Quote:
Originally Posted by Shrub
I'm an nursing student in my senior year, so please be gentle.
Taking into account the possible long QT and the host of other cardiac conditions. I'm thing about early stage of mitral valve prolapse.
Why?
Dyspnea
possible murmur heard
Lack of JVD
|
Glad to have you participate!
Absolutely reasonable to consider a valve problem in a patient with a murmur and acute cardiopulmonary decompensation. Acute valve problems are rare, but for that reason they are often under-considered. And I deliberately did not give a lot of details on the murmur
Mitral valve prolapse in isolation is most typically characterized by a mid-systolic click. It typically only has a true murmur if associated with mitral regurgitation. The of the most dangerous two sequelae of MVP are worsening MR and also a predisposition to arrhythmias. Dyspnea would most likely be caused by MR in MVP.
If we're thinking acute mitral regurgitation 2/2 mitral valve prolapse, that's less likely due to clear lung fields and lack of JVD... acute MR looks much like acute decompensated heart failure. But if we're thinking that my murmur was more of a click and specifically thinking MVP -> arrhythmia, its much more possible.
So we'll throw that on our differential too!
Differential:
Long QT (QTc = 652)
MVP -> Arrhythmia