When should I refer a patient with mitral regurgitation to a cardiologist for further evaluation?

Refer a patient with mitral regurgitation to a cardiologist for further evaluation if they have moderate or severe mitral valve disease of any type after echocardiography. This includes adults with moderate or severe mitral regurgitation identified on echocardiogram.

Urgent referral (within 2 weeks) is indicated if the patient has a systolic murmur with exertional syncope or severe symptoms such as angina or breathlessness on minimal exertion or at rest thought to be related to valvular heart disease.

Consider referral for intervention in asymptomatic patients with severe primary mitral regurgitation if they have any of the following echocardiographic findings: left ventricular ejection fraction (LVEF) less than 60%, end-systolic dimension (ESD) more than 45 mm or indexed ESD more than 22 mm/m2, or an increase in systolic pulmonary artery pressure to more than 60 mmHg on exercise testing.

Also refer pregnant women or those considering pregnancy with moderate or severe valve disease for specialist cardiology assessment.