Mitral valve prolapse medical therapy: Difference between revisions

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Most patients only need reassurance. Those with mitral valve prolapse and symptoms of dysautonomia ([[palpitations]], [[chest pain]]) may often benefit from [[beta-blockers]] (e.g., [[propranolol]]). Patients with prior [[stroke]] and/or [[atrial fibrillation]] may require anticoagulation is, such as [[aspirin]] or [[warfarin]].
Most patients only need reassurance. Those with mitral valve prolapse and symptoms of dysautonomia ([[palpitations]], [[chest pain]]) may often benefit from [[beta-blockers]] (e.g., [[propranolol]]). Patients with prior [[stroke]] and/or [[atrial fibrillation]] may require anticoagulation is, such as [[aspirin]] or [[warfarin]].


==2008 ACC/AHA Guidelines for the Management of Patients with Valvular Heart Disease - Medical Therapy in Mitral Valve Prolapse<ref name="pmid18820172">{{cite journal |author=Bonow RO, Carabello BA, Chatterjee K, ''et al.'' |title=2008 Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons |journal=Circulation |volume=118 |issue=15 |pages=e523–661 |year=2008 |month=October |pmid=18820172 |doi=10.1161/CIRCULATIONAHA.108.190748 |url=}}</ref>==
==2008 and Incorporated 2006 ACC/AHA Guidelines for the Management of Patients with Valvular Heart Disease (DO NOT EDIT) <ref name="pmid18820172">{{cite journal |author=Bonow RO, Carabello BA, Chatterjee K, ''et al.'' |title=2008 Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons |journal=Circulation |volume=118 |issue=15 |pages=e523–661 |year=2008 |month=October |pmid=18820172 |doi=10.1161/CIRCULATIONAHA.108.190748 |url=}}</ref>==
 
===Medical Therapy (DO NOT EDIT) <ref name="pmid18820172">{{cite journal |author=Bonow RO, Carabello BA, Chatterjee K, ''et al.'' |title=2008 Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons |journal=Circulation |volume=118 |issue=15 |pages=e523–661 |year=2008 |month=October |pmid=18820172 |doi=10.1161/CIRCULATIONAHA.108.190748 |url=}}</ref>===


{|class="wikitable"
{|class="wikitable"
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| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|-
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' Aspirin therapy (75 to 325 mg per day) is recommended for symptomatic patients with [[MVP]] who experience [[cerebral transient                                          ischemic attack|cerebral transient                                          ischemic attacks]]. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level C]])<nowiki>"</nowiki>
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' Aspirin therapy (75 to 325 mg per day) is recommended for symptomatic patients with [[MVP]] who experience [[transient                                          ischemic attack|cerebral transient                                          ischemic attacks]]. ([[ACC AHA guidelines classification scheme#Level of Evidence|''Level of Evidence: C'']])<nowiki>"</nowiki>
|-
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' In patients with [[MVP]] and [[atrial fibrillation]], warfarin therapy is recommended for patients aged greater than 65 or those with                                          [[hypertension]], MR murmur, or a history of [[heart failure]]. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level C]])<nowiki>"</nowiki>
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' In patients with [[MVP]] and [[atrial fibrillation]], warfarin therapy is recommended for patients aged greater than 65 or those with                                          [[hypertension]], MR murmur, or a history of [[heart failure]]. ([[ACC AHA guidelines classification scheme#Level of Evidence|''Level of Evidence: C'']])<nowiki>"</nowiki>
|-
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''3.''' Aspirin therapy (75 to 325 mg per day) is recommended for patients with [[MVP]] and [[atrial fibrillation]] who are less than 65 years                                          old and have no history of [[MR]], [[hypertension]], or [[heart failure]]. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level C]])<nowiki>"</nowiki>
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''3.''' Aspirin therapy (75 to 325 mg per day) is recommended for patients with [[MVP]] and [[atrial fibrillation]] who are less than 65 years                                          old and have no history of [[MR]], [[hypertension]], or [[heart failure]]. ([[ACC AHA guidelines classification scheme#Level of Evidence|''Level of Evidence: C'']])<nowiki>"</nowiki>
|-
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''4.''' In patients with [[MVP]] and a history of [[stroke]], warfarin therapy is recommended for patients with [[MR]], [[atrial fibrillation]], or                                          left atrial thrombus. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level C]])<nowiki>"</nowiki>
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''4.''' In patients with [[MVP]] and a history of [[stroke]], warfarin therapy is recommended for patients with [[MR]], [[atrial fibrillation]], or                                          left atrial thrombus. ([[ACC AHA guidelines classification scheme#Level of Evidence|''Level of Evidence: C'']])<nowiki>"</nowiki>
|}
|}


{|class="wikitable"
{|class="wikitable"
|-
|-
| colspan="1" style="text-align:center; background:LightCoral"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
| colspan="1" style="text-align:center; background:LightCoral"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]]


|-
|-
| bgcolor="LightCoral"|<nowiki>"</nowiki>'''1.''' In patients with [[MVP]] and a history of [[stroke]] who do not have [[MR]], [[atrial fibrillation]], or left atrial thrombus, warfarin therapy                                          is reasonable for patients with echocardiographic evidence of thickening (5 mm or greater) and/or redundancy of the valve                                          leaflets. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level C]])<nowiki>"</nowiki>
| bgcolor="LightCoral"|<nowiki>"</nowiki>'''1.''' In patients with [[MVP]] and a history of [[stroke]] who do not have [[MR]], [[atrial fibrillation]], or left atrial thrombus, warfarin therapy                                          is reasonable for patients with echocardiographic evidence of thickening (5 mm or greater) and/or redundancy of the valve                                          leaflets. ([[ACC AHA guidelines classification scheme#Level of Evidence|''Level of Evidence: C'']])<nowiki>"</nowiki>
|-
|-
| bgcolor="LightCoral"|<nowiki>"</nowiki>'''2.''' In patients with [[MVP]] and a history of [[stroke]], aspirin therapy is reasonable for patients who do not have [[MR]], [[atrial fibrillation]],                                          left atrial thrombus, or echocardiographic evidence of thickening (5 mm or greater) or redundancy of the valve leaflets.  ([[ACC AHA guidelines classification scheme#Level of Evidence|Level C]])<nowiki>"</nowiki>
| bgcolor="LightCoral"|<nowiki>"</nowiki>'''2.''' In patients with [[MVP]] and a history of [[stroke]], aspirin therapy is reasonable for patients who do not have [[MR]], [[atrial fibrillation]],                                          left atrial thrombus, or echocardiographic evidence of thickening (5 mm or greater) or redundancy of the valve leaflets.  ([[ACC AHA guidelines classification scheme#Level of Evidence|''Level of Evidence: C'']])<nowiki>"</nowiki>
|-
|-
| bgcolor="LightCoral"|<nowiki>"</nowiki>'''3.''' Warfarin therapy is reasonable for patients with [[MVP]] with [[transient ischemic attacks]] despite aspirin therapy. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level C]])<nowiki>"</nowiki>
| bgcolor="LightCoral"|<nowiki>"</nowiki>'''3.''' Warfarin therapy is reasonable for patients with [[MVP]] with [[transient ischemic attacks]] despite aspirin therapy. ([[ACC AHA guidelines classification scheme#Level of Evidence|''Level of Evidence: C'']])<nowiki>"</nowiki>
|-
|-
| bgcolor="LightCoral"|<nowiki>"</nowiki>'''4.''' Aspirin therapy (75 to 325 mg per day) can be beneficial for patients with [[MVP]] and a history of [[stroke]] who have contraindications                                          to [[anticoagulants]]. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level B]])<nowiki>"</nowiki>
| bgcolor="LightCoral"|<nowiki>"</nowiki>'''4.''' Aspirin therapy (75 to 325 mg per day) can be beneficial for patients with [[MVP]] and a history of [[stroke]] who have contraindications                                          to [[anticoagulants]]. ([[ACC AHA guidelines classification scheme#Level of Evidence|''Level of Evidence: B'']])<nowiki>"</nowiki>
|}
|}


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|-
|-
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.'''  Aspirin therapy (75 to 325 mg per day) may be considered for patients in [[sinus rhythm]] with echocardiographic evidence of                                    high-risk [[MVP]]. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level C]])<nowiki>"</nowiki>
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.'''  Aspirin therapy (75 to 325 mg per day) may be considered for patients in [[sinus rhythm]] with echocardiographic evidence of                                    high-risk [[MVP]]. ([[ACC AHA guidelines classification scheme#Level of Evidence|''Level of Evidence: C'']])<nowiki>"</nowiki>
|}
|}


Latest revision as of 16:40, 8 November 2012

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

Overview

Medical Therapy

Most patients only need reassurance. Those with mitral valve prolapse and symptoms of dysautonomia (palpitations, chest pain) may often benefit from beta-blockers (e.g., propranolol). Patients with prior stroke and/or atrial fibrillation may require anticoagulation is, such as aspirin or warfarin.

2008 and Incorporated 2006 ACC/AHA Guidelines for the Management of Patients with Valvular Heart Disease (DO NOT EDIT) [1]

Medical Therapy (DO NOT EDIT) [1]

Class I
"1. Aspirin therapy (75 to 325 mg per day) is recommended for symptomatic patients with MVP who experience cerebral transient ischemic attacks. (Level of Evidence: C)"
"2. In patients with MVP and atrial fibrillation, warfarin therapy is recommended for patients aged greater than 65 or those with hypertension, MR murmur, or a history of heart failure. (Level of Evidence: C)"
"3. Aspirin therapy (75 to 325 mg per day) is recommended for patients with MVP and atrial fibrillation who are less than 65 years old and have no history of MR, hypertension, or heart failure. (Level of Evidence: C)"
"4. In patients with MVP and a history of stroke, warfarin therapy is recommended for patients with MR, atrial fibrillation, or left atrial thrombus. (Level of Evidence: C)"
Class III
"1. In patients with MVP and a history of stroke who do not have MR, atrial fibrillation, or left atrial thrombus, warfarin therapy is reasonable for patients with echocardiographic evidence of thickening (5 mm or greater) and/or redundancy of the valve leaflets. (Level of Evidence: C)"
"2. In patients with MVP and a history of stroke, aspirin therapy is reasonable for patients who do not have MR, atrial fibrillation, left atrial thrombus, or echocardiographic evidence of thickening (5 mm or greater) or redundancy of the valve leaflets. (Level of Evidence: C)"
"3. Warfarin therapy is reasonable for patients with MVP with transient ischemic attacks despite aspirin therapy. (Level of Evidence: C)"
"4. Aspirin therapy (75 to 325 mg per day) can be beneficial for patients with MVP and a history of stroke who have contraindications to anticoagulants. (Level of Evidence: B)"
Class IIb
"1. Aspirin therapy (75 to 325 mg per day) may be considered for patients in sinus rhythm with echocardiographic evidence of high-risk MVP. (Level of Evidence: C)"

Sources

  • 2008 ACC/AHA Guidelines incorporated into the 2006 guidelines for the management of patients with valvular heart disease [1]

References

  1. ↑ 1.0 1.1 1.2 Bonow RO, Carabello BA, Chatterjee K; et al. (2008). "2008 Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons". Circulation. 118 (15): e523–661. doi:10.1161/CIRCULATIONAHA.108.190748. PMID 18820172. Unknown parameter |month= ignored (help)

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