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Condition/Disorder Synonyms

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  • Barlow's syndrome

  • Floppy mitral valve

  • Mitral-click murmur syndrome

  • Systolic-click murmur syndrome

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ICD-9-CM Code

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  • 424.0 Mitral valve disorders

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ICD-10-CM Code

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  • I34.1 Nonrheumatic mitral (valve) prolapse

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Preferred Practice Pattern1

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Key Features

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Description

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  • Abnormally thickened mitral valve that becomes displaced into left atrium during systolic contraction

  • Classic and non-classic

    • Non-classic carries low risk of complications

    • Complications of classic MVP include mitral valve regurgitation, endocarditis, congestive heart failure, cardiac arrest

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Essentials of Diagnosis

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  • Stethoscope for auscultation systolic click in the mitral position, possible late systolic murmur

  • EKG/ECG 2

  • Echocardiography

  • Exercise stress test

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General Considerations

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  • Education on disease management reduces hospitalization

  • Patients with significant prolapse may show signs and symptoms of congestive heart failure

  • Strenuous activity should be limited for symptomatic mitral prolapse

  • Can lead to sudden cardiac death, arrhythmias, embolic events, and coronary disease

  • Patients can develop bacterial endocarditis

  • Mild to moderate prolapse generally does not cause symptoms

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Demographics

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  • Prevalent in 2% of thin female adoloscents5

  • Equal incidence of classic and non-classic

  • Equal incidence between genders and age groups

  • More common in patients with underlying genetic disease

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Clinical Findings

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Signs and Symptoms

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  • Murmur accentuated with standing, hand-grip maneuver, Valsalva maneuver, and diminished with squatting

  • Cardiovascular collapse or shock

  • Angina pectoris 3

  • Syncope 3

  • Congestive heart failure 3

  • Dyspnea on exertion

  • Shortness of breath 3

  • Anginal chest pain that increases with exercise

  • Orthopnea 3

  • Fatigue, weakness 3

  • Fainting, dizziness with activity

  • Palpitations

  • Palpable heaves/thrills over precordium

  • Arrhythmias, particularly atrial fibrillation

  • Endocarditis

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Functional Implications

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  • Symptoms depend on degree of valvular dysfunction

  • Severe mitral prolapse causes progressive shortness of breath and signs of congestive heart failure

  • Patients may be unaware of reduced cardiovascular capacity

  • MVP can cause syncope, chest pain, heart failure if severe

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Possible Contributing Causes

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  • Excessive connective tissue in valve leaflets

  • Ehler's-Danlos syndrome

  • Marfan syndrome

  • Polycystic kidney disease

  • Grave's disease

  • Pectus excavatum

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Differential Diagnosis

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  • Acute coronary syndrome

  • Aortic regurgitation

  • Aortic stenosis

  • Mitral valve regurgitation

  • Mitral stenosis

  • Myocardial infarction complication

  • Shock, hypovolemia

  • Cardiac pump dysfunction

    • Muscle dysfunction produces slight-to-moderate reduction in cardiac output (CO)

    • Mild-to-moderate activity limitation

    • Functional capacity of ⩽ 5 to 6 metabolic equivalents (METS)

  • Cardiac pump failure

    • Muscle dysfunction produces moderate-to-severe reduction in CO

    • Marked activity limitation

    • Functional capacity of ⩽ 4 to 5 METS

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Means of Confirmation or Diagnosis

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Imaging2

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  • Echocardiography

    • Visualization of enlarged mitral leaflets

    • Displacement of leaflets into left atrium during ...

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