Mitral Valve Prolapse in Emergency Medicine Differential Diagnoses

Updated: Aug 03, 2016
  • Author: Michael C Plewa, MD; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
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DDx

Diagnostic ConsiderationsImportant considerationsOther conditions to consider

Evidence of mitral valve prolapse (MVP) should not be a reason to terminate further diagnostic evaluation of patients with symptoms such as chest pain, palpitations, dyspnea, or syncope.

MVP does not predispose women to any increased risk during pregnancy.

Aviators with MVP may develop MR under positive-G force and may be at risk for dysrhythmia or syncope.

MVP should be considered in the differential diagnosis of patients with unexplained cerebral ischemia. [37]

Patients with MVP and a murmur should avoid high-intensity competitive sports if they have syncope associated with dysrhythmia, a family history of sudden death associated with MVP, significant supraventricular or ventricular dysrhythmias, or moderate-to-severe MR. Those who have had a previous embolic event also should avoid high-intensity competitive sports.

MVP is the third most common cause of sudden death in athletes, following congenital coronary artery anomalies and hypertrophic cardiomyopathy.

Other conditions to consider in patients with suspected mitral stenosis include the following:

  • 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

Differential Diagnoses