Internal Medicine

0521779407-14 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:16

996 Mitral Valve Prolapse

MITRAL VALVE PROLAPSE

JUDITH A. WISNESKI, MD

history & physical

■Most common – no other associated illness

■Mitral valve prolapse associated with:

➣Marfan’s syndrome

➣Ehlers-Danlos syndrome

➣Osteogenesis imperfecta

➣Pseudoxanthoma elastican

➣Periarteritis nodosa

➣Hyperthyroidism

➣Ebstein’s anomaly of tricuspid valve

➣Straight-back syndrome

History

■Asymptomatic (most common)

■Palpitations

■Chest pain

■Syncope

Signs & Symptoms

■Midsystolic click+/−late systolic murmur

➣Valsalva maneuver – click occurs earlier in systole, murmur

louder and longer

tests

■ECG

➣Most common – normal

➣If significant mitral insufficiency (MR) – see section on MR

■Chest X-Ray

➣Most common – normal

➣If significant MR – see section on MR

■Echo/Doppler (most important in diagnosis)

➣Prolapse of mitral valve leaflets

➣Detect presence and severity of MR – see section on MR

differential diagnosis

■Other causes of mitral insufficiency

management

■Medical