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 0

Squatting or 0

Hand 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