Mitral Valve Prolapse in Emergency Medicine Medication

  • Author: Michael C Plewa, MD; Chief Editor: David FM Brown, MD   more...
 
Updated: Jun 27, 2011
 

Medication Summary

Medications generally are not necessary. Beta-blockers may be helpful if palpitations are severe.

Antiplatelet agents such as aspirin, aspirin with extended-release dipyridamole (Aggrenox), or clopidogrel (Plavix) are indicated for patients with transient ischemic attack or stroke.[30] Some authors recommend prophylaxis with antiplatelet agents in all patients with mitral valve prolapse (MVP) and murmur because of a small but significant increase in risk of stroke (10%).[31]

Orthostatic hypotension and presyncope symptoms may be treated with sodium chloride tablets; however, if this treatment is not successful, fludrocortisone 0.05-0.10 mg/d PO may be used.

Magnesium supplementation may improve symptoms of the classic MVP syndrome.[10]

Significant mitral regurgitation (MR) in the setting of hypertension (systolic blood pressure >140 mm Hg) may be improved with the use of angiotensin-converting enzyme inhibitors. No evidence exists as yet to support the use of these medications to halt the progression of MVP to MR.

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Antibiotics

Class Summary

Antibiotic prophylaxis to prevent infective endocarditis is no longer recommended prior to dental or surgical procedures for any patient with MVP (even those with a murmur or nontrivial MR on echo and men older than 45 years with valve thickening) unless there is a history of endocarditis.[32] Antibiotic prophylaxis to prevent infective endocarditis is no longer recommended prior to genitourinary or gastrointestinal procedures, even with a history of endocarditis.[32, 33]

Patients with MVP with prior endocarditis who are undergoing a dental, respiratory tract, infected skin, or musculoskeletal tissue procedure (eg, contaminated wound repair or abscess incision and drainage) should receive prophylaxis for infective endocarditis with amoxicillin 2 g (50 mg/kg) PO 1 hour prior to the procedure. Patients with MVP with prior endocarditis who are unable to take oral medications may be treated with ampicillin 2 g (50 mg/kg) IM or IV, or cefazolin or ceftriaxone 1 g (50 mg/kg) IM or IV 1 hour prior to the procedure.

Patients with MVP with prior endocarditis who are allergic to penicillin may be treated 1 hour before the procedure with cephalexin 2 g (50 mg/kg) PO, clindamycin 600 mg (20 mg/kg) PO, or azithromycin or clarithromycin 500 mg (15 mg/kg) PO. Clindamycin 600 mg (20 mg/kg), or cefazolin or ceftriaxone 1 g (50 mg/kg), may be administered IM or IV 30 minutes before the procedure, as an alternative to the PO route.

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Amoxicillin (Amoxil, Biomox, Polymox)

 

DOC; interferes with the synthesis of cell wall mucopeptide during active multiplication, resulting in a bactericidal activity against susceptible bacteria.

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Ampicillin (Marcillin, Omnipen)

 

Alternative parenteral agent. Interferes with bacterial cell wall synthesis during active multiplication, causing bactericidal activity against susceptible organisms. Given in place of amoxicillin in patients who are unable to take medication orally.

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Beta-blockers

Class Summary

Blood pressure control may prevent chordal rupture and the progression of MVP to severe MR. Clonidine has been shown to diminish symptoms of the classic (disputed) MVP syndrome. Beta-blocking agents (eg, propranolol, atenolol, pindolol) may also be effective in those with neurocardiogenic syncope.

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Atenolol (Tenormin)

 

Selectively blocks beta1-receptors with little or no effect on beta2 types.

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Antiarrhythmics

Class Summary

Digoxin has been effective in treating supraventricular tachycardia and in the prevention of symptoms of classic MVP syndrome (eg, chest pain, fatigue).

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Digoxin (Lanoxin)

 

Cardiac glycoside with direct inotropic effects in addition to indirect effects on the cardiovascular system. Effects on the myocardium involve both a direct action on cardiac muscle that increases myocardial systolic contractions and indirect actions that result in increased carotid sinus nerve activity and enhanced sympathetic withdrawal for any given increase in mean arterial pressure.

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Contributor Information and Disclosures
Author

Michael C Plewa, MD  Research Coordinator, Consulting Staff, Department of Emergency Medicine, Lucas County Emergency Physicians, Inc, and Mercy Saint Vincent Medical Center

Michael C Plewa, MD, is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, Physicians for Social Responsibility, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Richard Worthington  MD, Department of Emergency Medicine, Wood County Hospital

Richard Worthington is a member of the following medical societies: American College of Emergency Physicians, Ohio State Medical Association, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Robert M McNamara, MD, FAAEM  Chair and Professor, Department of Emergency Medicine, Temple University School of Medicine

Robert M McNamara, MD, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American Medical Association, Pennsylvania Medical Society, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Paul Blackburn, DO, FACOEP, FACEP  Attending Physician, Department of Emergency Medicine, Maricopa Medical Center

Paul Blackburn, DO, FACOEP, FACEP is a member of the following medical societies: American College of Emergency Physicians, American College of Osteopathic Emergency Physicians, American Medical Association, and Arizona Medical Association

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

David FM Brown, MD  Associate Professor, Division of Emergency Medicine, Harvard Medical School; Vice Chair, Department of Emergency Medicine, Massachusetts General Hospital

David FM Brown, MD is a member of the following medical societies: American College of Emergency Physicians and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

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Mitral valve prolapse. A patient with straight back syndrome.
 
 
 
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