Mitral valve prolapse murmur ? - USMLE Forums
USMLE Forums Logo
USMLE Forums         Your Reliable USMLE Online Community     Members     Posts
Home
USMLE Articles
USMLE News
USMLE Polls
USMLE Books
USMLE Apps
Go Back   USMLE Forums > USMLE Step 1 Forum

USMLE Step 1 Forum USMLE Step 1 Discussion Forum: Let's talk about anything related to USMLE Step 1 exam


Reply
 
Thread Tools Search this Thread Display Modes
  #1  
Old 06-30-2013
USMLE Forums Addict
 
Steps History: Not yet
Posts: 192
Threads: 34
Thanked 39 Times in 33 Posts
Reputation: 49
Stethoscope Mitral valve prolapse murmur ?

Hey
I understand the timing of mid systolic click and the effect of increase/decrease preload on it, but what I dont understand is the effect of preload changes on mitral valve prolapse INTENSITY of murmur
why does an increase in perload cause an increase in mitral valve prolapse as written in FA errata of 2013 ?
thanks
Reply With Quote Quick reply to this message



  #2  
Old 06-30-2013
USMLE Forums Addict
 
Steps History: Not yet
Posts: 192
Threads: 34
Thanked 39 Times in 33 Posts
Reputation: 49
Default

and why is it the opposite for HOCM ??????
Reply With Quote Quick reply to this message
  #3  
Old 06-30-2013
USMLE Forums Guru
 
Steps History: 1 + CK
Posts: 454
Threads: 20
Thanked 338 Times in 160 Posts
Reputation: 358
Default

Quote:
Originally Posted by seliac View Post
and why is it the opposite for HOCM ??????
As far as i understand .... In mitral valve prolapse when the preload increases the LVEDV also increases thereby increasing both FSV AND RFV hence the increas in murmur intensity.... For HOCM notice that it is a dynamic obstruction which means that the more the preload the more the wider the outflow the less the obstruction.... Hope that helps... There is an article on dynamic changes on murmur on the internet so try to look that up
Reply With Quote Quick reply to this message
The above post was thanked by:
seliac (06-30-2013)
  #4  
Old 06-30-2013
MedicalExaminer's Avatar
USMLE Forums Master
 
Steps History: 1+CK+CS+3
Posts: 824
Threads: 66
Thanked 463 Times in 298 Posts
Reputation: 473
Default

Quote:
Originally Posted by seliac View Post
Hey
I understand the timing of mid systolic click and the effect of increase/decrease preload on it, but what I dont understand is the effect of preload changes on mitral valve prolapse INTENSITY of murmur
why does an increase in perload cause an increase in mitral valve prolapse as written in FA errata of 2013 ?
thanks
increase in preload decreases MVP murmur
__________________
Everything is possible for him who believes (MARK 9:23)
245/247/passed on 1st attempt/223/2mos Obsie /3 US LORS/visa not needed/2008 grad
Reply With Quote Quick reply to this message
  #5  
Old 06-30-2013
USMLE Forums Addict
 
Steps History: Not yet
Posts: 192
Threads: 34
Thanked 39 Times in 33 Posts
Reputation: 49
Default

Quote:
Originally Posted by MedicalExaminer View Post
increase in preload decreases MVP murmur
Well thats what is written in FA book , but in errata it is corrected and it is written that increase in preload increases MVP murmur
Reply With Quote Quick reply to this message
  #6  
Old 06-30-2013
USMLE Forums Addict
 
Steps History: Not yet
Posts: 192
Threads: 34
Thanked 39 Times in 33 Posts
Reputation: 49
Default

Quote:
Originally Posted by aman_j View Post
As far as i understand .... In mitral valve prolapse when the preload increases the LVEDV also increases thereby increasing both FSV AND RFV hence the increas in murmur intensity.... For HOCM notice that it is a dynamic obstruction which means that the more the preload the more the wider the outflow the less the obstruction.... Hope that helps... There is an article on dynamic changes on murmur on the internet so try to look that up
That makes since a little bit , thanks alot
Reply With Quote Quick reply to this message
  #7  
Old 06-30-2013
MedicalExaminer's Avatar
USMLE Forums Master
 
Steps History: 1+CK+CS+3
Posts: 824
Threads: 66
Thanked 463 Times in 298 Posts
Reputation: 473
Default

Mitral valve prolapse murmur ?-murmur.jpg

Thats from latest MTB2
__________________
Everything is possible for him who believes (MARK 9:23)
245/247/passed on 1st attempt/223/2mos Obsie /3 US LORS/visa not needed/2008 grad
Reply With Quote Quick reply to this message
  #8  
Old 06-30-2013
USMLE Forums Addict
 
Steps History: Not yet
Posts: 192
Threads: 34
Thanked 39 Times in 33 Posts
Reputation: 49
Default

i c ..thats now confusing , dunno y they have corrected it in errata
thanks alot my friend
Reply With Quote Quick reply to this message
  #9  
Old 06-30-2013
MedicalExaminer's Avatar
USMLE Forums Master
 
Steps History: 1+CK+CS+3
Posts: 824
Threads: 66
Thanked 463 Times in 298 Posts
Reputation: 473
Default

Quote:
Originally Posted by seliac View Post
i c ..thats now confusing , dunno y they have corrected it in errata
thanks alot my friend
U are welcome
__________________
Everything is possible for him who believes (MARK 9:23)
245/247/passed on 1st attempt/223/2mos Obsie /3 US LORS/visa not needed/2008 grad
Reply With Quote Quick reply to this message
  #10  
Old 06-30-2013
npktun's Avatar
USMLE Forums Veteran
 
Steps History: 1+CK+CS+3
Posts: 297
Threads: 23
Thanked 312 Times in 144 Posts
Reputation: 322
Default

in my opinion

In MVP there is displacement of an abnormally thickened mitral valve leaflet into the left atrium during systole

So Increased preload= increased LVEDV. Due to this, there's more work for the ventricles to perform and it takes longer to reach the critical pressure level to 'move' the leaflets into the atrium. So, the "click" and the murmur moves towards S2.

In MVR ....Increased preload = Increased LVEDV ... so as more blood sweeps back into the atrium so more the intensity of the murmur

I think FA has messed it up it should MVR not MVP ..... it can't be MVP ....

Also people should know MVP means simple prolapse of the leaflets ...it doesn't mean back leak of the blood ....Although severe MVP can progress to MVR and the pathophysiology changes here ....

Also prolonged squatting as compared to rapid squatting( increased preload) would increase intensity of MVP as it increases afterload . Since increasing afterload will prevent blood from flowing in a normal forward path, it will increase any murmurs that are due to backwards flowing blood . so increased intensity

Correct me if i am wrong
__________________
256/262/passed/237/2016/need Visa/ 3 months USCE/ 1 Pub

To view links or images in signatures your post count must be 10 or greater. You currently have 0 posts.

Last edited by npktun; 06-30-2013 at 11:04 AM.
Reply With Quote Quick reply to this message
The above post was thanked by:
MedicalExaminer (06-30-2013)
  #11  
Old 07-06-2013
npktun's Avatar
USMLE Forums Veteran
 
Steps History: 1+CK+CS+3
Posts: 297
Threads: 23
Thanked 312 Times in 144 Posts
Reputation: 322
Default

i may have messed up a little so i thing i was owed to correct it

Murmur intensity and click are different things .....

generally if we have a early click the intensity of the murmur is less

when compared to late systolic click during increased preload .... the murmur intensity increases even though the murmur has short duration

i found a table in emedicine that states what i said

__________________
256/262/passed/237/2016/need Visa/ 3 months USCE/ 1 Pub

To view links or images in signatures your post count must be 10 or greater. You currently have 0 posts.
Reply With Quote Quick reply to this message



Reply

Tags
Audio-, Cardiovascular-, Clinical-Signs

Quick Reply
Message:
Options

Register Now

In order to be able to post messages on the USMLE Forums forums, you must first register.
Please enter your desired user name, your email address and other required details in the form below.
User Name:
Password
Please enter a password for your user account. Note that passwords are case-sensitive.
Password:
Confirm Password:
Email Address
Please enter a valid email address for yourself.
Email Address:
Medical School
Choose "---" if you don't want to tell. AMG for US & Canadian medical schools. IMG for all other medical schools.
USMLE Steps History
What steps finished! Example: 1+CK+CS+3 = Passed Step 1, Step 2 CK, Step 2 CS, and Step 3.

Choose "---" if you don't want to tell.

Favorite USMLE Books
What USMLE books you really think are useful. Leave blank if you don't want to tell.
Location
Where you live. Leave blank if you don't want to tell.

Log-in

Human Verification

In order to verify that you are a human and not a spam bot, please enter the answer into the following box below based on the instructions contained in the graphic.



Thread Tools Search this Thread
Search this Thread:

Advanced Search
Display Modes


Similar Threads
Thread Thread Starter Forum Replies Last Post
mitral valve prolapse chienpolska USMLE Step 1 Forum 1 09-11-2011 10:25 PM
Mitral valve prolapse question aksyonez USMLE Step 2 CK Forum 4 07-01-2011 02:16 PM
Management of suspected mitral valve prolapse (MVP) Haisook USMLE Step 2 CK Forum 5 02-19-2011 12:58 PM
Mitral Valve Prolapse and Panic Attacks! Jeanne87 USMLE Step 2 CK Forum 1 06-09-2010 12:53 PM

RSS Feed
Find Us on Facebook
vBulletin Security provided by vBSecurity v2.2.2 (Pro) - vBulletin Mods & Addons Copyright © 2017 DragonByte Technologies Ltd.

USMLE® & other trade marks belong to their respective owners, read full disclaimer
USMLE Forums created under Creative Commons 3.0 License. (2009-2014)