Heart Murmurs/Valvular Heart Disease*
- Most common causes of mitral/aortic valve disorders are congenital defects; other causes include rheumatic heart disease, connective tissue disorders, infection, sensile conditions
- Most common presenting symptoms: dyspnea, fatigue, decreased exercise tolerance
- Other: Cough, rales, paroxysmal nocturnal dyspnea or hemoptysis, hoarseness
- Physical exam - heart murmur +/- palpable thrill
- Diagnostic Studies
- EKG - not useful for specific diagnosis → shows chamber hypertrophy
- CXR
- Aortic → left sided atrial enlargement, ventricular hypertrophy
- Mitral → atrial enlargement only
- Echo (transesophageal) and cardiac cath → definitive
- Treatment
- Surgical repair or replacement of defective valve
- Good exercise tolerance → diuretics and vasodilators for pulmonary congestion and digoxin or BB for dysrhythmias
- Anticoagulant therapy for thromboemboli prophylaxis
- Antibiotics to prevent endocarditis and recurrent rheumatic fever
Mitral Valve Prolapse
Regurgitant flow across mitral valve
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Decreased left ventricular volume results in earlier prolapse and click heard earlier in systole, closer to S1
Increased left ventricular volume results in delayed prolapse, click heard later in systole
Thin females with minor chest wall deformities
Associated: Ehlers-Danlos, Marfan Syndrome, Mitral Regurgitation
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1. Mid-systolic click
2. Followed by a mid-to-late systolic murmur (mitral regurgitation)
3. Loud S2
“Click” is caused by prolapse of leaflets into left atrium and tensing of mitral valve apparatus
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1. Maneuvers that increase left ventricular end diastolic volume (preload)/worsen: seated/standing → squatting
2. Maneuvers causing delay in prolapse: handgrip, standing from seated position, valsalva
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Health Maintenance
1. Leads to mitral regurgitation
2. Predisposed to infective endocarditis
3. ADA no longer recommends prophylactic antibiotics for MVP
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