Mitral Regurgitation and Vomiting
Vomiting is not a recognized symptom of mitral regurgitation, either chronic or acute. The established symptom profile of MR does not include gastrointestinal manifestations.
Recognized Symptoms of Chronic Mitral Regurgitation
The American College of Cardiology identifies the following as common presentations of chronic MR:
- Exertional dyspnea is the primary symptom, though it may be absent or subtle even in severe disease due to enhanced left atrial compliance accommodating large regurgitant volumes without pressure elevation 1
- Fatigue represents another cardinal manifestation 1
- Palpitations occur commonly, particularly when atrial fibrillation develops 1
- Patients often unconsciously reduce activity levels to avoid symptoms, making symptom assessment challenging 1
Acute Severe Mitral Regurgitation Presentation
When MR develops acutely (from papillary muscle rupture, chordal rupture, or endocarditis), the presentation is dramatically different but still does not include vomiting:
- Sudden hemodynamic deterioration with cardiogenic shock and pulmonary edema dominates the clinical picture 2, 3
- Acute dyspnea and respiratory distress from pulmonary congestion occur rapidly 3, 4
- The physical examination may reveal a hyperdynamic left ventricle on echocardiography, though the classic holosystolic murmur may be soft or absent due to rapid equalization of left atrial and ventricular pressures 3
Clinical Pitfall to Avoid
If a patient presents with both vomiting and suspected cardiac disease, consider alternative diagnoses:
- Acute coronary syndrome can present with nausea and vomiting, particularly inferior wall myocardial infarction, which may subsequently cause papillary muscle dysfunction or rupture leading to MR 3, 4
- The vomiting in this scenario would be from the myocardial infarction itself, not from the resulting mitral regurgitation 4
- Severe right heart failure from advanced pulmonary hypertension (which can result from chronic severe MR) may cause hepatic congestion and abdominal symptoms, though vomiting is not typically prominent 1
When to Suspect MR in Symptomatic Patients
Focus your assessment on cardiopulmonary symptoms rather than gastrointestinal complaints:
- Ask specifically about the most vigorous activity the patient can currently perform compared to previous capabilities 1
- Inquire about orthopnea, paroxysmal nocturnal dyspnea, and exercise intolerance 5
- Family members may report diminished activity that the patient has not recognized 1
- Consider exercise testing or a 6-minute walk test to objectively assess functional capacity in apparently asymptomatic patients 1