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Query: UMLS:C0033377 (prolapse)
 11,717 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The effects of oral digoxin on symptoms, arrhythmias, exercise tolerance and echocardiographic function in primary mitral leaflet prolapse were studied in 23 patients using a double-blind crossover protocol. Digoxin reduced the incidence and severity of chest pain compared with both the control (P = 0.0002) and placebo (P = 0.0005) periods. We found a high (83%) incidence of predominantly minor arrhythmias on continuous ambulatory monitoring. Digoxin favourably affected the incidence of frequent supraventricular ectopic beats and supraventricular tachycardia but was associated with a significant number (P less than 0.0025) of asymptomatic bradyarrhythmias. In patients with frequent ventricular ectopics, digoxin had no consistent effect. No difference in exercise tolerance between treatment periods was found on maximal treadmill stress testing, but digoxin administration resulted in an increase in echocardiographic mean circumferential fibre shortening velocity (P less than 0.01) and fractional shortening percent (P less than 0.01). This study demonstrates the efficacy of oral digoxin therapy in ameliorating chest pain in patients with primary mitral leaflet prolapse and suggests a favourable effect on supraventricular arrhythmias in such patients.
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PMID:The effects of oral digoxin therapy in primary mitral leaflet prolapse. 636 77

One hundred and eighty-two patients (100 females, 82 males) with mitral valve prolapse (MVP) confirmed by echocardiography are described. Their ages range from 12 to 87 years (mean 48 years). The symptoms of breathlessness, pain in the chest and palpitations were analysed. They were associated with left ventricular failure, co-existing ischaemic heart disease and arrhythmias in some, but in a proportion the symptoms were thought to be due to psychoneurosis. Seventy-two patients (40 per cent) were referred because of complications of MVP. In 67 patients (37 per cent) the condition was discovered by chance and in 43 patients (24 per cent) neurotic symptoms had led to referral to hospital. A systolic click was heard in 117 patients (54 per cent); 41 patients (23 per cent) had a late systolic murmur and 30 patients (16 per cent) had a pansystolic murmur. The incidence of murmurs rose with increasing age, and pansystolic murmurs were more frequent in males. Thirty-two patients (18 per cent) had neither a click nor a murmur. Twenty-four patients (13 per cent) had associated supraventricular tachycardia and 22 (12 per cent) atrial fibrillation. Twelve patients (7 per cent) had severe mitral incompetence and eight (4 per cent) developed bacterial endocarditis. Only three patients had symptoms suggesting cerebral ischaemia. Twelve patients (7 per cent) had associated aortic incompetence. Twenty-two patients had had an inguinal hernia, the incidence in males over 50 being 26 per cent. Twenty-six patients (14 per cent) had non-specific T wave changes in the electrocardiogram. Echocardiography showed that 112 patients (62 per cent) had mid-systolic buckling of the posterior leaflet and 70 patients (38 per cent) had holosystolic prolapse. In view of the high incidence of complications it is felt that the long-term prognosis not as good as has been generally believed.
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PMID:Mitral valve prolapse: an assessment of clinical features, associated conditions and prognosis. 661 38

Diagnosis of ventricular arrhythmias is generally easy. The differentiation between ventricular tachycardia (VT) and supraventricular tachycardia (ST) with aberrant intraventricular conduction deserves some comments. Frequently the distinction can be made on the electrocardiogram alone. VT is characterized by: a) QRS wider than 0.14 sec., b) left axis deviation (a and b criteria are no longer reliable when a preexisting bundle branch block is present), c) mono or biphasic V1 configuration (biphasic rSR' in ST), d) multiformity, e) A-V ratio different from 1:1 in spontaneous conditions or during vagal or pharmacological (ATP, verapamil) stimulation, f) presence of fusion or capture beats. None of these criteria has an absolute diagnostic value. His bundle potential (H) recording confirms the diagnosis when bundle of His is activated during or after QRS complex or when H-V interval is shorter than during sinus rhythm. Special cases are discussed, particularly the diagnosis of rapid supraventricular arrhythmias with anterograde conduction through an anomalous pathway. Characteristics of "slow", "bidirectional" and "iterative" VT are reported. "iterative" VT are reported. Electrocardiographic aspects of "torsades de pointe" are obtained in relation to the presence or the absence of a QT interval prolongation (multiform VT). The torsade is the result of rapid variations in depolarizing wavefront direction due to a high degree of electrical heterogeneity of ventricular myocardium; it has a severe prognostic significance regardless of the QT interval duration. However a long QT interval, when present, is the mark of the pathophysiological mechanism of the arrhythmia and a major indicator for therapeutical decisions. Finally the malignant aspects of unsustained ventricular arrhythmias in different cardiac diseases (mitral prolapse, obstructive cardiomyopathy, ischemic cardiac disease) and in apparently normal subjects are taken into consideration. The concept that the prognostic significance of the arrhythmias is in a large part dependent upon the type and severity of the underlying cardiac disease is stressed. The risk related to R/T premature ventricular beats is confirmed.
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PMID:[Malignant ventricular hyperkinetic arrhythmias: diagnostic aspects]. 688 68

Prolapsed mitral valve prolapse (PMV) is classically associated with disorders of ventricular excitability whose significance is unclear. However, syncope can suggest the possibility of a serious ventricular arrhythmia. The objective of this study was to try to identify the mechanisms of dizziness and syncope associated with PMV. We report the results of programmed atrial and ventricular stimulation performed under baseline conditions and after administration of Isuprel in 56 patients with PMV: 27 patients had a history of presyncope or syncope (group I), 14 had spontaneous atrial or supraventricular tachycardias without dizziness or syncope (group II) and 15 were asymptomatic and investigated for VEBs or conduction disorders (group III). The following results were obtained: In group I, 6 patients experienced sustained inducible ventricular tachycardia (VT); an atrial tachycardia (atrial tachycardia and/or atrial fibrillation) (AT) was also induced in 5 of them. In another 19 patients, a supraventricular tachycardia (SVT) and/or AT was induced. A total of 24 atrial or junctional tachycardias were triggered in this group. In group II, AT and/or SVT were reproduced in 13 out of 14 cases (93%). In group III, AT was triggered in 3 patients (20%). SVT were induced by Isuprel while AT were triggered prior to administration of Isuprel, under baseline conditions, and 3 of them were reproduced during vagal manoeuvres. A ventricular arrhythmogenic effect was observed in two cases in group II while taking class I antiarrhythmics. In conclusion, spontaneous AT and SVT of PMV are easily inducible with a sensitivity of 93%, but are difficult to induce in asymptomatic subjects. The high incidence of TA and SVT in the case of unexplained presyncope in subjects without documented tachycardia therefore appears to be suggestive of a relationship between these presyncopes and AT or SVT. However, the search for VT should take precedence. SVT appear to be catecholaminergic while AT tend to be vagal.
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PMID:[Syncopes associated with mitral valve prolapse. Mechanisms]. 876 45