0071643192.pdf

CHRONICMITRALREGURGITATION

SYMPTOMS

■ Often asymptomatic
■ Gradual progression of dyspnea
■ Palpitations (from atrial fibrillation)

EXAM

■ Holosystolic murmur heard best at the apex with radiation to the base
■ S3 heart sound

DIAGNOSIS

■ ECG: Left atrial enlargement, LVH, atrial fibrillation (common)
■ CXR: CHF in advanced cases

TREATMENT

■ Treat CHF and atrial fibrillation (consider anticoagulation).
■ Anticoagulate if systemic embolization occurs.
■ Endocarditis prophylaxis
■ Valve replacement

COMPLICATIONS

■ Atrial fibrillation (very common)
■ Systemic emboli from left atrial thrombus
■ Endocarditis

Mitral Valve Prolapse

This is one of the most common valvular disorders. The prototypical patient is
a young, thin female. The exact etiology is unknown, but is likely congenital.
Associated with anxiety, eating disorders, panic attacks.

PATHOPHYSIOLOGY

■ Myxomatous proliferation of valve leaflet →abnormal stretching of valve
leaflets during systole.

SYMPTOMS

■ Usually asymptomatic
■ Atypical chest pain
■ Palpitations
■ Lightheadedness
■ Dyspnea

EXAM

■ Early to midsystolic click with high-pitched late systolic murmur heard
best at left lateral heart border.
■ Decreasing the LV volume (standing, Valsalva maneuver) →earlier
and greater prolapse →accentuates the click and moves it closer to S1..

CARDIOVASCULAR EMERGENCIES

Atrial fibrillation and systemic

emboli are common in chronic

mitral regurgitation.

In mitral valve prolapse,

decreasing the LV volume will

accentuate the click and move

it closer to S1.