Mitral valve prolapse: back to the basics

Article Abstract:

A brief review is presented of the causes of mitral valve prolapse, a condition in which the mitral valve (between the heart's left atrium and ventricle) flops up into the atrium when the ventricle contracts to pump blood to the body. This can be accompanied by a spurt of blood into the left atrium (regurgitation). Mitral valve prolapse can be either primary, that is, caused by structural abnormalities of the valve or its supporting structures, or secondary, associated with normal valve apparatus but reduced left ventricular volume (as sometimes occurs in anorexic patients). Mitral valve prolapse can be serious and can even lead to death due to arrhythmia (abnormal heart rhythm), infection (endocarditis), or heart failure. Patients' hearts should be evaluated for mitral valve prolapse during lying, sitting, standing, squatting, and when standing after squatting. This latter sequence of movements accentuates prolapse, if it is present. Echocardiography, a noninvasive test, can be carried out to aid in diagnosis. The American Heart Association recommends that patients with characteristic clicks and murmurs heard in the stethoscope take amoxicillin preventively. Patients with clicks only may also need preventive amoxicillin. Accurate diagnosis requires a good physical examination and cannot always be made using ultrasound criteria alone. One condition that is often described by patients with great consternation is ''pseudoprolapse'' of the mitral valve, a condition that exists as a result of overdiagnosis when physicians interpret echocardiograms of patients they have not even examined. Pediatricians should be extremely careful to diagnose mitral valve prolapse accurately, since it is potentially a serious disorder. It cannot be said to be present if the clinical findings of click and/or murmur are absent, regardless of the ultrasound findings. (Consumer Summary produced by Reliance Medical Information, Inc.)

Diagnosis, Physiological aspects, Mitral valve prolapse, editorial

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Clinical experience with fetal echocardiography

Article Abstract:

Fetal echocardiography is an ultrasound technique for examining the heart of a fetus. It can identify abnormal cardiac conditions such as congenital heart disease, structural anomalies, and cardiac dysrhythmia (abnormal heart beat). A four-year clinical study evaluated the accuracy of diagnosis, frequency of fetal heart defect, and the overall effects of the fetal echocardiogram on prenatal care and fetal outcome. The study demonstrated that fetal echocardiography can be a valuable diagnostic tool. Some patients were referred because of a family history of congenital heart disease (CHD); three percent of these cases showed abnormalities on the echocardiogram. Five percent of the patients referred because of a history of diabetes mellitus had abnormalities. The highest rate of abnormalities, 31 percent, was detected in patients referred for dysrhythmia, which was followed closely by patients suspected to have CHD (29 percent). The most serious condition detected was sustained fetal bradycardia (abnormally slowed heart rate). Five of the nine infants diagnosed with this condition died in utero (in the uterus) or soon after birth. When patients are referred for suspected major fetal defects, fetal echocardiography should be conducted in conjunction with amniocentesis or fetal blood sampling. It is estimated that 32 percent of fetuses with CHD may have associated chromosomal abnormalities. (Consumer Summary produced by Reliance Medical Information, Inc.)

Methods, Fetus, Fetal heart rate monitoring, Electronic fetal monitoring, Echocardiography, Prenatal diagnosis

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The morbidity of cardiac nondisease revisited: is there lingering concern associated with an innocent murmur?

Article Abstract:

Parents may believe that a child's harmless heart murmur is cause for concern even after the child has been examined by a pediatric cardiologist. Parents of 71 school children were interviewed one to five years after their child was examined by a cardiologist. The interviews covered family history of heart disease, parents' recollection of the diagnosis and recommendations of the cardiologist and their level of satisfaction with the visit to the cardiologist. Parents were also asked if they were still concerned about the child's heart murmur. None of the parents restricted their child's activities, but 17% of the parents expressed continuing concern about the heart murmur. The parents who were least satisfied with the visit to the cardiologist reported concern most often. Primary-care physicians should follow up with parents of children they refer to pediatric cardiologists to dispel possible misunderstandings.

Psychological aspects, Health aspects, Parent and child, Parent-child relations, Heart murmurs

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