Mitral valve prolapse and Infective Endocarditis Prophylaxis - USMLE Forums
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  #1  
Old 04-23-2011
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Heart Mitral valve prolapse and Infective Endocarditis Prophylaxis

Is there an indication of Infective Endocarditis prophylaxis in Mitral Valve Prolapse :

a. with murmur
b. without murmur

Thanks.
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  #2  
Old 04-23-2011
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erm.... yes i think there is... but mostly prophylaxis is always reinstated when the patient is about to undergo a dental procedure....right?
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Old 04-23-2011
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yes i meant before any such procedure... I am not sure if prophylaxis is now required in MVP with murmur..there has been some change recently
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Old 04-23-2011
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The latest American Heart Association Guidelines for the prophylaxis of IE indicated there's no need to give IE prophylaxis in patients with MVP.

Here's a quote from the guideline
Quote:
the absolute incidence of endocarditis is extremely low for the entire population with MVP, and it is not usually associated with the grave outcome associated with the conditions identified in Table 3. Thus, IE prophylaxis is no longer recommended for this group of individuals.
The full text of the guidelines is available for free download on the web, here's the link http://circ.ahajournals.org/cgi/repr...AHA.106.183095

When MVP patients develop a murmur (other than the usual mid-systolic click) then it means it has progressed to Mitral Valve Regurgitation and in that case IE prophylaxis is recommended.

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Old 04-23-2011
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for step2 ck -

with murmur YES
without murmur NO
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Old 04-23-2011
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Default IE prophylaxis

Quote:
Originally Posted by drarnab View Post
for step2 ck -

with murmur YES
without murmur NO
Well according to Master the boards Step 2 CK / Step 3

THE ONLY CARDIAC DEFECTS THAT REQUIRE IE PROPHYLAXIS ARE
1. Prosthetic Valves
2. Unrepaired Cyanotic heart disease
3. Previous endocarditis
4. Transplant recipients that develop a valve disease

THE ONLY PROCEDURE THAT REQUIRE PROPHYLAXIS ARE
1. Dental procedures that cause bleeding .
2. Respiratory tract surgery
3. Surgery on infected skin

THE FOLLOWING PROCEDURES DO NOT REQUIRE PROPHYLAXIS
1. Dental fillings
2. All flexible Scopes
3. All GYN/OBS procedures
4. All Urinary procedures

THE FOLLOWING CARDIAC DEFECTS DON'T REQUIRE IE PROPHYLAXIS
1. AS/AR
2. MS/MR
3. Atrial or ventricular septal defect
4. Mitral Valve prolapse even with a murmur
5. Implantable pacemakers, defibs .

So the answer is no prophylaxis
Remember folks that this is a board favorite topic do clear your concept .
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i think i would rather go with the LATEST AHA guidelines. all other books or resources will eventually update themselves to the AHA guidelines.
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Old 04-23-2011
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no in both condition, no indication of prophylaxis in Mvp
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Old 04-25-2011
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what about GIT/ URINARY PROCEDURE

in kaplan note IM page 224 they said no need

but dr Fischer in video tabe said you need ampicillin ,if allergic vancomycin

but he said endoscopy no need for prophylaxis
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Old 04-25-2011
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Quote:
Originally Posted by kemoo1985 View Post
what about GIT/ URINARY PROCEDURE

in kaplan note IM page 224 they said no need

but dr Fischer in video tabe said you need ampicillin ,if allergic vancomycin

but he said endoscopy no need for prophylaxis
again i think just go with the AHA. murmur or no murmur there is no need for prophylaxis UNLESS the prolapse has now become mitral regurgitation.

as far as ive read on this forum for over a year ++, and from goljan's audio and kaplan videos, we are always reminded to take the latest information from journals and associations like the AHA etc to answer our questions.
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Old 05-11-2011
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Quote:
Originally Posted by Seetal View Post
again i think just go with the AHA. murmur or no murmur there is no need for prophylaxis UNLESS the prolapse has now become mitral regurgitation.

as far as ive read on this forum for over a year ++, and from goljan's audio and kaplan videos, we are always reminded to take the latest information from journals and associations like the AHA etc to answer our questions.
I have taken the above table from Master The Boards step 2 ck , dated November 2010 .
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Old 05-11-2011
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MVP with no murmur....no prophylaxis
MVP + murmur............must give prophylaxis
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Old 05-12-2011
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Default hmmm

even for obs dilatage and curretage procedure we don't need prophylaxis then?
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Old 11-08-2011
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Quote:
Originally Posted by Seetal View Post
i think i would rather go with the LATEST AHA guidelines. all other books or resources will eventually update themselves to the AHA guidelines.
But that is precisely the source! the latest AHA guidelines (from 2007) recommend no prophylaxis for MVP, and the other books (such as master the boards from 2010) have already updated themselves, that is why they recommend no prophylaxis.
For more detail follow the link in Sabio's post above it will take you to the AHA guidelines, or even read the paragraph he copied from the guidelines, it is pretty clear. Just don't pay attention to the last sentence in that post, which states what was the common practice until those guidelines were released in 2007.
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