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Aetiology: primary or secondary

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Primary mitral regurgitation is due to valve disease which may be caused by:

  • redundant cusp mitral leaflet prolapse (a 'floppy' mitral valve). This is the commonest cause of mitral regurgitation in Europe and North America.

  • rheumatic mitral regurgitation - this is frequently associated with mitral stenosis and aortic valve disease. Chordal rupture does not occur in this condition. The cusps are shrunken and fibrotic.

  • ischaemic heart disease - a mild degree of mitral regurgitation (late systolic murmur) often follows inferior infarction. This condition is relatively benign unless there is papillary muscle rupture.

  • localised cardiomyopathy affecting a papillary muscle - this is a rare cause of primary mitral regurgitation.

  • connective tissue disease (eg Marfan's syndrome, Ehlers Danlos, osteogenesis imperfecta) may result in degenerative valve changes

  • in elderly women - calcification of the mitral ring (very rare)

Secondary mitral regurgitation occurs secondary to a dilated left ventricle e.g. in dilated cardiomyopathy, ischaemic heart disease, acute myocarditis) but is seldom severe. This may be difficult to distinguish from end-stage primary regurgitation.


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The content herein is provided for informational purposes and does not replace the need to apply professional clinical judgement when diagnosing or treating any medical condition. A licensed medical practitioner should be consulted for diagnosis and treatment of any and all medical conditions.

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