Makindo Medical Notes.com

Related Subjects: |Mitral Regurgitation (Incompetence) |Mitral Stenosis |Mitral Stenosis vs Regurgitation |Mitral Valve prolapse |Atrial Fibrillation (AF) |Cardiac Valve replacement |Prosthetic Valves <

About

• Also called floppy mitral valve. Common that it has many associations.
• Whether these are just coincidental or not is hard to say
• Most patients however with mitral valve prolapse have a benign clinical course
• There does seem to be a risk of stroke and sudden cardiac death

Aetiology

• There is a suggestion of an autosomal dominant genetic component
• Myxomatous degeneration of the valve such as Marfan's syndrome where there is a defect in the fibrillin gene
• Patients with MVP have been found to have elevated urine and plasma catecholamine levels compared with controls

Clinical

• Classically a mid-systolic click followed by a mid to late systolic murmur. The "click-murmur" complex
• Association with atypical chest pain and palpitations with arrhythmias

Complications - some may just represent population levels

• Endocarditis - give antibiotics
• Sudden cardiac death - very rare
• Stroke is very rare
• Mitral regurgitation may develop
• AF and other arrhythmias - rare

Associations with MVP - Almost everything as it is common!

• Marfan's syndrome, Ehlers-Danlos syndrome
• Pseudoxanthoma elasticum, Osteogenesis imperfecta, Pectus excavatum
• False positive Exercise stress tests in females
• Acute rheumatic fever, Ischaemic heart disease
• Hypertrophic cardiomyopathy, Wolff-Parkinson-White syndrome
• Von Willebrand's disease, ASD and Ebstein anomaly

Investigations

• FBC, U&E, LFT, CRP if needed
• CXR - May be cardiomegaly in advanced severe cases
• ECG and 24 hr tape to look for Arrhythmias
• Echocardiography - early echo did not fully appreciate mitral valve anatomy and over-diagnosed MVP.

Management

• There is a relationship between endocarditis and antibiotic prophylaxis should be given where there is significant Mitral regurgitation but there is much debate about this.
• Some suggest prophylaxis where the click is followed by a murmur or where there is echo evidence of thickening of the valve leaflets or MR.
• Beta blockers may be indicated and Aspirin or even Warfarin if there is any evidence of embolic phenomena. Valve replacement if severe MR