Valvular Disease and Heart Failure: Mitral Regurgitation
A 75-year-old female with a past medical history of type 2 diabetes mellitus, hypertension, and implantable cardioverter-defibrillator (ICD) and chronic left ventricular systolic dysfunction for over 5 years presented with increasing exertional dyspnea. Three months ago, she suffered syncope with ICD interrogation with ventricular fibrillation, and successful delivery of shock therapy. At that time, she underwent coronary angiography that demonstrated no obstructive coronary artery disease. An echocardiogram demonstrated LV ejection fraction 15% and a dilated left ventricle (end-diastolic dimension by M-mode echocardiography 81 mm) with decreased right ventricular function and severe mitral regurgitation (MR). There is no evidence of mitral valve prolapse, prior endocarditis, or other valve leaflet pathology. Of note, the MR has been present for the past 2 years, with a slow, progressive dilatation of the LV, though she has remained relatively asymptomatic (class I–II) with most daily activities. She is on carvedilol 12.5 mg twice a day, lisinopril 5 mg daily, and furosemide 20 mg twice a day.
KeywordsMitral valve insufficiency Left sided heart failure
- 4.Carabello BA, Nakano K, Corin W, Biederman R, Spann JF Jr. Left ventricular function in experimental volume overload hypertrophy. Am J Phys. 1989;256(4 Pt 2):H974–81.Google Scholar
- 5.Bursi F, Barbieri A, Grigioni F, Reggianini L, Zanasi V, Leuzzi C, Ricci C, Piovaccari G, Branzi A, Modena MG. Prognostic implications of functional mitral regurgitation according to the severity of the underlying chronic heart failure: a long-term outcome study. Eur J Heart Fail. 2010;12(4):382–8.CrossRefPubMedGoogle Scholar
- 7.Comin-Colet J, Sanchez-Corral MA, Manito N, Gomez-Hospital JA, Roca J, Fernandez-Nofrerias E, Valdovinos P, Esplugas E. Effect of carvedilol therapy on functional mitral regurgitation, ventricular remodeling, and contractility in patients with heart failure due to left ventricular systolic dysfunction. Transplant Proc. 2002;34(1):177–8.CrossRefPubMedGoogle Scholar
- 10.Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE Jr, Drazner MH, Fonarow GC, Geraci SA, Horwich T, Januzzi JL, Johnson MR, Kasper EK, Levy WC, Masoudi FA, McBride PE, McMurray JJ, Mitchell JE, Peterson PN, Riegel B, Sam F, Stevenson LW, Tang WH, Tsai EJ, Wilkoff BL, American College of Cardiology Foundation, American Heart Association Task Force on Practice Guidelines. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2013;62(16):e147–239.CrossRefPubMedGoogle Scholar
- 11.Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC), European Association for Cardio-Thoracic Surgery, Vahanian A, Alfieri O, Andreotti F, Antunes MJ, Baron-Esquivias G, Baumgartner H, Borger MA, Carrel TP, De Bonis M, Evangelista A, Falk V, Iung B, Lancellotti P, Pierard L, Price S, Schafers HJ, Schuler G, Stepinska J, Swedberg K, Takkenberg J, Von Oppell UO, Windecker S, Zamorano JL, Zembala M. Guidelines on the management of valvular heart disease (version 2012). Eur Heart J. 2012;33(19):2451–96.CrossRefGoogle Scholar