workshop 12 iii-c6 matematico matias maulion medenilla medina, k. medina, s. mejino melgarejo...
DESCRIPTION
4 Years PTA Irregular palpitations heart beats associated with increased sweating and SOB Patient consulted and given Verapamil for which she took for only three days and would take it intermittently for palpitation Few Hours PTA Palpitation accompanied by SOBCONSULT AND ADMISSIONTRANSCRIPT
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MITRAL VAVLE PROLAPSE
WORKSHOP 12III-C6
Matematico Matias Maulion Medenilla Medina, K. Medina, S.
Mejino Melgarejo Mendoza, A
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CC: PALPITATION
• MM•23 years old•Female
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4 Years PTA •Irregular palpitations• heart beats associated with increased sweating and SOB•Patient consulted and given Verapamil for which she took for only three days and would take it intermittently for palpitation
Few Hours PTA •Palpitation accompanied by SOB
•CONSULT AND ADMISSION
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PHYSICAL EXAMINATION
• Conscious, coherent, ambulatory• BP: 110/70 CR 80/min regular RR 16/min• BMI 19• Symmetrical chest expansion, narrow A-P
diameter of the chest, no retractions, clear breath sounds
• Adynamic precordium, AB at 5th LICS MCL, no murmurs, (+) midsystolic click followed by 2/6 midsystolic cresecendo murmur noted at the apex
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REVIEW OF SYSTEMS
(-) dizziness (-) loss of consciousness (-) cough or colds (-) PND or Orthopnea
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LABORATORY AND ANCILLARY TEST 2D Echo-Doppler: MVP, anterior
mitral valve leaflet with moderate MR, slightly dilated LA with no evidence of thrombus
123L ECG: sinus rhythm, occasional premature atrial complexes
CXR: Normal
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1. WHAT ARE COMMON PHYSICAL EXAMINATOIN FINDINGS OF MVP?
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Physical examination Body weight is often low ; asthenic Blood pressure is usually normal or
low Orthostatic hypotension Resting bradycardia
Thoracic skeletal abnormalities suggesting MVP: Scoliosis, pectus excavatum, straightened
thoracic spine, and narrowed AP dm of the chestZippes, D., et al. (2005) Braunwald’s Heart Disease: A textbook of Cardiovascular Medicine, 7th ed. USA:
Elsevier Saunders
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Auscultation:▪ Nonejection systolic click at least 0.14 sec after
S1▪ Multiple mid and late systolic clicks along the L
lower sternal border▪ Mid to late crescendo systolic murmur that
continues to A2
Zippes, D., et al. (2005) Braunwald’s Heart Disease: A textbook of Cardiovascular Medicine, 7th ed. USA: Elsevier Saunders
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Dynamic Auscultation:End-diastolic LV volume
Critical LV volume is achieved earlier in systole
Click-murmur moves closer to S1
LV systolic volume/ afterload
Lengthens the time from onset of the systole to MVP
Click-murmur moves closer to S2
Zippes, D., et al. (2005) Braunwald’s Heart Disease: A textbook of Cardiovascular Medicine, 7th ed. USA: Elsevier Saunders
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Dynamic Auscultation:Response of the Murmur of MVP to Interventions
Intervention Timing Intensity Standing uprightRecumbent or 0Squatting or 0Hand grip +Valsalva +Amyl nitrite +
Fuster, V.,et al. (2008) . Hurst’s The Heart, 12the ed. China: McGrawHill Co.
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2. WHAT ARE THE COMMON AND UNCOMMON SYMPTOMS OF MVP?
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Symptoms
COMMON Easy fatigability Shortness of
breath Palpitation Chest pain Light-
headedness Syncope
UNCOMMON TIA Congestive
Heart Failure Endocarditis
in MR associated with MVP
Sudden death
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Symptoms associated with AUTONOMIC DYSFUNCTION are associated with GENETICALLY INHERITED
MVP: Anxiety Panic attacks Exercise
intolerance Palpitations (may
be a symptom of benign arrythmias)
Atypical chest pain
FatigueOrthostasisSyncope or
presyncopeNeuropsychiat
ric symptoms
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Symptoms
FatigueDyspneaExercise intoleranceOrthopneaParoxysmal nocturnal dyspnea
Related to progression of Mitral Regurgitation:
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3. WHAT ARE THE LONG TERM COMPLICATIONS OF MVP?
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Long term complications:Severe Mitral Regurgitation
over years or decades, due to chordal rupture and massive prolapse of both leaflets
rapidly, due to chordal or endocarditisArrythmias
most commonly ventricular premature contractions and paroxysmal supraventricular and ventricular tachycardia
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Long term complications:Transient cerebral ischemic
attacks secondary to emboli from the mitral
valve due to endothelial disruption have been reported,
Infective endocarditis may occur in patients with MR and/or
leaflet thickening
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4. WHAT POPULATION GROUP IS ASSOCIATED WITH AN INCREASED PREDILECTION FOR MVP?
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Greater frequency among those with Collagen (type 3) Disorders: Marfan’s Syndrome Osteogenesis Imperfecta Ehlers-Danlos Syndrome
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5. WHEN DO YOU GIVE PROPHYLACTIC TREATMENT IN MVP?
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THANK YOU!