Incompetence (Mitral Regurgitation)

Mitral regurgitation (MR) is a type of valvular heart disease. The mitral valve doesn't close properly, causing blood to leak backward.
Blood leaks back into the left atrium from the left ventricle during contraction.
MR is the most common form of valvular heart disease.

Causes of Mitral Incompetence

Rheumatic heart disease: Fibrosis and retraction of the valve cusps.
Congenital: Present from birth.
Functional: Due to left ventricular dilation.
Surgical: Following mitral commissurotomy or prosthetic valve dysfunction.
Mitral valve prolapse: Issues with the valve structure.
Papillary muscle dysfunction: Problems with the muscles supporting the valve, e.g., ischemic heart disease or cardiomyopathy.

Hemodynamics of Mitral Incompetence

Left atrial dilatation: The left atrium expands to accommodate the increased blood volume it receives from the left ventricle during systole (contraction phase).
No immediate pulmonary congestion: Compensated MR doesn't immediately cause pulmonary congestion.
Systolic pulsations: Blood flow through the left atrium causes pulsations/stirring. Thromboembolism is less common in compensated mitral incompetence compared to mitral stenosis.

Left Ventricular Dilation

Left ventricle dilates to accommodate increased blood volume.
Hypertrophy occurs to maintain contractility.
Long-standing cases can lead to left ventricular failure and a vicious cycle of progressive mitral regurgitation.
Onset of heart failure is associated with rising end-diastolic pressures, and pulmonary venous pressure.

Eccentric vs. Concentric Hypertrophy

Eccentric hypertrophy: Characterized by chamber dilation, but cardiomyocyte size generally increases.
Concentric hypertrophy: Characterized by wall thickening.

Symptoms During Systole and Diastole

Systole: Blood regurgitates to the left atrium, causing low cardiac output and left atrial dilation.
Diastole: Excessive blood volume now enters the left ventricle, leading to potential enlargement and left ventricular failure.

Compensated Mitral Incompetence

Slow development over months to years.
Left ventricle adapts with eccentric hypertrophy, allowing normal forward cardiac output.
Pulmonary congestion decreases due to improved left atrial drainage.
Individuals often asymptomatic or have normal exercise tolerance.

Decompensated Mitral Incompetence

The left ventricle loses the ability to compensate with adequate contraction.
Forward cardiac output declines, and end-systolic volume increases.
Increased filling pressures and pulmonary congestion leads to symptoms of congestive heart failure.
Left ventricle dilation worsens regurgitation.

Clinical Manifestations

Compensated: Asymptomatic or non-specific symptoms like palpitations or fatigue.
Decompensated: Symptoms of heart failure (dyspnea, hemoptysis, recurrent bronchopulmonary infections), fatigue.

Complications

Left ventricular failure: A major complication.
Infective endocarditis: Possible due to inflammation and abnormal growths on the valve.

Clinical Manifestations (Mild Cases)

Absence of noticeable symptoms
Mild cardiac output symptoms (Fatigue, confusion, low blood pressure)
Pulmonary congestion symptoms (Orthopnea, cough, haemoptysis)

Diagnostic Methods

ECG: Can show left atrial and left ventricular enlargement.
Chest X-ray: Shows chamber enlargement and pulmonary congestion if left ventricular failure is present.
Echocardiography: Diagnoses mitral incompetence, assesses severity, and detects associated lesions.
Cardiac catheterization & angiography: Invasive procedure. Useful for diagnosing mitral incompetence, assessing the severity, associated lesions, chamber enlargement, and detection of coronary artery disease.

Treatment

Medical: Prophylaxis against infective endocarditis, treating heart failure/arrhythmias, embolisms, and rheumatic activity.
Surgical: Mitral valve repair (preferred), replacement if repair isn't feasible.

Surgical Indications

Marked symptoms unresponsive to medical treatment
Progressive cardiomegaly
Decreasing left ventricular function (ejection fraction).

Points of Comparison (Mitral Stenosis vs. Mitral Incompetence)

Differences in presentation, symptoms, and the timing of congestion and other symptoms and patterns.

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Description

Explore the essential aspects of mitral incompetence, including its causes, effects on hemodynamics, and implications for patients. This quiz covers types of mitral regurgitation, and how it impacts heart function. Test your knowledge on this common valvular heart disease.