Mitral regurgitation in coronary heart disease.

Abstract

Mitral regurgitation is a relatively common finding in coronary heart disease. In this series of 127 patients, selected with a view to coronary or left ventricular surgery on the basis of severity of symptoms, the incidence was 39 (31%). Mitral regurgitation is significantly more common in patients with a history or electrocardiographic evidence ofprevious myocardial infarction. Clinically it may present as a pan-or late systolic or even a mid-systolic, ejection type murmur at the apex or at the left sternal edge; but in 39 per cent of the patients with angiographic mitral regurgitation no murmur was present. Angiographically important mitral regurgitation (grades 2-4/4) was usually associated with a systolic murmur; this finding was independent of ejection fractions. Left ventricular enlargement clinically or radiographically is likely to accompany mitral regurgitation but left atrial enlargement (electrocardiographically or on chest x-ray) is a more reliable pointer to mitral regurgitation and pulmonary venous hypertension is even more strongly suggestive of its presence. The electrocardiographic signs of papillary muscle infarction were rare in this series (15%) and were not related to angiographic mitral regurgitation. There was no difference in the incidence of mitral regurgitation in association with anterior or inferior myocardial infarction or in distribution of coronary artery disease. There is, however, a higher incidence of mitral regurgitation in more severe coronary arterial disease (P<005).The incidence of mitral regurgitation is significantly higher with reduction in left ventricular ejection fraction (P< 0001), with rise in the left ventricular end-diastolic pressure (P<0'02), and with abnormalcontraction patterns, but the severity of mitral regurgitation is not significantly related to these findings.

2008 Focused Update Incorporated Into the ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease

“…In patients undergoing catheterization to evaluate the cause and severity of MR, CAD is present in an average of 33%. 1023,1024 In patients undergoing catheterization for acute ischemic syndromes, an average of 20% have associated MR.(1025 Those with chronic CAD and MR usually have lower LV ejection fractions and more extensive CAD than those without MR. 1023,1026 However, CAD is infrequent in patients with degenerative MV disease undergoing surgery. In a large series, only 1.3% of such patients had CAD, and they only had single-vessel disease.…”

Myocardial Infarction in Women

“…The treatment for an acute ventricular septal rupture is surgical repair. Rupture of the free wall, however, is frequently a catastrophic occurrence and results in approximately 10% of in-hospital deaths from myocardial infarction [47], Acute, severe mitral regurgi tation may occur with rupture of the papil lary muscle but may also seen with papillary muscle dysfunction [80], Gender is usually not addressed in reports of acute mitral re gurgitation [80,81 ], however, there is no evi dence to support a predilection for this com plication in women [79,82], Right ventricular involvement occurs in one to two thirds of patients with inferior wall myocardial infarction [47,83]. Al though acutely right ventricular infarction may have profound hemodynamic impact, the overall long-term prognosis is usually felt to be good [83][84][85].…”

Ischemic Mitral Regurgitation and Its Related Risk After Myocardial Infarction

“…The data Bursi et al report support findings from the 1970s, which suggested that clinical examination is not sensitive in the detection and assessment of mitral regurgitation. 2 The authors conclude that Doppler echocardiographic assessment of mitral regurgitation should be actively sought and included in post-MI risk stratification.…”