1. Definition: the backward flow of blood into the LA during systole. *Read pages 10 – 17in The Echocardiographer’s Pocket Reference; Read pages 292 – 304 and 311 – 319 in Otto; Read pages 202 – 205 and 210 – 217 in Echo Review

2. *Mitral regurgitation can be acute or chronic! Acute MR can be the result of : chordal rupture: papillary muscle rupture: flailed mitral valve leaflet:

3. Chronic MR can be caused by: Calcification: MV prolapse:

4.  Fatigue (earliest symptom)  Dyspnea upon exertion  Atypical chest pain (may indicate MVP)  Palpitations  Congestive heart failure (due to increased LA or LV pressures)  Peripheral edema (due to right heart failure)

5.  LV volume overload with LV dilatation  Pulmonary HTN  Pulmonary edema (especially in acute cases)  Left atrial thrombus  Congestive heart failure  Right heart failure *MR will cause a blowing, high-pitched holosystolic(throughout systole) murmur *This murmur is best heard at the cardiac apex radiating to the axilla. It is also best heard with the patient in the left decubitus position.

6. Evaluate the Length of the jet, the Area of the jet and the Width the jet covers with color flow doppler. The further back the jet goes into the LA and the wider, the more severe Mild MRModerate MRSevere MR

7. *MR is a very subjective disease state, in that, what you may call mild, someone else may call it trivial, etc. It is a very common and most often doesn’t require intervention or treatment. Just know that with MR, figure out how the doctors and sonographers read where you are at. Over time, you will become very confident with determining the severity degree of MR.