Mitral valve prolapse physical examination: Difference between revisions

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==Overview==
==Overview==
Classic finding on cardiac exam is a late holosystolic murmur with a mid-systolic click. MVP patients tend to have a low [[body mass index]] (BMI) and are typically leaner than individuals without [[MVP]]. They may also have skeletal abnormalities possibly indicating the presence of a syndrome such as [[marfans syndrome]].
Classic finding on cardiac exam is a late holosystolic murmur with a mid-systolic click. MVP patients tend to have a low [[body mass index]] (BMI) and are typically leaner than individuals without [[MVP]]. They may also have skeletal abnormalities possibly indicating the presence of a syndrome such as [[marfan syndrome|marfans syndrome]].


==Physical Examination==
==Physical Examination==
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=====Heart Sounds=====
=====Heart Sounds=====
* A mid-to-late systolic click is present, followed by a late systolic [[heart sounds|murmur]] which is best heard at the cardiac apex.
* A mid-to-late systolic click is present, followed by a late systolic [[heart sounds|murmur]] which is best heard at the cardiac apex.
:* Click is early in systole, if patient is standing, sitting or [[valsalva maneuver]].<ref name="pmid2667419">{{cite journal| author=Devereux RB, Kramer-Fox R, Kligfield P| title=Mitral valve prolapse: causes, clinical manifestations, and management. | journal=Ann Intern Med | year= 1989 | volume= 111 | issue= 4 | pages= 305-17 | pmid=2667419 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2667419  }} </ref>
:* Click is early in [[systole]], if patient is standing, sitting or [[valsalva maneuver]].<ref name="pmid2667419">{{cite journal| author=Devereux RB, Kramer-Fox R, Kligfield P| title=Mitral valve prolapse: causes, clinical manifestations, and management. | journal=Ann Intern Med | year= 1989 | volume= 111 | issue= 4 | pages= 305-17 | pmid=2667419 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2667419  }} </ref>
:* Click is late in systole, if patient is squatting or leg raising.<ref name="pmid2667419">{{cite journal| author=Devereux RB, Kramer-Fox R, Kligfield P| title=Mitral valve prolapse: causes, clinical manifestations, and management. | journal=Ann Intern Med | year= 1989 | volume= 111 | issue= 4 | pages= 305-17 | pmid=2667419 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2667419  }} </ref>
:* Click is late in systole, if patient is squatting or leg raising.<ref name="pmid2667419">{{cite journal| author=Devereux RB, Kramer-Fox R, Kligfield P| title=Mitral valve prolapse: causes, clinical manifestations, and management. | journal=Ann Intern Med | year= 1989 | volume= 111 | issue= 4 | pages= 305-17 | pmid=2667419 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2667419  }} </ref>
* First heart sound, [[S1]] is normal as initial closure of mitral valve cusps is unimpeded.
* First heart sound, [[S1]] is normal as initial closure of [[mitral valve]] cusps is unimpeded.
* In presence of pulmonary hypertension, pulmonic component of second heart sound ([[P2]]) is loud.
* In presence of [[pulmonary hypertension]], pulmonic component of second heart sound ([[P2]]) is loud.
{{#ev:youtube|PsmGx2XMxF8}}
{{#ev:youtube|PsmGx2XMxF8}}


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* A holosystolic murmur may be present if severe prolapse occurs.
* A holosystolic murmur may be present if severe prolapse occurs.
* Best heard:
* Best heard:
:* Complete precordial area, if regurgitent blood is directed anteriorly.
:* Complete precordial area, if regurgitant blood is directed anteriorly.
:* Back and left axilla, if regurgitant blood is directed posteriorly.
:* Back and left axilla, if regurgitant blood is directed posteriorly.
* Murmur is prolonged, if patient is standing, sitting or [[valsalva maneuver]].<ref name="pmid2667419">{{cite journal| author=Devereux RB, Kramer-Fox R, Kligfield P| title=Mitral valve prolapse: causes, clinical manifestations, and management. | journal=Ann Intern Med | year= 1989 | volume= 111 | issue= 4 | pages= 305-17 | pmid=2667419 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2667419  }} </ref>
* Murmur is prolonged, if patient is standing, sitting or [[valsalva maneuver]].<ref name="pmid2667419">{{cite journal| author=Devereux RB, Kramer-Fox R, Kligfield P| title=Mitral valve prolapse: causes, clinical manifestations, and management. | journal=Ann Intern Med | year= 1989 | volume= 111 | issue= 4 | pages= 305-17 | pmid=2667419 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2667419  }} </ref>

Latest revision as of 19:29, 23 October 2012

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Classic finding on cardiac exam is a late holosystolic murmur with a mid-systolic click. MVP patients tend to have a low body mass index (BMI) and are typically leaner than individuals without MVP. They may also have skeletal abnormalities possibly indicating the presence of a syndrome such as marfans syndrome.

Physical Examination

Appearance

Skeletal deformities which may be found in patients with MVP are:

Heart

Auscultation

Heart Sounds
  • A mid-to-late systolic click is present, followed by a late systolic murmur which is best heard at the cardiac apex.
  • Click is early in systole, if patient is standing, sitting or valsalva maneuver.[1]
  • Click is late in systole, if patient is squatting or leg raising.[1]

{{#ev:youtube|PsmGx2XMxF8}}

Murmurs
  • Late systolic murmur is present early in the course of disease.
  • A holosystolic murmur may be present if severe prolapse occurs.
  • Best heard:
  • Complete precordial area, if regurgitant blood is directed anteriorly.
  • Back and left axilla, if regurgitant blood is directed posteriorly.
  • Murmur is prolonged, if patient is standing, sitting or valsalva maneuver.[1]
  • Murmur is shortened, if patient is squatting or leg raising.[1]

References

  1. 1.0 1.1 1.2 1.3 Devereux RB, Kramer-Fox R, Kligfield P (1989). "Mitral valve prolapse: causes, clinical manifestations, and management". Ann Intern Med. 111 (4): 305–17. PMID 2667419.


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