Management of suspected mitral valve prolapse (MVP) - USMLE Forums
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Old 02-18-2011
Haisook's Avatar
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Heart Management of suspected mitral valve prolapse (MVP)

I'm not sure about the management of MVP esp. as it's considered a benign phenomenon. So I thought I'd present my questions as clinical vignettes, as we all prefer this format. Anyone can help us with these?

CASE 1
A 26-year-old woman appears for a routine visit. Physical exam is unremarkable except for a midsystolic click at the apex. What's the most appropriate next step to be taken?

A) Chest X-ray
B) EKG
C) Echocardiography
D) Reassurance

CASE 2
A 26-year-old woman presents with left-sided chest pain that 'comes every now and then' and persists for 5-10 seconds. It's not related to effort. She also says she has anxiety. Physical exam is unremarkable except for a midsystolic click at the apex. What's the most appropriate next step to be taken?

A) Chest X-ray
B) EKG
C) Echocardiography
D) Reassurance
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Old 02-18-2011
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ll do echo to confirm

echocardiography is the most useful method of diagnosing a prolapsed mitral valve. Two- and three-dimensional echocardiography are particularly valuable as they allow visualization of the mitral leaflets relative to the mitral annulus. This allows measurement of the leaflet thickness and their displacement relative to the annulus. Thickening of the mitral leaflets >5 mm and leaflet displacement >2 mm indicates classic mitral valve prolapse
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  #3  
Old 02-18-2011
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Some argue that reassurance is enough.
What do you think about that?
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Old 02-19-2011
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since its a suspected case first thing would be to confirm the diagnosis and meanwhile give her something for her chest pain
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Old 02-19-2011
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I would go ahead with echo too! Good to know to decide if she needs of IE prophylaxis! Having said that, here in the UK, those with asymptomatic MVP no longer need prophylaxis.

I'm not sure of endocardition prophylaxis guidelines in US.
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Old 02-19-2011
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well, kaplan says reassurance is enough, so i'd go for it. doing an echo is not going to change management or the prognosis either, so why do it?
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