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Cardiovascular Medicine Mitral Regurgitation Diagnosis Acute MR most often occurs in patients with chordae tendineae rupture. Characteristic findings include the abrupt onset of dyspnea, pulmonary edema, or cardiogenic shock. The murmur may be short or absent in patients with acute MR. A soft S, and P, are usually heard. Chronic mitral regurgitation is classified as primary invoMng any portion of the mitral annulus, or secondary involving causes other than the annulus (e.g., ventricular dysfunction). TTE serves as the main imaging modality in the evaluation and management of MR. Treatment Acute MR: . nitroprusside o intra-aortic balloon pump r prompt surgical correction Indications for surgical repair/replacement for chronic MR: o symptomatic patients . asymptomatic patients with EF <60% andior LV end-systolic diameter >40 mm For patients who are not surgical candidates, transcatheter mitral valve repair with a clip device leads to increased valve closure and a reduction in regrrrgitation. Patients with chronic secondary mitral regurgitation should be treated with guideline-directed medical therapy for ventricular dysfunction. DO]I'T BETRICKED o ACE inhibitors and ARBs have not been shown to be effective in preventing progression of LV dysfunction in patients with chronic MR. TESTYOURSELF A 63 year-old man who is asymptomatic and active is found to have primary MR. LV systolic dimension is 45 mm, and the EF is 55%. ANSWER: For treatment, select mitral valve replacement or repair. Mitral Valve Prolapse Diagnosis MVP is the most common cause of significant MR, but most patients with prolapse have either minimal or no MR. The initial diagnostic study is echocardiography. Patients with symptoms of arrhythmia require ambulatory ECG monitoring. 35