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Mitral Valve Prolapse
Aka: Mitral Valve Prolapse, MVP
- Epidemiology
- Incidence: 2.4%
- Pathophysiology
- Redundant valve tissue with elongated chordae tendineae
- Symptoms
- Chest Pain (occurs in 50% of those with MVP)
- Prolonged, sharp and non-exertional
- May mimic Angina
- Vague associated symptoms
- Palpitations
- Weakness
- Red Flags for problems associated with MVP
- Exertional Syncope
- Family History of Sudden Cardiac Death
- Arrhythmia with Exercise
- Marked Mitral Regurgitation
- Signs
- Midsystolic click
- Results from sudden tensing of mitral valve
- Occurs as leaflets prolapse into left atrium
- Systolic Murmur
- Late systolic or holosystolic murmur
- Murmur prolonged with Valsalva
- Murmur decreased with squatting
- Timing of click and murmur
- Decreased end-diastolic volume (Standing)
- Click and murmur start just after S1 Heart Sound
- Increased end-diastolic volume (Squatting)
- Click and murmur start closer to S2 Heart Sound
- Diagnosis
- Electrocardiogram often abnormal
- Inverted T Waves in leads II, III, and AVF
- Holter Monitor
- Variety of Dysrhythmias
- Echocardiogram
- Mitral Valve Prolapse is a common echo finding
- New criteria based on three dimensional valve shape
- Management
- Reassurance
- Low Incidence of serious complications
- Symptomatic treatment
- Indications
- Chest Pain
- Palpitations
- Anxiety
- Medications
- Beta Blockers
- General measures
- Alcohol cessation
- Tobacco Cessation
- Caffeine cessation
- SBE Prophylaxis
- Indicated only if Mitral Regurgitation present
- References
- Kondos (1998) CMEA Medicine Review Lecture, San Diego
- Assi (1998) Postgrad Med 104(6):99-110 [PubMed]
- Bonow (1998) Circulation 98:1949-84 [PubMed]
- Carabello (1997) N Engl J Med 337(1):32-41 [PubMed]
- Joy (1996) Physician and Sportsmed 24(7):78-86
- Shipton (2001) Am Fam Physician 63(11):2201-8 [PubMed]