Presentation
[…] at any time and may present with varying severity of symptoms. [omicsonline.org]
She was presented to our hospital due to respiratory distress. On physical examination, an apical holosystolic murmur radiating to the axillary region was recognized. [ncbi.nlm.nih.gov]
An 86-year-old woman with a history of hypertension presented with acute onset of chest pain and evidence of shock (hypotension and tachycardia). [circ.ahajournals.org]
This latest revision presents updated clinical information and has eight new chapters, including obesity and metabolic syndrome, women and heart disease, and heart failure treatment. [books.google.com]
(Choice E) Spontaneous papillary muscle rupture usually presents in elderly people who have acute chest pain or as a complication of myocardial infarction. None of these are present here. bbbbbbb is rt ans Report Abuse [usmleforum.com]
Entire Body System
- Pain
Chest pain. Chest pain associated with Mitral Valve Prolapse is different from chest pain associated with coronary artery disease and is a frequent complaint. [hopkinsmedicine.org]
Pericarditis pain is distinguishable from infarct pain because of its pleuritic nature, radiation to the left trapezius ridge, and the associated low-grade fever and pericardial friction rub. [brown.edu]
Acute mitral regurgitation, particularly due to papillary muscle rupture, or ventricular septal rupture Recurrent ischemic chest pain, with signs of hemodynamic instabilit Contraindications to IABP placement: Significant aortic regurgitation Abdominal [errolozdalga.com]
He denies fever, chills, cough or abdominal pain. He has no other medical problems. He had surgery for bilateral inguinal hernia when he was 16. He does not use tobacco, alcohol or illicit drugs. [usmleforum.com]
An octogenarian male patient was admitted with chest pain and dyspnea, and diagnosed with rupture of the papillary muscle after sub-acute myocardial infarction. Urgent mitral valve replacement was performed. [library.dctabudhabi.ae]
- Congestive Heart Failure
The reduced left ventricular ejection fraction may lead to congestive heart failure and predispose to ventricular arrhythmias. [brown.edu]
Clinically: 64-year-old male patient, acute congestive heart failure with acute mitral-insufficiency caused by papillary muscle rupture. Source: © PathoPic [pictures.doccheck.com]
Complications congestive heart failure pulmonary hypertension mass-effect from left atrial enlargement (e.g. [radiopaedia.org]
In each case severe mitral regurgitation was suggested by the sudden appearance of a systolic murmur followed by progressive congestive heart failure. [nejm.org]
Tricuspid regurgitation (A) is another cause of a holosystolic murmur, however does not result from inferior infarction and does not commonly cause congestive heart failure. [healio.com]
Respiratoric
- Dyspnea
An octogenarian male patient was admitted with chest pain and dyspnea, and diagnosed with rupture of the papillary muscle after sub-acute myocardial infarction. Urgent mitral valve replacement was performed. [library.dctabudhabi.ae]
Pulmonary edema is manifested by shortness of breath, initially with exertion, but later at rest, orthopnea and nocturnal dyspnea attacks. [echopedia.org]
His history was positive for dyspnea on minimal exertion since the onset of symptoms; however there was no associated orthopnea or paroxysmal nocturnal dyspnea. His social history was negative for smoking, alcohol or illicit drug use. [revportcardiol.org]
A 70-year-old female patient presented with shortness of breath (SOB), progressive dyspnea and chest discomfort for two weeks. [medcraveonline.com]
Cardiovascular
- Heart Disease
This latest revision presents updated clinical information and has eight new chapters, including obesity and metabolic syndrome, women and heart disease, and heart failure treatment. [books.google.com]
Definition (NCI_FDA) The backward flow of blood from the left ventricle into the left atrium, owing to insufficiency of the mitral valve; it may be acute or chronic, usually due to mitral valve prolapse, rheumatic heart disease or a complication of cardiac [fpnotebook.com]
The primary form of Mitral Valve Prolapse is seen frequently in people with Marfan's Syndrome or other inherited connective tissue diseases, but is most often seen in people with no other form of heart disease. Secondary Mitral Valve Prolapse. [hopkinsmedicine.org]
- Tachycardia
Cardiovascular exam was pertinent for sinus tachycardia without a murmur. Pulmonary exam was notable for bibasilar crackles. [omicsonline.org]
Hemodynamics Major goals are relative tachycardia and reduced afterload. Slow heart rates (long diastole and thus regurgitation) and increases in afterload should be avoided. [openanesthesia.org]
Initial electrocardiogram showed sinus tachycardia and ST elevation in leads II, III, and aVF compatible with an inferior ST-elevation myocardial infarction. [ceemjournal.org]
An 86-year-old woman with a history of hypertension presented with acute onset of chest pain and evidence of shock (hypotension and tachycardia). [circ.ahajournals.org]
The initial EKG shows sinus tachycardia with occasional premature ventricular complexes. The chest x-ray reveals no cardiomegaly, but bilateral alveolar infiltrates and hilar prominence are present. [usmleforum.com]
- Chest Pain
Chest pain. Chest pain associated with Mitral Valve Prolapse is different from chest pain associated with coronary artery disease and is a frequent complaint. [hopkinsmedicine.org]
Acute mitral regurgitation, particularly due to papillary muscle rupture, or ventricular septal rupture Recurrent ischemic chest pain, with signs of hemodynamic instabilit Contraindications to IABP placement: Significant aortic regurgitation Abdominal [errolozdalga.com]
An octogenarian male patient was admitted with chest pain and dyspnea, and diagnosed with rupture of the papillary muscle after sub-acute myocardial infarction. Urgent mitral valve replacement was performed. [library.dctabudhabi.ae]
pain and dyspnoea for 6 hours. [ceemjournal.org]
Stenosis Causes of mitral valve stenosis Acquired Degeneracy Rheumatic fever Space occupying lesion Myxoma Congenital Parachute valve Cor triatriatum Effects of mitral valve stenosis: Chest pain, of breath when lying flat, with exertion and attacks during [echopedia.org]
- Systolic Murmur
A systolic murmur was noted and an urgent transoesophageal echocardiogram was performed (top, transgastric view; MV, mitral valve; LV, left ventricle; LA, left atrium). [heart.bmj.com]
On auscultation of the heart, an early, decrescendo, systolic murmur at the cardiac apex is heard; the murmur decreases with Valsalva maneuver, and increases with the grip maneuver, radiating to the axilla. [usmleforum.com]
In each case severe mitral regurgitation was suggested by the sudden appearance of a systolic murmur followed by progressive congestive heart failure. [nejm.org]
Diagnosis is made by detection of a new systolic ejection murmur, often associated with a precordial thrill. [brown.edu]
- Pansystolic Murmur
Examination revealed an apical pansystolic murmur and crepitations at both lung bases. [ceemjournal.org]
A typical grade 3/6 pansystolic murmur was heard at the apex with radiation to the axillae. [medcraveonline.com]
Auscultation reveals a pansystolic murmur at the apex. Acute MR due to papillary muscle rupture should be considered in patients presenting with acute pulmonary oedema or shock following an acute myocardial infarction. [patient.info]
Neurologic
- Stroke
The combination of the forward stroke volume and the regurgitant volume is known as the total stroke volume of the left ventricle. [wikidoc.org]
An easy-to-read approach covers everything from airway management and rhythms and their management to electrical therapy, acute coronary syndromes, and acute stroke. [books.google.com]
Regurgitant fractions less than 30% of total stroke volume are mildly symptomatic, 30–60% is moderate, and fractions greater than 60% cause severe disease. [openanesthesia.org]
Palpitations by atrial fibrillation, which can cause embolism, such as a stroke. Treatment The valve can be opened by balloon angioplasty or surgically treated by valve replacement. Click here for mitral stenosis quantification. [echopedia.org]
This causes the stroke volume to decrease and the cardiac output to decrease 1,2. This volume overload eventually causes a drop in forward cardiac output 1,2. [radiopaedia.org]
- Dizziness
For the person with symptoms of dizziness or fainting, maintaining adequate hydration (fluid volume in the blood vessels) with liberal salt and fluid intake is important. Support stockings may be beneficial. [hopkinsmedicine.org]
Workup
Diagnostic Workup Diagnostic Workup Figure 1. ECG Figure 2. CXR Day 1 FINDINGS: The lungs are adequately expanded without focal opacity. [hfsa.org]
X-Ray
- Kerley B Lines
Patients with acute mitral regurgitation are also likely to show x-ray signs of acute pulmonary edema with kerley-B lines, and peri-hilar infiltrates (the so-called "bat wing" appearance). Asymmetric pulmonary edema may be seen with eccentric jets. [clinicalpainadvisor.com]
Treatment
Surgical treatment within 48 hours after MI may increase mortality, but expeditious diagnosis and treatment is important to avoid heart failure and LCO. [thieme-connect.com]
guidelines, discoveries in your fields of interest; be notified You are informed about innovative treatments, techniques and innovations in medicine This video is limited to doctors and other health professionals. [medtube.net]
Immediate surgical intervention is considered the optimal and most rational treatment, despite high risks. [ctaegypt.org]
Valve repair is considered to be the preferred surgical treatment in patients with severe MR. [patient.info]
This latest revision presents updated clinical information and has eight new chapters, including obesity and metabolic syndrome, women and heart disease, and heart failure treatment. [books.google.com]
Prognosis
Prognosis [ 1 ] The best short-term and long-term results are obtained in asymptomatic patients operated on in specialist centres with low operative mortality (≤1%) and high repair rates (≥80-90%). [ 12 ] Acute MR is poorly tolerated and has a poor prognosis [patient.info]
By definition, patients in quadrant 4 are in "cardiogenic shock" and have a poor prognosis, unless they have a correctable mechanical complication, or unless they are early into the course of their MI, and some of the ischemic myocardium is recovered [brown.edu]
Current prognosis of ischemic mitral regurgitation. Implications for future management. Circulation. 1988; 78 (3 Pt 2)-9[ PubMed ] 5. Clements SD, Jr, Story WE, Hurst JW, Craver JM, Jones EL. [zjrms.com]
Whenever possible, valve repair is preferred to replacement, as it avoids long-term anticoagulation and, all other things being equal, affords a better long term prognosis. [openanesthesia.org]
What is the prognosis for Mitral Valve Prolapse? This condition is usually harmless and does not shorten life expectancy. Healthy lifestyle behaviors and regular exercise are encouraged. [hopkinsmedicine.org]
Etiology
What is the etiology? The most common etiology of acutely elevated right sided pressures is left sided failure. Of course pulmonary embolism is a relatively common cause as well. [hqmeded-ecg.blogspot.com]
Mitral regurgitation can be divided into acute and chronic forms, which have differing etiologies and imaging features 1,2. [radiopaedia.org]
Etiology is a major determinant of outcome in cardiac surgical patients. Medical and Surgical Treatment Medical treatment may include digoxin, diuretics, and/or vasodilators—including ACE inhibitors. [openanesthesia.org]
The most common etiology of LV pseudoaneurysm is AMI. (LV pseudoaneurysm is twice as common with inferior AMI as it is with anterior AMI.) LV pseudoaneurysms may also develop after surgical interventions, especially after mitral valve replacement. [emedicine.medscape.com]
Etiology not completely clear but looks like an iatrogenic lesion (good illustration) Myocardial Hemorrhage Following Mitral Valve Replacement: Gross, natural color, horizontal section of left ventricle showing a large area of mural hemorrhage extending [wikidoc.org]
Epidemiology
Epidemiology Trivial MR is frequent in healthy subjects. [patient.info]
Delling FN, Vasan RS (2014) Epidemiology and pathophysiology of mitral valve prolapse: new insights into disease progression, genetics and molecular basis. Circulation 129(21): 2158-2170. [medcraveonline.com]
Pathophysiology
The severity of complications depends on the larger involvement of the chordae. ( More ruptured chordae causes more severe complications ) To explain the pathophysiological mechanism, lets consider that the ruptured chordae are those of the mitral valve [hmphysiology.blogspot.com]
Delling FN, Vasan RS (2014) Epidemiology and pathophysiology of mitral valve prolapse: new insights into disease progression, genetics and molecular basis. Circulation 129(21): 2158-2170. [medcraveonline.com]
In a pathophysiological sense, acute mitral regurgitation is an emergency because of the normal compliance of the left atrium. In chronic mitral regurgitation the left atrium dilates to facilitate a higher volume. [clinicalpainadvisor.com]
Prevention
They attach to the cusps of the atrioventricular valves (also known as the mitral and tricuspid valves) via the chordae tendineae and contract to prevent inversion or prolapse of these valves on systole (or ventricular contraction). [1] The papillary [en.wikipedia.org]
Specific inhibitors and promoters of calcium action in the excitation-contraction coupling of heart muscle and their role in the prevention or production of myocardial lesions. In Calcium and the Heart, ed. [books.google.es]
Successful percutaneous coronary intervention with stenting of the RCA was performed ( Figure 1 ); the patient was admitted to the telemetry floor for close monitoring, and continued on intravenous normal saline to prevent contrast-induced nephropathy [revportcardiol.org]