doc_clotaire
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A slim, healthy 30-year-old woman is scheduled for a dental
prosthodontic procedure and was sent for medical evaluation of a known
history of mitral valve prolapse (MVP). The patient is a highly active
individual and denies palpitations, chest pain, or shortness of
breath. She admits to having a family history of heart disease,
notably her father, who had died of a heart attack in his forties, and
her mother, who had mitral valve prolapse. On physical examination,
the patient is comfortable and has normal vital signs. Auscultation of
the heart reveals a normal S1 and S2 and a prominent midsystolic
click, which is accentuated in the standing position. No systolic
murmur is appreciated. What is your overall assessment and plan for
this patient?
(A) Get an echocardiogram to evaluate mitral valve motion and blood
flow prior to clearing her for the procedure
(B) Prescribe empiric antibiotics for endocarditis prophylaxis and
clear her for the procedure
(C) Get a cardiology consultation prior to medical clearance because
the patient has a significant family history of heart disease
(D) Clear her for the procedure without endocarditis prophylaxis
(E) Clear her for the procedure with endocarditis prophylaxis
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| Justice
Just signed contract
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What is the difference between (B) and (E)?
I go with (B)
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| sprint123
Forum Guru
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I will go for D....Since for MVP-IE prophylaxis is not needed if regurgitation murmur is not present....
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| dr.wad
Forum Senior
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( D ) . MVP without murmur >>>> no end carditis prophylaxis
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| cookie909
Forum Newbie
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sprint is correct...no regurg so no need for prophylaxis...
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| docnikki
Forum Guru
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no prophylaxis needed.there is no murmur heard. MVP without a murmur doesnt qualify for prophylaxis.
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| nadiabarati
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promionent click or murmur is an indication for prophylaxis
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| nadiabarati
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sorry for my previous post. We don't need prophylaxis. Just in the case of murmur or thickened leaflets.
But you know I thought that prominent click means equal to thickened leaflets!!
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| nadiabarati
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Although if we choose A...so there is nothing wrong with our decision!
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| snowdrops
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d
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| doc_clotaire
Forum Guru
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Posts: 1,301
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Answer:
(D) Clear her for the procedure without endocarditis prophylaxis
Explanation:
Mitral valve prolapse (MVP) is a commonly diagnosed valvular disorder
affecting women more often than men in a 3:1 ratio. MVP is most
commonly diagnosed in people between the ages of 20 and 40. Most
people have no presenting symptoms. There is myxomatous degeneration
of the valve leaflets, resulting in a stretching of the leaflets and
chordae tendinae. Because of the disproportionate size of the left
ventricle and mitral valve, there is uneven closure of the valve
during each heartbeat and subsequent prolapse of the leaflets into the
left atrium. The prolapse is similar to the opening of a parachute.
The prolapse causes the classic mid-to-late systolic click. If there
is regurgitation of blood back into the atrium, an apical systolic
murmur can often be appreciated upon auscultation.
This patient is generally healthy and has a known history of MVP. On
examination, she is found to have the midsystolic click but no
systolic murmur. The lack of a murmur indicates that blood is not
being regurgitated into the atrium. In this setting, the patient does
not require antibiotics for endocarditis prophylaxis prior to the
dental procedure. Prophylaxis for patients with MVP is recommended if
a murmur is present or if evidence of nontrivial mitral regurgitation
is found on the echocardiogram. Because the patient has a known
history of MVP, she would not require a cardiology consultation or
echocardiogram to reconfirm the diagnosis. In fact, an echocardiogram
is not a required study to diagnose MVP because dynamic auscultation
can be more reliable. Furthermore, the fact that she has remained
symptom- and complaint-free would indicate that her condition is
stable, and so no study should be warranted at this time. Besides all
this, dental prosthodontic procedures do not need antibiotic
prophylaxis.
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