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MITRAL VAVLE PROLAPSE

WORKSHOP 12 III-C6 Matematico  Matias  Maulion  Medenilla  Medina, K.  Medina, S.  Mejino  Melgarejo  Mendoza, A. MITRAL VAVLE PROLAPSE. CC: PALPITATION. MM 23 years old Female. PHYSICAL EXAMINATION. Conscious, coherent, ambulatory

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MITRAL VAVLE PROLAPSE

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  1. WORKSHOP 12 III-C6 Matematico  Matias  Maulion  Medenilla  Medina, K.  Medina, S.  Mejino  Melgarejo  Mendoza, A MITRAL VAVLE PROLAPSE

  2. CC: PALPITATION MM 23 years old Female

  3. 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 • Adynamicprecordium, AB at 5th LICS MCL, no murmurs, (+) midsystolic click followed by 2/6 midsystoliccresecendo murmur noted at the apex

  4. REVIEW OF SYSTEMS • (-) dizziness • (-) loss of consciousness • (-) cough or colds • (-) PND or Orthopnea

  5. 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

  6. 1. WHAT ARE COMMON PHYSICAL EXAMINATOIN FINDINGS OF MVP?

  7. 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

  8. 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

  9. Dynamic Auscultation: Zippes, D., et al. (2005) Braunwald’s Heart Disease: A textbook of Cardiovascular Medicine, 7th ed. USA: Elsevier Saunders

  10. Dynamic Auscultation: Response of the Murmur of MVP to Interventions Fuster, V.,et al. (2008) . Hurst’s The Heart, 12the ed. China: McGrawHill Co.

  11. 2. WHAT ARE THE COMMON AND UNCOMMON SYMPTOMS OF MVP?

  12. Symptoms Common Uncommon TIA Congestive Heart Failure Endocarditis in MR associated with MVP Sudden death • Easy fatigability • Shortness of breath • Palpitation • Chest pain • Light-headedness • Syncope

  13. Symptoms associated with AUTONOMIC DYSFUNCTION are associated with GENETICALLY INHERITED MVP: Atypical chest pain Fatigue Orthostasis Syncope or presyncope Neuropsychiatric symptoms • Anxiety • Panic attacks • Exercise intolerance • Palpitations (may be a symptom of benign arrythmias)

  14. Symptoms Related to progression of Mitral Regurgitation: • Fatigue • Dyspnea • Exercise intolerance • Orthopnea • Paroxysmal nocturnal dyspnea

  15. 3. WHAT ARE THE LONG TERM COMPLICATIONS OF MVP?

  16. Long term complications: • Severe Mitral Regurgitation • over years or decades, due to chordal rupture and massive prolapse of both leaflets • rapidly, due to chordal or endocarditis • Arrythmias • most commonly ventricular premature contractions and paroxysmal supraventricular and ventricular tachycardia

  17. Long term complications: • Transient cerebral ischemic attacks • secondary to emboli from the mitral valve due to endothelial disruption have been reported, • Infective endocarditis • may occur in patients with MR and/or leaflet thickening

  18. 4. WHAT POPULATION GROUP IS ASSOCIATED WITH AN INCREASED PREDILECTION FOR MVP?

  19. Greater frequency among those with Collagen (type 3) Disorders: • Marfan’s Syndrome • OsteogenesisImperfecta • Ehlers-Danlos Syndrome

  20. 5. WHEN DO YOU GIVE PROPHYLACTIC TREATMENT IN MVP?

  21. THANK YOU!

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