Mitral regurgitation causes: Difference between revisions

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| [[Mitral regurgitation resident survival guide|'''Resident'''<br>'''Survival'''<br>'''Guide''']]
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{{Mitral regurgitation}}
{{Mitral regurgitation}}
{{CMG}}; '''Associate Editor-In-Chief:''' {{CZ}}; [[Varun Kumar]], M.B.B.S.; [[Lakshmi Gopalakrishnan]], M.B.B.S.; [[User:Mohammed Sbeih|Mohammed A. Sbeih, M.D.]] [mailto:msbeih@perfuse.org]
{{CMG}}; {{AE}} [[User:Mohammed Sbeih|Mohammed A. Sbeih, M.D.]] [mailto:msbeih@wikidoc.org]; {{CZ}}; [[Varun Kumar]], M.B.B.S.; [[Lakshmi Gopalakrishnan]], M.B.B.S.; {{M.P}}


==Overview==
==Overview==
Regurgitation means leaking from a valve that doesn't close all the way. It is caused by diseases that weaken or damage the valve or its supporting structures. Mitral regurgitation becomes chronic when the condition persists rather than occurring for only a short time period. The causes of chronic mitral regurgitation should be distinguished from the acute mitral regurgitation causes.
The causes of mitral regurgitation (MR) depend on the acuity of the valvular abnormality and the underlying pathological mechanism. Acute MR occurs when there is sudden disruption of one or more of the components of the mitral valve, such as leaflet perforation, rupture of a chordae tendineae, or rupture of the papillary muscle. The sudden disruption of the mitral valve can be caused by [[infective endocarditis]], degenerative mitral valve disease, or acute [[ST elevation myocardial infarction]].<ref name="pmid24603192">{{cite journal| author=Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Guyton RA et al.| title=2014 AHA/ACC guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. | journal=J Am Coll Cardiol | year= 2014 | volume= 63 | issue= 22 | pages= 2438-88 | pmid=24603192 | doi=10.1016/j.jacc.2014.02.537 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24603192  }} </ref>  Chronic primary MR is most commonly caused by [[mitral valve prolapse]]; other causes include [[rheumatic fever]] and [[Marfan's syndrome]]. Chronic secondary MR results from the dysfunction and dilatation of the left ventricle rather than an intrinsic abnormality in one of the components of the mitral valve and it can be caused by coronary artery disease (ischemic) or any disease causing [[left ventricular dysfunction]] and dilatation (functional).<ref name="pmid21586426">{{cite journal| author=Ciarka A, Van de Veire N| title=Secondary mitral regurgitation: pathophysiology, diagnosis, and treatment. | journal=Heart | year= 2011 | volume= 97 | issue= 12 | pages= 1012-23 | pmid=21586426 | doi=10.1136/hrt.2010.219170 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21586426  }} </ref>
 
'''Common Causes of Mitral Regurgitation'''
 
*Acute Mitral Regurgitation.
:*Dysfunction or injury to the mitral valve following a heart attack. [[Papillary muscle rupture]] or dysfunction that is associated with [[ST elevation myocardial infarction]].
:*Infection of the heart valve (infective endocarditis). These conditions may rupture the valve or surrounding structures, leaving an opening for blood to move backwards.
:*Trauma.
 
*Chronic Mitral Regurgitation.
:*[[Mitral valve prolapse]] now accounts for 45% of cases in the Western world.
:*[[Ischemic heart disease]] / [[Coronary artery disease]].
:*[[Rheumatic heart disease]], in the past, this was the most common cause of MR in the Western world. In developing countries, [[rheumatic heart disease]] remains the most common cause.


==Causes==
===Life Threatening Causes===
Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.<ref name="pmid246031922">{{cite journal| author=Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Guyton RA et al.| title=2014 AHA/ACC guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. | journal=J Am Coll Cardiol | year= 2014 | volume= 63 | issue= 22 | pages= 2438-88 | pmid=24603192 | doi=10.1016/j.jacc.2014.02.537 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24603192  }}</ref><ref name="pmid215864262">{{cite journal| author=Ciarka A, Van de Veire N| title=Secondary mitral regurgitation: pathophysiology, diagnosis, and treatment. | journal=Heart | year= 2011 | volume= 97 | issue= 12 | pages= 1012-23 | pmid=21586426 | doi=10.1136/hrt.2010.219170 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21586426  }}</ref>


*[[Acute coronary syndrome]]
*[[chest trauma|Blunt or penetrating chest trauma]]
*[[Infective endocarditis]]
*[[Myocardial rupture]]
*[[NSTEMI]]
*[[Papillary muscle rupture]]
*[[STEMI]]
*[[Temporal arteritis]]


===Common Causes===
====Acute Mitral Regurgitation====
* [[Acute coronary syndrome]]
* [[Papillary muscle rupture]]
* [[Infective endocarditis]]
* [[chest trauma|Blunt or penetrating chest trauma]]


====Chronic Mitral Regurgitation====
=====Primary Mitral Regurgitation=====


Autosomal recessive conditions
*'''Developed World:''' [[Mitral valve prolapse]] ([[MVP]])
Cohen syndrome
*'''Developing World:''' [[Rheumatic heart disease]]
Pseudoxanthoma elasticum


=====Secondary Mitral Regurgitation=====
* [[Ischemic heart disease]]
* Dilated [[left ventricle]] (due to any cause of [[dilated cardiomyopathy]], including [[aortic insufficiency]], nonischemic dilated [[cardiomyopathy]] and [[noncompaction cardiomyopathy]])


==Complete Differential Diagnosis of the Causes of Mitral Regurgitation==
===Causes by Organ System===


(By organ system)
{|style="width:70%; height:100px" border="1"
{|style="width:70%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | Atrial septal defect (ostium primum), balloon valvuloplasty of the mitral valve, dilatation of the [[left ventricle]], causing stretching of the [[mitral valve]] annulus and displacement of the [[papillary muscles]] <ref>[http://www.uptodate.com/patients/content/topic.do?topicKey=~Ux3kbGWsXmiaqiH Functional mitral regurgitation] By William H Gaasch, MD. Retrieved on Jul 8, 2010</ref>(causes include [[aortic insufficiency]],[[dilated cardiomyopathy]] and [[Takotsubo cardiomyopathy]] <ref name="pmid19774331">{{cite journal |author=Haghi D, Röhm S, Suselbeck T, Borggrefe M, Papavassiliu T |title=Incidence and clinical significance of mitral regurgitation in Takotsubo cardiomyopathy |journal=[[Clinical Research in Cardiology : Official Journal of the German Cardiac Society]] |volume=99 |issue=2 |pages=93–8 |year=2010 |month=February |pmid=19774331 |doi=10.1007/s00392-009-0078-1|url=http://dx.doi.org/10.1007/s00392-009-0078-1 |accessdate=2011-04-16}}</ref><ref name="pmid17692942">{{cite journal |author=Brunetti ND, Ieva R, Rossi G, Barone N, De Gennaro L, Pellegrino PL, Mavilio G, Cuculo A, Di Biase M |title=Ventricular outflow tract obstruction, systolic anterior motion and acute mitral regurgitation in Tako-Tsubo syndrome |journal=[[International Journal of Cardiology]] |volume=127 |issue=3 |pages=e152–7 |year=2008 |month=July |pmid=17692942|doi=10.1016/j.ijcard.2007.04.149 |url=http://linkinghub.elsevier.com/retrieve/pii/S0167-5273(07)01161-8 |accessdate=2011-04-16}}</ref>), dysfunction or injury to the mitral valve following a heart attack.
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | [[Acute coronary syndrome]], [[aortic insufficiency]], [[Atrial septal defect|atrial septal defect (ostium primum)]], [[carcinoid syndrome]], [[cardiac myxoma]], [[cardiac tumors]], [[congenital heart disease]], [[congestive heart failure]], [[coronary artery disease]], [[dilated cardiomyopathy]], [[endocardial cushion defect]], [[endocarditis]], [[endomyocardial fibrosis]], [[hypertrophic cardiomyopathy]], [[hypertensive heart disease]], [[infective endocarditis]], [[ischemic heart disease]], [[Kawasaki disease]], [[cardiomegaly|left ventricle dialation]], [[mitral annular calcification]], [[mitral valve prolapse]], [[myocardial rupture]], [[myocarditis]], [[NSTEMI]], [[papillary muscle rupture]], [[rheumatic heart disease]], [[STEMI]], [[Takotsubo cardiomyopathy]]
 
Endomyocardial fibrosis, endocardial cushion defect, familial hypertrophic cardiomyopathy, heart tumors, high blood pressure, infection of the heart valve (infective endocarditis) <ref name=agabegi2nd-ch1>{{cite book|author=Elizabeth D Agabegi; Agabegi, Steven S. |title=Step-Up to Medicine (Step-Up Series) |publisher=Lippincott Williams & Wilkins|location=Hagerstwon, MD |year=2008 |pages=|isbn=0-7817-7153-6 |oclc= |doi= |accessdate=}}  Chapter 1: Diseases of the Cardiovascular system > Section: Valvular Heart Disease</ref>, [[ischemic heart disease]] ([[coronary artery disease]]), [[mitral valve prolapse]] (accounts for 45% of cases in the western world <ref name='MedicineNetMVP-Kulick'>{{cite web|url=http://www.medicinenet.com/mitral_valve_prolapse/article.htm|title=Mitral Valve Prolapse (MVP) |accessdate=2010-01-18 |last=Kulick |first=Daniel|work=MedicineNet.com |publisher=MedicineNet, Inc }}</ref>, MVP is a common cause. However, most patients with MVP do not develop severe mitral regurgitation. Older age, male gender, and auscultatory evidence of severe MR are prognostic clues that identify patients with mitral valve prolapse who are at a relatively high risk of complications).
 
[[Papillary muscle rupture]] or dysfunction that is associated with [[ST elevation myocardial infarction]] <ref name=agabegi2nd-ch1/>, [[rheumatic heart disease]] (this was the most common cause of MR in the western world) and swelling of the left lower heart chamber.
 
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
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|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Dermatologic'''
| '''Dermatologic'''
|bgcolor="Beige"| No underlying causes.
|bgcolor="Beige"| [[Psoriatic arthropathy]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
| '''Drug Side Effect'''
|bgcolor="Beige"| Certain forms of medication can cause mitral regurgitation such as [[cabergoline]], [[fenfluramine]], [[methysergide]] and [[pergolide]].
|bgcolor="Beige"| [[3,4-Methylenedioxymethamphetamine]], [[cabergoline]], [[dexfenfluramine]], [[ergotamine]], [[fenfluramine]], [[fluoxetine]], [[methysergide]], [[paroxetine]], [[pergolide]], [[phentermine]], [[sertraline]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
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|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Genetic'''
| '''Genetic'''
|bgcolor="Beige"| No underlying causes.
|bgcolor="Beige"| [[Barth syndrome]], [[Becker muscular dystrophy]], [[Cohen syndrome]], [[Duchenne muscular dystrophy]], [[Emery-Dreifuss muscular dystrophy]], [[Fabry disease]], [[hypertrophic cardiomyopathy|familial hypertrophic cardiomyopathy]], [[Friedreich ataxia]], [[Marfan's syndrome]], [[myotonic dystrophy]], [[osteogenesis imperfecta]], [[polycystic kidney disease]], [[Pompe's disease]], [[pseudoxanthoma elasticum]], [[Turner syndrome]], [[dilated cardiomyopathy|X-linked dilated cardiomyopathy]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Hematologic'''
| '''Hematologic'''
|bgcolor="Beige"| No underlying causes.
|bgcolor="Beige"| [[Antiphospholipid syndrome]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Iatrogenic'''
| '''Iatrogenic'''
|bgcolor="Beige"| No underlying causes.
|bgcolor="Beige"| [[balloon valvuloplasty|Balloon valvuloplasty of the mitral valve]], [[cardiac catheterization]], [[cardiopulmonary resuscitation]], [[catheter ablation|cathether ablation for arrhythmias]], [[heart surgery]], [[pacemaker syndrome]], [[percutaneous coronary intervention]], [[postpericardiotomy syndrome]], [[prosthetic valve|prosthetic valve dysfunction]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Infectious Disease'''
| '''Infectious Disease'''
|bgcolor="Beige"| [[Infective endocarditis]] (the predominant organism is ''[[Staphylococcus aureus|S. aureus]]'' <ref name=agabegi2nd-ch1>{{cite book|author=Elizabeth D Agabegi; Agabegi, Steven S. |title=Step-Up to Medicine (Step-Up Series) |publisher=Lippincott Williams & Wilkins |location=Hagerstwon, MD |year=2008 |pages=|isbn=0-7817-7153-6 |oclc= |doi= |accessdate=}}  Chapter 1: Diseases of the Cardiovascular system > Section: Valvular Heart Disease</ref>, but varies depending upon the patient) and untreated [[syphilis]] (rare).
|bgcolor="Beige"| [[Chagas disease]], [[cytomegalovirus]], [[diphtheria]], [[ECHO virus]], [[infective endocarditis]], [[Lyme disease]], [[myocarditis]], [[pneumococcus]], [[rheumatic fever]],[[coxsackie B virus]], [[rickettsial disease]], [[staphylococcus]], [[streptococcus]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Musculoskeletal / Ortho'''
| '''Musculoskeletal / Ortho'''
|bgcolor="Beige"| Contractural arachnodactyly.
|bgcolor="Beige"| [[Ankylosing spondylitis]], [[Becker muscular dystrophy]], [[Duchenne muscular dystrophy]], [[Ehlers-Danlos syndrome]], [[Emery-Dreifuss muscular dystrophy]], [[Marfan's syndrome]], [[osteogenesis imperfecta]], [[psoriatic arthropathy]], [[rheumatoid arthritis]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Neurologic'''
| '''Neurologic'''
|bgcolor="Beige"| No underlying causes.
|bgcolor="Beige"| [[Friedreich ataxia]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Nutritional / Metabolic'''
| '''Nutritional / Metabolic'''
|bgcolor="Beige"| No underlying causes.
|bgcolor="Beige"| [[Barth syndrome]], [[Fabry disease]], [[Pompe's disease]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
| '''Obstetric/Gynecologic'''
|bgcolor="Beige"| No underlying causes.
|bgcolor="Beige"| [[Peripartum cardiomyopathy]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Oncologic'''
| '''Oncologic'''
|bgcolor="Beige"| No underlying causes.
|bgcolor="Beige"| [[Carcinoid syndrome]], [[cardiac myxoma]], [[cardiac tumors]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
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|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Psychiatric'''
| '''Psychiatric'''
|bgcolor="Beige"| No underlying causes.
|bgcolor="Beige"| [[Takotsubo cardiomyopathy]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
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|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Renal / Electrolyte'''
| '''Renal / Electrolyte'''
|bgcolor="Beige"| Polycystic kidney disease-adult (autosomal dominant type).
|bgcolor="Beige"| [[End stage renal disease]], [[polycystic kidney disease]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Rheum / Immune / Allergy'''
| '''Rheum / Immune / Allergy'''
|bgcolor="Beige"| [[Ankylosing spondylitis]], [[collagen vascular disease]]s such as [[marfan's syndrome]], ehlers-danlos syndrome and osteogenesis imperfecta, [[rheumatoid]] disease, systemic lupus erythematosus ([[Systemic Lupus Erythematosus|SLE]]) <ref name=agabegi2nd-ch1/>, polychondritis.
|bgcolor="Beige"| [[Ankylosing spondylitis]], [[Behçet's disease]], [[Ehlers-Danlos syndrome]], [[Marfan's syndrome]], [[osteogenesis imperfecta]], [[polychondritis]], [[rheumatic heart disease]], [[rheumatoid arthritis]], [[Sjögren's syndrome]], [[systemic lupus erythematosus]], [[temporal arteritis]]
 
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
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|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Trauma'''
| '''Trauma'''
|bgcolor="Beige"| Trauma to the heart (stab wound).
|bgcolor="Beige"| [[chest trauma|Blunt or penetrating chest trauma]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
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|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Miscellaneous'''
| '''Miscellaneous'''
|bgcolor="Beige"| Chromosomal abnormalities such as turner syndrome, Congenital (present from birth) mitral regurgitation is most often part of a more complex heart defect or syndrome (atrial septal defect (ostium primum), mendelian inherited conditions (autosomal dominant conditions such as contractural arachnodactyly, familial hypertrophic cardiomyopathy, osteogenesis imperfecta and polycystic kidney disease-adult), X-linked inherited conditions such as fabry disease.
|bgcolor="Beige"| [[Alcoholism]], [[athletes]], [[functional mitral regurgitation]]
|-
|-
|}
|}


==Differential Diagnosis of the Causes of Acute Mitral Regurgitation==
===Causes in Alphabetical Order===
 
{{col-begin|width=80%}}
In alphabetical order:
{{col-break|width=33%}}
 
*[[3,4-methylenedioxymethamphetamine]]
*Balloon valvuloplasty of the [[mitral valve]].
*[[Acute coronary syndrome]]
*[[Infective endocarditis]] <ref name=agabegi2nd-ch1>{{cite book|author=Elizabeth D Agabegi; Agabegi, Steven S. |title=Step-Up to Medicine (Step-Up Series) |publisher=Lippincott Williams & Wilkins |location=Hagerstwon, MD |year=2008 |pages=|isbn=0-7817-7153-6 |oclc= |doi= |accessdate=}} Chapter 1: Diseases of the Cardiovascular system > Section: Valvular Heart Disease</ref>.
*[[Alcoholism]]<ref name="pmid7420729">{{cite journal| author=Koide T, Kato A, Takabatake Y, Iizuka M, Uchida Y, Ozeki K et al.| title=Variable prognosis in congestive cardiomyopathy. Role of left ventricular function, alcoholism, and pulmonary thrombosis. | journal=Jpn Heart J | year= 1980 | volume= 21 | issue= 4 | pages= 451-63 | pmid=7420729 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7420729 }} </ref>
*[[Papillary muscle rupture]] <ref name=agabegi2nd-ch1/>.
*[[Ankylosing spondylitis]]
*[[ST elevation myocardial infarction]].
*[[Antiphospholipid syndrome]]<ref name="pmid23743123">{{cite journal| author=Scantlebury DC, Nkomo VT, Enriquez-Sarano M| title=Antiphospholipid syndrome and recurrent thrombotic valve disease. | journal=J Am Coll Cardiol | year= 2013 | volume= 61 | issue= 23 | pages= e177 | pmid=23743123 | doi=10.1016/j.jacc.2012.12.058 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23743123 }} </ref>
*Trauma.
*[[Aortic insufficiency]]
 
*[[Athletes]]
==Differential Diagnosis of the Causes of Chronic Mitral Regurgitation==
*[[Atrial septal defect|Atrial septal defect (Ostium primum)]]
 
*[[balloon valvuloplasty|Balloon valvuloplasty of the mitral valve]]
In alphabetical order:
*[[Barth syndrome]]
 
*[[Becker muscular dystrophy]]
*Atrial septal defect (ostium primum).
*[[Behçet's disease]]
*[[Ankylosing spondylitis]].
*[[chest trauma|Blunt or penetrating chest trauma]]
*[[Aortic Insufficiency]].
*[[Cabergoline]]<ref name="pmid19683643">{{cite journal| author=Bhattacharyya S, Schapira AH, Mikhailidis DP, Davar J| title=Drug-induced fibrotic valvular heart disease. | journal=Lancet | year= 2009 | volume= 374 | issue= 9689 | pages= 577-85 | pmid=19683643 | doi=10.1016/S0140-6736(09)60252-X | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19683643 }} </ref>
*[[Cabergoline]] drug.
*[[Carcinoid syndrome]]
*Chromosomal abnormalities.
*[[Cardiac catheterization]]
*[[Collagen vascular disease]]s.
*[[Cardiac myxoma]]
*Contractural Arachnodactyly.
*[[Cardiac tumor]]
*Dilatation of the [[left ventricle]].
*[[Cardiopulmonary resuscitation]]
*[[Dilated cardiomyopathy]].
*[[catheter ablation|Cathether ablation for arrhythmias]]<ref name="pmid23797742">{{cite journal| author=Penaranda Canal JG, Enriquez-Sarano M, Asirvatham SJ, Munger TM, Friedman PA, Suri RM| title=Mitral valve injury after radiofrequency ablation for Wolff-Parkinson-White syndrome. | journal=Circulation | year= 2013 | volume= 127 | issue= 25 | pages= 2551-2 | pmid=23797742 | doi=10.1161/CIRCULATIONAHA.113.002711 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23797742 }} </ref>
*Ehlers-Danlos syndrome.
*[[Chagas disease]]
*[[Endocarditis]] <ref name=agabegi2nd-ch1>{{cite book|author=Elizabeth D Agabegi; Agabegi, Steven S. |title=Step-Up to Medicine (Step-Up Series) |publisher=Lippincott Williams & Wilkins |location=Hagerstwon, MD |year=2008 |pages=|isbn=0-7817-7153-6 |oclc= |doi= |accessdate=}} Chapter 1: Diseases of the Cardiovascular system > Section: Valvular Heart Disease</ref>.
*[[Cohen syndrome]]
*Endocardial cushion defect.
*[[Congenital heart disease]]
*Endomyocardial fibrosis.
*[[Congestive heart disease]]
*Familial hypertrophic cardiomyopathy
*[[Coxsackie B virus]]
*[[Fabry disease]].
*[[Cytomegalovirus]]
*[[Fenfluramine]] drug.
*[[Dexfenfluramine]]
*Heart tumors.
*[[Dilated cardiomyopathy]]
*High blood pressure.
*[[Diphtheria]]
*[[Ischemic heart disease]] ([[Coronary artery disease]]).
*[[Duchenne muscular dystrophy]]
*[[Marfan's syndrome]] <ref name=agabegi2nd-ch1/>.
{{col-break|width=33%}}
*Mendelian inherited conditions.
*[[ECHO virus]]
*[[Methysergide]] drug.
*[[Ehlers-Danlos syndrome]]
*[[Mitral valve prolapse]].
*[[Emery-Dreifuss muscular dystrophy]]
*Osteogenesis Imperfecta
*[[Endocardial cushion defect]]
*[[Pergolide]] drug.
*[[Endocarditis]] <ref name=agabegi2nd-ch1>{{cite book|author=Elizabeth D Agabegi; Agabegi, Steven S. |title=Step-Up to Medicine (Step-Up Series) |publisher=Lippincott Williams & Wilkins |location=Hagerstwon, MD |year=2008 |pages=|isbn=0-7817-7153-6 |oclc= |doi= |accessdate=}} Chapter 1: Diseases of the Cardiovascular system > Section: Valvular Heart Disease</ref>
*Polychondritis.
*[[Endomyocardial fibrosis]]
*Polycystic kidney disease-adult (autosomal dominant type).
*[[Ergotamine]]<ref name="pmid8665020">{{cite journal| author=Hendrikx M, Van Dorpe J, Flameng W, Daenen W| title=Aortic and mitral valve disease induced by ergotamine therapy for migraine: a case report and review of the literature. | journal=J Heart Valve Dis | year= 1996 | volume= 5 | issue= 2 | pages= 235-7 | pmid=8665020 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8665020 }} </ref><ref name="pmid9129909">{{cite journal| author=Wilke A, Hesse H, Hufnagel G, Maisch B| title=Mitral, aortic and tricuspid valvular heart disease associated with ergotamine therapy for migraine. | journal=Eur Heart J | year= 1997 | volume= 18 | issue= 4 | pages= 701 | pmid=9129909 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9129909 }} </ref>
*[[Rheumatic heart disease]].
*[[Fabry disease]]
*[[Rheumatoid]] disease.
*[[hypertrophic cardiomyopathy|Familial hypertrophic cardiomyopathy]]
*Swelling of the left lower heart chamber.
*[[Fenfluramine]]
*Systemic Lupus Erythematosus.
*[[Fluoxetine]]
*[[Syphilis]] (rare).
*[[Friedreich ataxia]]
*[[Takotsubo cardiomyopathy]].
*[[Functional mitral regurgitation]]
*Turner syndrome.
*[[Heart surgery]]
*X-linked inherited conditions such as Fabry disease.
*[[Heart tumors]]
*[[Hypertensive heart disease]]
*[[Hypertrophic cardiomyopathy]]
*[[Infective endocarditis]]<ref name=agabegi2nd-ch1>{{cite book|author=Elizabeth D Agabegi; Agabegi, Steven S. |title=Step-Up to Medicine (Step-Up Series) |publisher=Lippincott Williams & Wilkins|location=Hagerstwon, MD |year=2008 |pages=|isbn=0-7817-7153-6 |oclc= |doi= |accessdate=}} Chapter 1: Diseases of the Cardiovascular system > Section: Valvular Heart Disease</ref>
*[[Ischemic heart disease]]
*[[Kawasaki disease]]
*[[cardiomegaly|Left ventricle dialation]]<ref>[http://www.uptodate.com/patients/content/topic.do?topicKey=~Ux3kbGWsXmiaqiH Functional mitral regurgitation] By William H Gaasch, MD. Retrieved on Jul 8, 2010</ref>
*[[Marfan's syndrome]]
*[[Methysergide]]<ref name="pmid4420941">{{cite journal| author=Bana DS, MacNeal PS, LeCompte PM, Shah Y, Graham JR| title=Cardiac murmurs and endocardial fibrosis associated with methysergide therapy. | journal=Am Heart J | year= 1974 | volume= 88 | issue= 5 | pages= 640-55 | pmid=4420941 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4420941 }} </ref>
*[[Mitral valve prolapse]]
*[[Myocardial rupture]]
*[[Myocarditis]]
*[[Myotonic dystrophy]]
*[[NSTEMI]]
*[[Lyme disease]]
*[[Osteogenesis imperfecta]]
{{col-break|width=33%}}
*[[Pacemaker syndrome]]<ref name="pmid15869664">{{cite journal| author=Barold SS, Ovsyshcher IE| title=Pacemaker-induced mitral regurgitation. | journal=Pacing Clin Electrophysiol | year= 2005 | volume= 28 | issue= 5 | pages= 357-60 | pmid=15869664 | doi=10.1111/j.1540-8159.2005.09486.x | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15869664 }} </ref>
*[[Papillary muscle rupture]]
*[[Paroxetine]]
*[[Percutaneous coronary intervention]]
*[[Pergolide]]<ref name="pmid12479512">{{cite journal| author=Pritchett AM, Morrison JF, Edwards WD, Schaff HV, Connolly HM, Espinosa RE| title=Valvular heart disease in patients taking pergolide. | journal=Mayo Clin Proc | year= 2002 | volume= 77 | issue= 12 | pages= 1280-6 | pmid=12479512 | doi=10.4065/77.12.1280 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12479512 }} </ref>
*[[Peripartum cardiomyopathy]]
*[[Phentermine]]
*[[Pneumococcus]]
*[[Polychondritis]]
*[[Polycystic kidney disease]]
*[[Pompe's disease]]
*[[Postpericardiotomy syndrome]]
*[[prosthetic valve|Prosthetic valve dysfunction]]
*[[Pseudoxanthoma elasticum]]
*[[Psoriatic arthropathy]]
*[[Rheumatic heart disease]]
*[[Rheumatoid arthritis]]
*[[Rickettsial disease]]
*[[Sertraline]]
*[[Sjögren's syndrome]]
*[[Staphylococcus]]
*[[STEMI]]<ref name=agabegi2nd-ch1/>
*[[Streptococcus]]
*[[Syphilis]]
*[[Systemic lupus erythematosus]] ([[SLE]])<ref name=agabegi2nd-ch1/>
*[[Takotsubo cardiomyopathy]]<ref name="pmid19774331">{{cite journal |author=Haghi D, Röhm S, Suselbeck T, Borggrefe M, Papavassiliu T |title=Incidence and clinical significance of mitral regurgitation in Takotsubo cardiomyopathy |journal=[[Clinical Research in Cardiology : Official Journal of the German Cardiac Society]] |volume=99 |issue=2 |pages=93–8 |year=2010 |month=February |pmid=19774331 |doi=10.1007/s00392-009-0078-1|url=http://dx.doi.org/10.1007/s00392-009-0078-1 |accessdate=2011-04-16}}</ref><ref name="pmid17692942">{{cite journal |author=Brunetti ND, Ieva R, Rossi G, Barone N, De Gennaro L, Pellegrino PL, Mavilio G, Cuculo A, Di Biase M |title=Ventricular outflow tract obstruction, systolic anterior motion and acute mitral regurgitation in Tako-Tsubo syndrome |journal=[[International Journal of Cardiology]] |volume=127 |issue=3 |pages=e152–7 |year=2008 |month=July |pmid=17692942|doi=10.1016/j.ijcard.2007.04.149 |url=http://linkinghub.elsevier.com/retrieve/pii/S0167-5273(07)01161-8 |accessdate=2011-04-16}}</ref>
*[[Temporal arteritis]]
*[[Turner syndrome]]
*[[dilated cardiomyopathy|X-linked dilated cardiomyopathy]]
{{col-end}}


==References==
==References==
{{reflist|2}}
{{reflist|2}}


[[Category:Crowdiagnosis]]
[[Category:Up-To-Date]]
[[Category:Up-To-Date cardiology]]
[[Category:Valvular heart disease]]
[[Category:Cardiology]]
[[Category:Cardiology]]
[[Category:Emergency medicine]]
[[Category:Disease]]
[[Category:Differential diagnosis]]
[[Category:Cardiac surgery]]
[[Category:Surgery]]
[[Category:Overview complete]]
[[Category:Overview complete]]
[[Category:Valvular heart disease]]
[[Category:Disease state]]
[[Category:Surgery]]
[[Category:Cardiac surgery]]


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Latest revision as of 15:56, 18 December 2019
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Mitral Regurgitation Microchapters

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohammed A. Sbeih, M.D. [2]; Cafer Zorkun, M.D., Ph.D. [3]; Varun Kumar, M.B.B.S.; Lakshmi Gopalakrishnan, M.B.B.S.; Mugilan Poongkunran M.B.B.S [4]

Overview

The causes of mitral regurgitation (MR) depend on the acuity of the valvular abnormality and the underlying pathological mechanism. Acute MR occurs when there is sudden disruption of one or more of the components of the mitral valve, such as leaflet perforation, rupture of a chordae tendineae, or rupture of the papillary muscle. The sudden disruption of the mitral valve can be caused by infective endocarditis, degenerative mitral valve disease, or acute ST elevation myocardial infarction.[1] Chronic primary MR is most commonly caused by mitral valve prolapse; other causes include rheumatic fever and Marfan's syndrome. Chronic secondary MR results from the dysfunction and dilatation of the left ventricle rather than an intrinsic abnormality in one of the components of the mitral valve and it can be caused by coronary artery disease (ischemic) or any disease causing left ventricular dysfunction and dilatation (functional).[2]

Causes

Life Threatening Causes

Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.[3][4]

Common Causes

Acute Mitral Regurgitation

Chronic Mitral Regurgitation

Primary Mitral Regurgitation
Secondary Mitral Regurgitation

Causes by Organ System

Cardiovascular Acute coronary syndrome, aortic insufficiency, atrial septal defect (ostium primum), carcinoid syndrome, cardiac myxoma, cardiac tumors, congenital heart disease, congestive heart failure, coronary artery disease, dilated cardiomyopathy, endocardial cushion defect, endocarditis, endomyocardial fibrosis, hypertrophic cardiomyopathy, hypertensive heart disease, infective endocarditis, ischemic heart disease, Kawasaki disease, left ventricle dialation, mitral annular calcification, mitral valve prolapse, myocardial rupture, myocarditis, NSTEMI, papillary muscle rupture, rheumatic heart disease, STEMI, Takotsubo cardiomyopathy
Chemical / poisoning No underlying causes.
Dermatologic Psoriatic arthropathy
Drug Side Effect 3,4-Methylenedioxymethamphetamine, cabergoline, dexfenfluramine, ergotamine, fenfluramine, fluoxetine, methysergide, paroxetine, pergolide, phentermine, sertraline
Ear Nose Throat No underlying causes.
Endocrine No underlying causes.
Environmental No underlying causes.
Gastroenterologic No underlying causes.
Genetic Barth syndrome, Becker muscular dystrophy, Cohen syndrome, Duchenne muscular dystrophy, Emery-Dreifuss muscular dystrophy, Fabry disease, familial hypertrophic cardiomyopathy, Friedreich ataxia, Marfan's syndrome, myotonic dystrophy, osteogenesis imperfecta, polycystic kidney disease, Pompe's disease, pseudoxanthoma elasticum, Turner syndrome, X-linked dilated cardiomyopathy
Hematologic Antiphospholipid syndrome
Iatrogenic Balloon valvuloplasty of the mitral valve, cardiac catheterization, cardiopulmonary resuscitation, cathether ablation for arrhythmias, heart surgery, pacemaker syndrome, percutaneous coronary intervention, postpericardiotomy syndrome, prosthetic valve dysfunction
Infectious Disease Chagas disease, cytomegalovirus, diphtheria, ECHO virus, infective endocarditis, Lyme disease, myocarditis, pneumococcus, rheumatic fever,coxsackie B virus, rickettsial disease, staphylococcus, streptococcus
Musculoskeletal / Ortho Ankylosing spondylitis, Becker muscular dystrophy, Duchenne muscular dystrophy, Ehlers-Danlos syndrome, Emery-Dreifuss muscular dystrophy, Marfan's syndrome, osteogenesis imperfecta, psoriatic arthropathy, rheumatoid arthritis
Neurologic Friedreich ataxia
Nutritional / Metabolic Barth syndrome, Fabry disease, Pompe's disease
Obstetric/Gynecologic Peripartum cardiomyopathy
Oncologic Carcinoid syndrome, cardiac myxoma, cardiac tumors
Opthalmologic No underlying causes.
Overdose / Toxicity No underlying causes.
Psychiatric Takotsubo cardiomyopathy
Pulmonary No underlying causes.
Renal / Electrolyte End stage renal disease, polycystic kidney disease
Rheum / Immune / Allergy Ankylosing spondylitis, Behçet's disease, Ehlers-Danlos syndrome, Marfan's syndrome, osteogenesis imperfecta, polychondritis, rheumatic heart disease, rheumatoid arthritis, Sjögren's syndrome, systemic lupus erythematosus, temporal arteritis
Sexual No underlying causes.
Trauma Blunt or penetrating chest trauma
Urologic No underlying causes.
Miscellaneous Alcoholism, athletes, functional mitral regurgitation

Causes in Alphabetical Order

References

  1. ↑ Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Guyton RA; et al. (2014). "2014 AHA/ACC guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines". J Am Coll Cardiol. 63 (22): 2438–88. doi:10.1016/j.jacc.2014.02.537. PMID 24603192.
  2. ↑ Ciarka A, Van de Veire N (2011). "Secondary mitral regurgitation: pathophysiology, diagnosis, and treatment". Heart. 97 (12): 1012–23. doi:10.1136/hrt.2010.219170. PMID 21586426.
  3. ↑ Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Guyton RA; et al. (2014). "2014 AHA/ACC guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines". J Am Coll Cardiol. 63 (22): 2438–88. doi:10.1016/j.jacc.2014.02.537. PMID 24603192.
  4. ↑ Ciarka A, Van de Veire N (2011). "Secondary mitral regurgitation: pathophysiology, diagnosis, and treatment". Heart. 97 (12): 1012–23. doi:10.1136/hrt.2010.219170. PMID 21586426.
  5. ↑ Koide T, Kato A, Takabatake Y, Iizuka M, Uchida Y, Ozeki K; et al. (1980). "Variable prognosis in congestive cardiomyopathy. Role of left ventricular function, alcoholism, and pulmonary thrombosis". Jpn Heart J. 21 (4): 451–63. PMID 7420729.
  6. ↑ Scantlebury DC, Nkomo VT, Enriquez-Sarano M (2013). "Antiphospholipid syndrome and recurrent thrombotic valve disease". J Am Coll Cardiol. 61 (23): e177. doi:10.1016/j.jacc.2012.12.058. PMID 23743123.
  7. ↑ Bhattacharyya S, Schapira AH, Mikhailidis DP, Davar J (2009). "Drug-induced fibrotic valvular heart disease". Lancet. 374 (9689): 577–85. doi:10.1016/S0140-6736(09)60252-X. PMID 19683643.
  8. ↑ Penaranda Canal JG, Enriquez-Sarano M, Asirvatham SJ, Munger TM, Friedman PA, Suri RM (2013). "Mitral valve injury after radiofrequency ablation for Wolff-Parkinson-White syndrome". Circulation. 127 (25): 2551–2. doi:10.1161/CIRCULATIONAHA.113.002711. PMID 23797742.
  9. ↑ 9.0 9.1 9.2 9.3 Elizabeth D Agabegi; Agabegi, Steven S. (2008). Step-Up to Medicine (Step-Up Series). Hagerstwon, MD: Lippincott Williams & Wilkins. ISBN 0-7817-7153-6. Chapter 1: Diseases of the Cardiovascular system > Section: Valvular Heart Disease
  10. ↑ Hendrikx M, Van Dorpe J, Flameng W, Daenen W (1996). "Aortic and mitral valve disease induced by ergotamine therapy for migraine: a case report and review of the literature". J Heart Valve Dis. 5 (2): 235–7. PMID 8665020.
  11. ↑ Wilke A, Hesse H, Hufnagel G, Maisch B (1997). "Mitral, aortic and tricuspid valvular heart disease associated with ergotamine therapy for migraine". Eur Heart J. 18 (4): 701. PMID 9129909.
  12. ↑ Functional mitral regurgitation By William H Gaasch, MD. Retrieved on Jul 8, 2010
  13. ↑ Bana DS, MacNeal PS, LeCompte PM, Shah Y, Graham JR (1974). "Cardiac murmurs and endocardial fibrosis associated with methysergide therapy". Am Heart J. 88 (5): 640–55. PMID 4420941.
  14. ↑ Barold SS, Ovsyshcher IE (2005). "Pacemaker-induced mitral regurgitation". Pacing Clin Electrophysiol. 28 (5): 357–60. doi:10.1111/j.1540-8159.2005.09486.x. PMID 15869664.
  15. ↑ Pritchett AM, Morrison JF, Edwards WD, Schaff HV, Connolly HM, Espinosa RE (2002). "Valvular heart disease in patients taking pergolide". Mayo Clin Proc. 77 (12): 1280–6. doi:10.4065/77.12.1280. PMID 12479512.
  16. ↑ Haghi D, Röhm S, Suselbeck T, Borggrefe M, Papavassiliu T (2010). "Incidence and clinical significance of mitral regurgitation in Takotsubo cardiomyopathy". Clinical Research in Cardiology : Official Journal of the German Cardiac Society. 99 (2): 93–8. doi:10.1007/s00392-009-0078-1. PMID 19774331. Retrieved 2011-04-16. Unknown parameter |month= ignored (help)
  17. ↑ Brunetti ND, Ieva R, Rossi G, Barone N, De Gennaro L, Pellegrino PL, Mavilio G, Cuculo A, Di Biase M (2008). "Ventricular outflow tract obstruction, systolic anterior motion and acute mitral regurgitation in Tako-Tsubo syndrome". International Journal of Cardiology. 127 (3): e152–7. doi:10.1016/j.ijcard.2007.04.149. PMID 17692942. Retrieved 2011-04-16. Unknown parameter |month= ignored (help)

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