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  • Barlow’s syndrome
  • Floppy mitral valve
  • Mitral-click murmur syndrome
  • Systolic-click murmur syndrome

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  • 424.0 Mitral valve disorders

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  • I34.1 Nonrheumatic mitral (valve) prolapse

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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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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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Signs and Symptoms

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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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Imaging2

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  • Echocardiography
    • Visualization of enlarged mitral leaflets
    • Displacement of leaflets into left atrium during systolic contraction
    • Mitral valve leaflets > 5mm, displacement > 2mm indicates classic MVP
  • Chest x-ray
    • Possible enlargement of left atrium or ventricle is concomitant mitral regurgitation (MR)
  • ECG
    • Results usually normal
    • Possible biphasic T waves
    • Possible signs of arrhythmias: fibrillation, tachycardia

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Diagnostic Procedures

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