eMedicine Specialties > Emergency Medicine > Cardiovascular
Mitral Valve Prolapse: Differential Diagnoses & Workup
Updated: Dec 22, 2008
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
- Multimedia
Differential Diagnoses
Other Problems to Be Considered
Hypertrophic cardiomyopathy (HCM)
Tachyarrhythmias, narrow complex
Tachyarrhythmias, wide complex
Ventricular septal defect (VSD)
Stickler syndrome
Postural orthostatic tachycardia syndrome (POTS)
Benign joint hypermobility syndrome
Neurocardiogenic syncope
Workup
Laboratory Studies
- Specific lab studies are not necessary to confirm mitral valve prolapse (MVP), although some may be indicated to exclude other diagnoses.
- Arterial blood gas (ABG) analysis may be obtained to exclude the diagnosis of hyperventilation, hypoxemia, and metabolic acidosis in patients with tachypnea or dyspnea.
- Serum electrolytes may be obtained to exclude the diagnosis of hypokalemia and acidosis in patients with dysrhythmias or palpitations.
- Serum hemoglobin may be obtained to exclude the diagnosis of anemia in patients with fatigue or near-syncope.
- Serum glucose may be obtained to exclude the diagnosis of hypoglycemia in patients with fatigue or near-syncope.
- Cardiac enzymes may be obtained to exclude the diagnosis of an acute myocardial event in patients with chest pain.
- A urine toxin screen may be obtained to exclude the diagnosis of an exposure to amphetamines, cocaine, or phencyclidine in patients with agitation, chest pain, dyspnea, and tachydysrhythmia.
Imaging Studies
- Chest radiography is not specifically indicated except to exclude other causes of chest pain and dyspnea.
- The chest radiograph may reveal an increased left atrial or pulmonary artery size, which is indicative of MR.
- A lateral chest radiograph may reveal dorsal spine straightening and a narrow anteroposterior diameter.
- Outpatient echocardiography (echo) is indicated for those with a murmur.
- Although screening subjects who are at a low risk for complications (ie, those without MR) is not indicated, 2-dimensional echo can detect the patients with more severe or unusual forms of MVP (eg, patients with significant MR, annular and leaflet thickening, chordal lengthening, atrial septal defect [ie, secundum], hypertrophic cardiomyopathy).
- Two-dimensional echo is less sensitive than M-mode echo, detecting only 50% of patients with M-mode echo and auscultatory findings, but it is more specific for MVP than M-mode echo.
- Diagnostic criteria include systolic billowing of one or both mitral leaflets. This systolic billowing occurs on the left atrial side, above the visualized annular plane, in the long-axis parasternal view.
- An M-mode echo gives many false-negative and false-positive results, but it can identify MVP with at least 2 mm of midsystolic prolapse or 3 mm of holosystolic or late-systolic movement of the leaflets, which are posterior to the line connecting the valve's opening and the closure points.
- Doppler echo is recommended every 2-3 years for patients with mild MR, and it is recommended yearly for those with significant MR.
Other Tests
- Electrocardiogram
- Results usually are normal.
- Minor QT prolongation (0.42 ± 0.05) may occur.
- Nonspecific ST and T-wave changes were previously noted, but they may not be more frequent than in the general population.
- Holter monitor
- Outpatient Holter monitoring or transtelephonic event recording should be considered in patients with palpitations that are associated with syncope or near-syncope.
- Supraventricular tachydysrhythmias occur in 30% of patients with MVP, but the incidence of ventricular dysrhythmias is similar to that of the general population.
- Electrophysiologic testing is indicated for those with near-sudden death, symptomatic complex ventricular ectopy, Wolff-Parkinson-White syndrome, and recurrent unexplained syncope.
- Contrary to earlier studies that report a false-positive result 50% of the time on exercise stress ECGs and thallium imaging studies, recent reports have found stress test abnormalities no more likely in patients with MVP than in the general population.
- Single-photon emission computed tomographic myocardial perfusion imaging has excluded myocardial ischemia in patients with MVP and exercise-induced chest pain16
More on Mitral Valve Prolapse |
| Overview: Mitral Valve Prolapse |
 Differential Diagnoses & Workup: Mitral Valve Prolapse |
| Treatment & Medication: Mitral Valve Prolapse |
| Follow-up: Mitral Valve Prolapse |
| Multimedia: Mitral Valve Prolapse |
| References |
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References
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Further Reading
Keywords
mitral valve prolapse, MVP, endocarditis, bacterial endocarditis, stroke, mitral valve surgery, sudden death, supraventricular arrhythmias, palpitations, mitral regurgitation, MR, syncope, Marfan syndrome, polyarteritis nodosa, relapsing polychondritis, systemic lupus erythematosus, Stickler syndrome, pseudoxanthoma elasticum, osteogenesis imperfecta, Ehlers-Danlos syndrome type I, Ehlers-Danlos syndrome type II, Ehlers-Danlos syndrome type IV, polycystic kidney disease, Duchenne muscular dystrophy, fragile X syndrome, mucopolysaccharidoses, myotonic dystrophy, atrial septal defect, Ebstein anomaly, papillary muscle dysfunction, cardiac trauma, post mitral valve surgery, rheumatic endocarditis, Wolff-Parkinson-White syndrome, Von Willebrand disease
