MITRAL VALVE PROLAPSE
Jan 18, 2018
MITRAL VALVE PROLAPSE
CC: PALPITATION
MM, 23 y/o, F
PHYSICAL EXAMINATION• Conscious, coherent, ambulatory• BP: 110/70 CR 80/min regular RR 16/min• BMI 19• Symmetrical chest expansion, narrow A-P
diameter of the chest, no retractions, clear breath sounds
• Adynamic precordium, AB at 5th LICS MCL, no murmurs, (+) midsystolic click followed by 2/6 midsystolic cresecendo murmur noted at the apex
REVIEW OF SYSTEMS
• (-) dizziness• (-) loss of consciousness• (-) cough or colds• (-) PND or Orthopnea
LABORATORY AND ANCILLARY TEST
• 2D Echo-Doppler: MVP, anterior mitral valve leaflet with moderate MR, slightly dilated LA with no evidence of thrombus
• 123L ECG: sinus rhythm, occasional premature atrial complexes
• CXR: Normal
WHAT ARE THE COMMON PE FINDINGS OF MVP?
Question # 1
Physical examination
• Body weight is often low ; asthenic• Blood pressure is usually normal or low • Orthostatic hypotension• Resting bradycardia
• Thoracic skeletal abnormalities suggesting MVP:– Scoliosis, pectus excavatum, straightened thoracic
spine, and narrowed AP dm of the chest
Zippes, D., et al. (2005) Braunwald’s Heart Disease: A textbook of Cardiovascular Medicine, 7th ed. USA: Elsevier Saunders
• Auscultation:• Nonejection systolic click at least 0.14 sec after S1• Multiple mid and late systolic clicks along the L lower
sternal border• Mid to late crescendo systolic murmur that continues to A2
Zippes, D., et al. (2005) Braunwald’s Heart Disease: A textbook of Cardiovascular Medicine, 7th ed. USA: Elsevier Saunders
• Dynamic Auscultation:
Zippes, D., et al. (2005) Braunwald’s Heart Disease: A textbook of Cardiovascular Medicine, 7th ed. USA: Elsevier Saunders
• Dynamic Auscultation:Response of the Murmur of MVP to Interventions
Intervention Timing Intensity Standing upright
Recumbent or 0Squatting or 0Hand grip +Valsalva +Amyl nitrite +
Fuster, V.,et al. (2008) . Hurst’s The Heart, 12the ed. China: McGrawHill Co.
NING =)
Yung mga hidden slides, pareho lang nung mga nakashow. Mas maganda kase yung ginawa ni
gelyn. Hehehe. Yung iba lang kase sa slides n a gnawa ko, may konting explanation
kaya sinama ko pa din. hehe
Question 2