Mitral valve prolapse

Background

• 1 or more mitral valve leaflets bow into left atrium during systole
• Most common valve disease in industrial countries (2.4% of pop.)
• Myxomatous degeneration from connective tissue disorder

Clinical Features

Symptoms

• Studies failed to demonstrate that chest pain, anxiety, or palpitations are associated with MVP
• Symptoms related to autonomic dysfunction: fatigue, anxiety, exercise intolerance
• If progresses to MR, CHF symptoms

Physical exam

• Mid-systolic click
• Late systolic murmur, crescendo into S2
  • Increasing preload decreases murmur while decreasing preload increases murmur
• May have associated physical features:
  • Pectus excavatum
  • Scoliosis
  • Low body weight
  • Marfanoid habitus

Differential Diagnosis

Valvular Emergencies

• Mitral stenosis
• Mitral regurgitation
  • Mitral valve prolapse
• Aortic stenosis
• Aortic regurgitation

Evaluation

Workup

• ECG can show nonspecific changes or arrhythmias
• CXR usually normal
• Echocardiography

Diagnosis

Transesophageal echocardiogram of mitral valve prolapse

• Echocardiogram is gold standard

Management

• Asymptomatic
  • None
• Symptoms of autonomic dysfunction
  • Beta-blocker
• Signs of progression to MR
  • Early surgical repair
• Neuro sequelae
  • Rule out a-fib/ left atrial thrombus, then aspirin daily
• Click / Murmur
  • Consider endocarditis

Complications

• Stroke
• Endocarditis
• Arrhythmia
• Mitral regurgitation

External Links

• Medscape - Mitral Valve Prolapse in Emergency Medicine