Mitral Prolapse

Question 1

Definition

Answer 1

Mitral valve prolapse occurs when the mitral leaflets do not close properly resulting in a bulging of one or both leaflets into the left atrium during systole and backflow of blood from the LV to the LA during contraction

Question 2

Epidemiology

Answer 2

More frequent in younger women
Tends to be familial
Up to 10% of the population have some degree of MVP
It is usually an isolated abnormality but may be associated with, Marfan’s syndrome and atrial septal defect

Question 3

Symptoms

Answer 3

Most patients are asymptomatic
when symptomatic, patients may present with a range of symptoms including
Palpitations
Chest pain (not associated with CAD or MI)
Exertional dyspnea
Fatigue
Cough
Orthopnea

MVP rarely presents in a form of panic disorder

Question 4

Physical Exam

Answer 4

Aardiac ausculation demonstrates
Mid-systolic click or late systolic murmur
May find palpable thrill over the chest wall

Question 5

Evaluation

Answer 5

Doppler echocardiography is gold standard for diagnosis shows regurgitant flow into LA from LV

ECG
May show resultant arrythmias
Atrial fibrillation is not uncommon

Question 6

Differential (Systolic Murmurs)

Answer 6

Hypertrophic obstructive
cardiomyopathy

Aortic Stenosis
Loud crescendo-decrescendo
systolic ejection murmor in
right 2nd intercostal space

Mitral Regurgitation
High pitched holosystolic
loudest at apex radiating to
axilla

Tricuspid Regurgitation
(soft holosystolic at right
sternal border)

Question 7

Differential (Diastolic Murmurs)

Answer 7

Aortic Regurgitation
High pitched blowing early
diastolic decrescendo murmor at left sternal border

Mitral Stenosis
Rumbling mid-diastolic
murmor with ccenuated S1.
S2, best heard on expiration
or when the patient is
squating or excercising
because venous return is
increased

Question 8

Treatment

Answer 8

No treatment indicated in most cases of asymptomatic to mild disease

Surgical repair indicated in cases of severe, symptomatic disease

Prophylactic antibiotics indicated in patients with history of infectious endocarditis prior to dental or
other surgical procedures

Question 9

Prevention, Prognosis and Complications

Answer 9

Prognosis is excellent in the majority of cases most have no effect on patient lifestyle

Complications may include
Bacterial endocarditis
Progression to regurgitation
Arrythmias