Mitral regurgitation following acute myocardial infarction

Yochai Birnbaum, Antonio J. Chamoun, Vincent R. Conti, Barry F. Uretsky

Research output: Contribution to journalReview articlepeer-review

63 Scopus citations

Abstract

Mitral valve regurgitation (MR) is a frequent Doppler echocardiographic finding in patients after acute myocardial infarction (AMI) and an independent predictor of long-term cardiovascular mortality. Reported risk factors include advanced age, prior myocardial infarction, infarct extension, and recurrent ischemia. During the early phase of AMI, transient ischemic MR is common and rarely causes hemodynamic compromise. However, when several chordae tendineae or a papillary muscle ruptures, acute left atrial and ventricular volume overload ensues, leading to abrupt hemodynamic deterioration with cardiogenic shock. Auscultation may be unrevealing due to decreased turbulence. Hence, the importance of a high index of suspicion for acute MR in any patient with acute pulmonary edema in the setting of AMI, especially if left ventricular systolic function is well preserved. Later, ventricular remodeling may lead to MR through annular dilatation or papillary muscle migration with malcoaptation of the leaflets. The widespread availability, ease of use and non-invasive nature of Doppler echocardiography have made it the standard diagnostic tool for detecting MR. Mechanical reperfusion of the infarct-related artery seems to be superior to fibrinolysis in decreasing its incidence acutely and in the long run. Nevertheless, when acute severe MR occurs, unless rapidly diagnosed and treated, this dreaded complication is associated with high morbidity and mortality. Prompt surgical intervention after hemodynamic stabilization is essential to ensure a good short-term and long-term prognosis. This review discusses the incidence, long-term prognosis, associated risk factors, complex pathophysiology, time of occurrence, clinical manifestations, diagnosis, and management of patients with MR after AMI.

Original languageEnglish (US)
Pages (from-to)337-344
Number of pages8
JournalCoronary Artery Disease
Volume13
Issue number6
DOIs
StatePublished - Sep 1 2002

Keywords

  • Acute myocardial infarction
  • Clinical manifestation
  • Echocardiography
  • Mitral regurgitation
  • Prognosis
  • Surgery
  • Treatment

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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