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Sections Mitral Valve Prolapse
- Overview
- Presentation
- DDx
- Workup
- Treatment
- References
Diagnostic Considerations
Consider all heritable connective tissue disorders mentioned previously, with emphasis on Marfan syndrome because of its increased frequency. The prevalence of mild mitral valve pathology in Marfan syndrome is estimated to be around 75%, whereas the prevalence of severe myxomatous mitral valve thickening with prolapse is closer to 25% in these individuals. [40] All causes of mitral regurgitation (MR) should be considered. However, if only a mid-systolic click and/or a mid-to-late systolic murmur is present, the diagnosis is almost always mitral valve prolapse (MVP). If only a late systolic murmur without a click is present, papillary muscle dysfunction secondary to coronary artery disease is a possibility.
Strict diagnostic criteria should be used to prevent the overdiagnosis of MVP that occurred in the 1970s and 1980s. In many patients, MVP was diagnosed on the basis of imprecise echocardiographic criteria, producing undue anxiety, particularly in asymptomatic patients.
In addition, being diagnosed with a heart condition can greatly affect patients' self-perceptions. Care should be taken to explain MVP syndrome in detail so that patients understand that the natural history of MVP is usually benign. The vast majority of patients with MVP should be strongly reassured of their benign prognosis.
Follow up patients with clinically significant MVP. When clinically significant MR develops or progresses, irreversible left ventricular dysfunction may occur in the absence of symptoms. Also, endocarditis can be a subtle illness that makes prompt diagnosis difficult.
Differential Diagnoses
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Devereux RB, Kramer-Fox R, Brown WT, et al. Relation between clinical features of the mitral prolapse syndrome and echocardiographically documented mitral valve prolapse. J Am Coll Cardiol. 1986 Oct. 8(4):763-72. [QxMD MEDLINE Link]. [Full Text].
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Levine RA, Triulzi MO, Harrigan P, Weyman AE. The relationship of mitral annular shape to the diagnosis of mitral valve prolapse. Circulation. 1987 Apr. 75(4):756-67. [QxMD MEDLINE Link].
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Tables
Qurat-ul-ain Jelani, MD Cardiologist, Northern Light Cardiology
Qurat-ul-ain Jelani, MD is a member of the following medical societies: American Physician Scientists Association
Disclosure: Nothing to disclose.
Adam E Schussheim, MD Cardiac Specialists, PC
Adam E Schussheim, MD is a member of the following medical societies: American College of Cardiology, American Society of Echocardiography, American Society of Hypertension, American Society of Nuclear Cardiology
Disclosure: Nothing to disclose.
Bhavik V Thakkar, MD Medical Director, Internal Medicine Hospitalist, AppleCare Medical Group
Bhavik V Thakkar, MD is a member of the following medical societies: American College of Physicians-American Society of Internal Medicine, American Heart Association, American Medical Association, Minnesota Medical Association, American Stroke Association, Society for Vascular 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: Received salary from Medscape for employment. for: Medscape.
Richard A Lange, MD, MBA President, Texas Tech University Health Sciences Center, Dean, Paul L Foster School of Medicine
Richard A Lange, MD, MBA is a member of the following medical societies: Alpha Omega Alpha, American College of Cardiology, American Heart Association, Association of Subspecialty Professors
Disclosure: Nothing to disclose.
Justin D Pearlman, MD, ME, PhD, FACC, MA Chief, Division of Cardiology, Director of Cardiology Consultative Service, Director of Cardiology Clinic Service, Director of Cardiology Non-Invasive Laboratory, Chair of Institutional Review Board, University of California, Los Angeles, David Geffen School of Medicine
Justin D Pearlman, MD, ME, PhD, FACC, MA is a member of the following medical societies: American College of Cardiology, International Society for Magnetic Resonance in Medicine, American College of Physicians, American Federation for Medical Research, Radiological Society of North America
Disclosure: Nothing to disclose.
Alan D Forker, MD Professor of Medicine, University of Missouri at Kansas City School of Medicine; Director, Outpatient Lipid Diabetes Research, MidAmerica Heart Institute of St Luke's Hospital
Disclosure: Nothing to disclose.
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Sections Mitral Valve Prolapse
- Overview
- Presentation
- DDx
- Workup
- Treatment
- References
