Mitral valve prolapse: is echocardiography yielding too little or too much to the practicing physician?
Article Abstract:
The upper atria and lower ventricular heart chambers are separated by valves which affect the flow of blood between them; on the left side of the heart the atrium, which receives freshly oxygenated blood from the pulmonary system, is separated from the ventricle, which pumps blood to the body by the mitral valve. A half century ago the presence of an additional sound heard during contraction of the ventricle was documented, and more than twenty-five years ago it was determined that this click originated in the mitral valve. This phenomenon, caused by a backward motion of the mitral valve leaflet, is diagnosed as mitral valve prolapse (MVP); the seriousness of MVP depends upon how severe the backflow or regurgitation of blood is from the left ventricle to the atrium. Physicians are now expected to be able to diagnose the presence and strength of a mitral valve click by listening to a patient's heart with a stethoscope. They are aided in diagnosis, prognosis and management of MVP by extensive research as well as by echocardiography (the use of ultrasound to graphically record the position and motion of internal structures of the heart). During the past twenty years ultrasonic technologies have progressed to the sophisticated two-dimensional (2-D), color Doppler, and computer-assisted equipment which make it possible to sufficiently assess the structure and function of the mitral valve without resorting to more invasive procedures. Clinical decisions for the small number of MVP patients who require surgical repair can be safely and reliably made by physicians and surgeons through use of 2-D echocardiography. Future MVP research will also utilize echocardiography.
Publication Name: American Journal of Medicine
Subject: Health care industry
ISSN: 0002-9343
Year: 1989
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Unsuspected mitral stenosis
Article Abstract:
Mitral stenosis is the narrowing of the heart valve that directs blood flow from the left atrium to the left ventricle. This abnormality may be detected by echocardiography, the use of sound waves to provide images of the heart. The records of 152 patients with mitral stenosis confirmed by echocardiography were reviewed to determine the clinical characteristics and course of patients with unsuspected mitral stenosis and factors that obscured the diagnosis. Mitral stenosis was not detected clinically in 18 patients until examination by echocardiography. These patients were elderly, averaging 72 years of age. Echocardiography was performed to evaluate congestive heart failure in eight patients; disease of the aortic valve (which directs blood flow between the left ventricle and aorta) in five patients; stroke and abnormal heart rhythms in the atria, in three patients. The pressures within the mitral valve of these patients ranged between 4 and 15 millimeters of mercury. The severity of mitral stenosis was moderate to severe in eight patients, and mild or trivial in seven patients. Surgery of the mitral valve improved congestive heart failure in two patients. Treatment with the drug warfarin, which prevents blood coagulation, was started in three patients to prevent the formation of blood clots. Thus, 5 of 18 patients required a major change in treatment after detection of mitral stenosis. These findings show that the diagnosis of mitral stenosis may be obscured by advanced age, other serious heart and medical disorders, or factors that interfere with physical examination. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: American Journal of Medicine
Subject: Health care industry
ISSN: 0002-9343
Year: 1991
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Major depression, panic disorder, and mitral valve prolapse in patients who complain of chest pain
Article Abstract:
There are many possible causes of chest pain, and many patients complaining of it do not have coronary artery disease (CAD). Persons with chest pain often have other medical or psychiatric disorders, such as: mitral valve prolapse, in which the valve that directs blood flow between the left atrium and left ventricle of the heart does not function properly; panic disorder (PD); or major depressive disorder (MDD). The degree of comorbidity, or extent to which mitral valve prolapse and PD or MDD occur together, was assessed in patients with chest pain found to be unrelated to CAD. Of 100 patients, 48 did not have CAD. The proportion of patients with MDD, PD or both was 42 percent among those without CAD versus only 19 percent of those with CAD. In addition, MDD or PD was detected in 80 percent of patients without CAD but with mitral valve prolapse. Thus, mitral valve prolapse is frequently associated with PD or MDD, and this relationship should be considered in the diagnosis and treatment of patients with chest pain unrelated to CAD. In addition, the relationship between mitral valve prolapse and MDD/PD may explain the complaints of these patients concerning symptoms. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: American Journal of Medicine
Subject: Health care industry
ISSN: 0002-9343
Year: 1990
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