Mitral valve prolapse physical examination: Difference between revisions
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==Overview== | ==Overview== | ||
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== | ||
===Appearance=== | ===Appearance=== | ||
Skeletal deformities which may be found in patients with MVP are: | Skeletal deformities which may be found in patients with MVP are: | ||
* | *Narrow anteroposterior chest diameter | ||
*Scoliosis or kyphosis | *[[Scoliosis]] or [[kyphosis]] | ||
*Pectus excavatum | *[[Pectus excavatum]] | ||
*Hypermobility of the joints | *[[Hypermobility]] of the joints | ||
*Arm span greater than height | *Arm span greater than height | ||
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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}} | ||
| Line 29: | Line 29: | ||
* 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 | :* 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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Mitral valve prolapse Microchapters |
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Diagnosis |
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Treatment |
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Mitral valve prolapse physical examination On the Web |
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American Roentgen Ray Society Images of Mitral valve prolapse physical examination |
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Risk calculators and risk factors for Mitral valve prolapse physical examination |
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:
- Narrow anteroposterior chest diameter
- Scoliosis or kyphosis
- Pectus excavatum
- Hypermobility of the joints
- Arm span greater than height
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]
- 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.
{{#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]