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Updated: Dec 7 2021

Mitral Valve Prolapse

Images echo.jpg
  • Snapshot
    • A 30-year-old woman presents to her first primary care appointment. She says she experiences episodes of mild shortness of breath and palpitations; however, it does not impair her activities of daily living. She is otherwise healthy. On physical exam, a systolic murmur with a mid-systolic click is noted in the 5th intercostal space at the mid-clavicular line. Preparations are made to undergo an echocardiogram.
  • Introduction
    • Clinical definition
      • disease of the mitral valve characterized by superior displacement and thickening of the mitral leaflets
    • Associated conditions
      • Marfan syndrome
      • Ehlers-Danlos syndrome
      • polycystic kidney disease
      • fragile X syndrome
  • Etiology
    • Myxomatous degeneration
      • can be spontaneous or secondary to a connective tissue disorder
    • Rheumatic fever
    • Myocardial infarction
    • Chordae rupture
    • Idiopathic
    • Pathogenesis
      • myxomatous degeneration of the mitral valve
        • valvular leaflets become abnormal secondary to
          • excessive degradation of collagen and elastin by proteolytic enzymes
          • accumulation of proteoglycans
        • the chordae tendinae become weakened and elongated
        • annular dilation of the mitral valve
      • connective tissue disorder
        • deficiency in collagen, elastin, and proteoglycans cause leaflets to be mostly thin and translucent
  • Epidemiology
    • Demographics
      • female > male
      • middle-aged adults
      • mitral valve prolapse is the most frequent valvular lesion
    • Location
      • mitral valve
  • Presentation
    • Symptoms
      • palpitations
      • chest pain, regardless of exertion
      • shortness of breath
    • Physical exam
      • systolic murmur
        • high-pitched late systolic crescendo murmur
        • midsystolic click from tensing of the chordae tendinae
        • loudest over the apex
        • murmur becomes softer with squatting
        • murmur becomes louder with standing, Valsalva maneuver, and nitrate administration
  • Imaging
    • Echocardiography
      • indication
        • confirms the diagnosis
        • rule out other valvular abnormalities
      • findings
        • superior displacement of mitral leaflets
  • Differential
    • Atrial myxoma
      • distinguishing factor
        • while this can also present with a systolic click, echocardiography will show mass in the atria
    • Murmurs
      Systolic Murmurs
      Diastolic Murmurs
      • Aortic stenosis
      • Mitral regurgitation
      • Tricuspid regurgitation
      • Aortic regurgitation
      • Mitral stenosis
  • Diagnosis
    • Making the diagnosis
      • based on clinical presentation and echocardiography
  • Treatment
    • Management approach
      • if patients do not have mitral regurgitation, treatment is typically not warranted
      • prophylaxis is not warranted for endocarditis or thromboembolism
    • Operative
      • mitral valve replacement or repair
        • indication
          • mitral valve prolapse with mitral regurgitation
  • Complications
    • Mitral regurgitation
    • Chorda tendinae rupture
    • Infective endocarditis
  • Prognosis
    • Progressive with age
    • Patients are susceptible to infective endocarditis
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