Rule of two’s


  • LV dilatation
  • Annular Calcification


Connective Tissue Disorders

Appetite Suppressants



  • Pansystolic murmur best heard in the mitral area, radiating to the axilla.
  • Heave
  • Displaced Apex Beat
  • Possible signs of:
Hang on a minute! – the blood in mitral regurg is flowing away from the axilla – why does the sound radiate to the axilla?
  • Well, the sound comes from the valve itself, and is not related to the direction of flow of blood. Due to the location of the mitral valve, any sound it produces (whether from regurg or stenosis) will radiate to the axilla.


Signs of any valve defect

  • Fatigue
  • Dyspnoea


  • ECG – P Mitrale – ‘bifid’ (two-peaks) P waves due to atrial hypertrophy
  • Trans-Oesophageal Ultrasound – TOE – used to asses the level of valve damage, to check if suitable for valve repair / replacement
  • Doppler-Echo – assesses the site and size of the regurgitant jet
  • Cardiac catheterisation  may be used to confirm the diagnosis, and to assess the level of underlying CAD (coronary artery disease)


  • Conservative – lifestyle advice (e.g. avoidance of RFs for underlying cause)
  • Medicalcontrol the signs and symptoms; e.g. diuretics if heart failure is a component, treat AF
  • Surgicalpatients may require valve replacement or repair.
    • Patients should be placed on antibiotics to prevent bacterial endocarditis

Valve replacements

Prosthetic – last about 10 years, after which time, may require another replacement. No need for long term anticoagulant therapy.
Metal last a life time, but require anticoagulant therapy for life. Also noisy (often make a loud ‘click’ sound). There are three types of metal valve

  • Tilting disc
  • Double tilting disc
  • Ball in a cage

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