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Internal Medicine Flashcard
FRONT
A healthy female patient, 35 years of age, with h/o prolonged episodes of atypical, substernal chest pain (CAD excluded with stress testing) has the following on PE:
- Systolic click(s) near S1, audible after the carotid upstroke is visible (when standing)
- ± High-pitched, late systolic murmur, loudest at the apex, “whooping” in character, diminished with squat
What is the diagnosis?
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BACK
Answer
Mitral valve prolapse (MVP)
Explanation
MVP is associated with connective tissue disorders, such as Marfan’s, osteogenesis imperfecta, and Ehlers-Danlos. Typically, however, MVP is idiopathic. The finding that the systolic clicks move closer to S1 in times of decreased ventricular volume (e.g., standing) helps you differentiate these clicks from other systolic sounds, such as a split S2. Ejection clicks not associated with MVP generally occur very near to S1 and before the carotid upstroke. Most patients are asymptomatic throughout life, but some may present with endocarditis, severe MR after rupture of the chordae, or arrhythmias.
Dx: echo
Tx: β-blockers for the patient with frequent ventricular ectopy; MV repair is done for patients with symptomatic, severe MR.
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