Mitral Valve Prolapse

Mitral valve prolapse (MVP) is described as bulging of one or more of the mitral leaflets into the left atrium in systole (see Fig. 27-21). Although the most common cause of significant MR (Cheng and Barlow., 1989), it can be isolated without valvular insufficiency. MVP with MR is a strong indication for prophylaxis against bacterial endocarditis during dental, GI, and genitourinary procedures. MVP carries a benign course (Freed et al., 2002). On rare occasions it may be associated with significant arrhythmias and sudden cardiac death. When associated with MR, patients need to be carefully monitored for progressive left atrial and left ventricular cavity dilation and atrial fibrillation.

Primary MVP might be familial and is inherited as an autosomal dominant trait with different rate of penetrance and typically found in patients with connective tissue disease, cardiomyopathies, and Marfan's syndrome (Pyeritz and Wappel, 1983). Secondary MVP is generally seen in patients with CAD and rheumatic heart disease.

Patients with MVP are often asymptomatic. However, some patients describe palpitations, chest pain, dyspnea, and fatigue with or without MR. Although previously thought that strokes occur more frequently in patients with MVP, recent data do not support this conclusion (Gilon et al., 1999). Panic attacks have been frequently described. A high-pitched midsystolic click is often heard that occurs shortly after S1 and can be associated with a systolic murmur. Baseline electrocardiography is often unrevealing, and routine stress testing carries a high false-positive rate. Stress imaging is more accurate in evaluating these patients for myocardial ischemia. An echocardiogram is the most helpful methodology for making the diagnosis of MVP. A displacement of the leaflets beyond the mitral annulus on a parasternal short axis is strongly suggestive of MVP. Cardiac catheterization is generally not needed for diagnosis.

Asymptomatic patients with MVP generally do not require treatment unless they have severe associated MR (Devereux et al., 1989). Symptomatic patients with MVP can be treated with beta blockers. Flail mitral leaflets caused by chordae rupture or severe MR associated with MVP needs to be followed and mitral valve repair becomes indicated if patients develop symptoms of dyspnea (NYHC III or IV), the ejection fraction and cavity size become adversely affected, or atrial fibrillation appears.

Do Not Panic

Do Not Panic

This guide Don't Panic has tips and additional information on what you should do when you are experiencing an anxiety or panic attack. With so much going on in the world today with taking care of your family, working full time, dealing with office politics and other things, you could experience a serious meltdown. All of these things could at one point cause you to stress out and snap.

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