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Chronic mitral regurgitation accounts for 2h of mitraj valve disease in the elderly. About lh of affected patients have a history of rheumatic fever and about yk have associated aortic valve disease, usually aortic regurgitation. Isolated mitral regurgitation often results from papillary muscle dysfunction following myocardial infarction. Calcification of the mitral annulus and myxomatous valve degeneration leading to mi¬tral valve prolapse also cause chronic mitral regurgitation and are dis¬cussed separately below.
Symptoms, Signs, and Laboratory Findings
The usual presentation includes atrial fibrillation, which may precipi¬tate hemodynamic deterioration; an apical holosystolic murmur, often with a soft first heart sound; and heart failure. Complicating systemic embolism may occur, as a result of either rheumatic disease or myocar¬dial infarction. When mitral regurgitation is due to papillary muscle dysfunction, a spindle-shaped apical murmur is heard during mid-systole. Electrocardiographic abnormalities and echocardiography ev¬idence of regional wall motion abnormalities may suggest coexisting coronary disease. Echocardiography can also delineate overall ventric¬ular function.

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