Do you have a patient with shortness of breath and pulmonary edema?
Don’t forget to place the color doppler over the mitral valve to look for acute mitral regurgitation.
Acute mitral regurgitation can be missed on initial evaluation or misdiagnosed as a primary pulmonary process because patients often present with severe dyspnea, an abnormal chest x-ray, or an absence of an audible murmur. Classically, these patients develop acute heart failure due to a rapid rise in left atrial pressure leading to pulmonary congestion. The abrupt reduction in forward stroke volume may also result in hypotension and cardiogenic shock.
When evaluating a patient with acute dyspnea, remember to apply color Doppler over the mitral valve, such as in the apical 4 chamber view, to assess for severe mitral regurgitation. In the image below, notice the backward flow of color into the left atrium.
Watanabe N. Acute mitral regurgitation. Heart. 2019 May;105(9):671-677. doi: 10.1136/heartjnl-2018-313373. Epub 2019 Mar 1. PMID: 30824479.
