Sourab



SYNOPSIS

Rajiv Gandhi University of Health Sciences, Karnataka,

Bangalore.

“CLINICAL SYMPTOMATOLOGY, ELECTROCARDIOGRAPHIC AND ECHOCARDIOGRAPHIC CHANGES IN MITRAL VALVE PROLAPSE -A CORRELATIVE STUDY”.

Name of the candidate : Dr. TUSHAR GOPALA KRISHNA

Guide : Dr. NARASIMHA HEGDE

Co-Guide : Dr. SAYYID M. KHILAR

Course and Subject : M.D (General Medicine)

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Department of General Medicine,

Father Muller Medical College,

Kankanady, Mangalore – 575002.

2013

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA, BANGALORE

ANNEXURE II

|1. |Name of the Candidate |DR TUSHAR GOPALAKRISHNA |

| |and Address |P G RESIDENT |

| | |FATHER MULLER MEDICAL COLLEGE |

| | |KANKANADY |

| | |MANGALORE |

|2. |Name of the Institution |FATHER MULLER MEDICAL COLLEGE |

| | |KANKANADY |

| | |MANGALORE |

|3. |Course of study and subject |M D General Medicine |

|4. |Date of admission to course |27th May 2013 |

|5. |Title of the Topic |

| | |

| |“CLINICAL SYMPTOMATOLOGY,ELECTROCARDIOGRAPHIC AND ECHOCARDIOGRAPHIC CHANGES IN MITRAL VALVE PROLAPSE-A CORRELATIVE STUDY”. |

|6. |Brief resume of the work |

| |6.1 Need for the study |

| |Mitral valve prolapse (MVP) is generally understood to be the systolic displacement of an abnormally thickened, redundant mitral |

| |leaflet into the left atrium during systole. This valvular abnormality has been associated with mid-systolic clicks, late systolic |

| |murmurs, and serious complications such as bacterial endocarditis, severe mitral regurgitation, and sudden death.(1) |

| |Unfortunately, our understanding of the prevalence, complication rate, and associations of mitral valve prolapse has been clouded |

| |by the use of varying techniques, changing diagnostic criteria, and conclusions drawn from highly selected referral populations. |

| |Despite this confusion, an understanding of the prevalence of mitral valve prolapse and the identification of subgroups most |

| |susceptible to complications remain important because MVP is the most common cause of valve repair/replacement for isolated mitral |

| |regurgitation  and the thickened leaflets form a recognized substrate for bacterial endocarditis.(1) |

| |Therefore, this study aims to study the correlation between these three factors i.e. clinical symptomatology, electrocardiogram and|

| |echocardiography so as to aid in the early detection and treatment of mitral valve prolapse. |

| |6.2 Review of Literature : |

| |Studies on MVP (mitral valve prolapse) have shown that mitral valve prolapse syndrome is associated with Marfanoid features such as|

| |pectus excavatum, horizontal arm span more than height, arachnodactyly, high arched palate and hypermobile joints ,frequent mood |

| |changes and anxiety disorder.(2) (7) |

| |Diagnostic criteria(2) (3) (7) |

| |Clinically patients presenting with features of: Slender body habitus, thoracic cage deformity, Chest pain, dyspnoea, anxiety, |

| |palpitations, fatigue, migraines and irritable bowel syndrome. |

| |12 lead ECG with ST-T wave depression or T wave inversion in II,III and aVF. |

| |On two-dimensional echocardiography, systolic displacement of one or both mitral leaflets in the parasternal long-axis view, |

| |particularly when they coapt on the atrial side of the annular plane, indicates a high likelihood of MVP. Other echocardiographic |

| |features associated with MVP that were assessed included mitral annular calcification/thickening, papillary muscle tug or superior |

| |traction, and exaggerated posterior wall motion.  |

| | |

| |In a study done on the outcomes of mitral valve prolapse, Women had more leaflet thickening, less flail, less posterior prolapsed |

| |and less frequent severe regurgitation. Among patients with severe regurgitation, women have higher mortality and lower surgery |

| |rates than men.(3) |

| |Natural history of asymptomatic MVP in the community is widely heterogeneous and may be severe. Clinical and echocardiographic |

| |characteristics allow separation of the majority of patients with excellent prognosis from subsets of patients displaying during |

| |follow-up high morbidity or even excess mortality as direct a consequence of MVP(4) |

| |Studies have found that there was a trend towards lower BMI in subjects with MVP compared to those without and its prevalence is |

| |similar across ethnic groups.(5) |

| | |

| | |

| |Recent studies have shown that 2 D ECHO is the diagnostic test of choice for MVP, cardiac auscultation has a low sensitivity.MVP is|

| |an important cause of progressive severe mitral regurgitation requiring mitral valve surgery, particularly in older men.(6) |

| |Studies have shown that the presence of mitral regurgitation, severity of MVP and associated prolonged QTc interval is not |

| |associated with higher prevalence of arrhythmias compared to matched normal controls(8) |

| |6.3 Objective of the study: |

| |To assess the correlation of the clinical symptomatology, Electrocardiogram and Echocardiograph of patients diagnosed with Mitral |

| |valve prolapse in Father Muller Medical College Hospital. |

|7. |MATERIALS AND METHODS |

| |7.1 Source of data: |

| |The data will be collected from patients in Father Muller Medical College Hospital diagnosed with mitral valve prolapse from 1st |

| |November 2013 to 1st August 2014. |

| |7.2. Method of collection of data: |

| |STUDY DESIGN |

| |The study will be a correlative study of the patients in Father Muller Medical College diagnosed with mitral valve prolapse. |

| |The study will include a minimum of 30 patients selected using purposive sampling technique diagnosed with mitral valve |

| |prolapse.Diagnosis will be based on three criteria i.e. clinical symptomatology , electrocardiogram and echocardiography |

| |interpretations . All the values will be statistically compared to determine the correlation between these three parameters in |

| |predicting the diagnosis. |

| |Inclusion Criteria |

| |Age more than or equal to 18 years. |

| |Patients with mitral valve prolapse. |

| |Exclusion Criteria |

| |Patients with congestive cardiac failure |

| |Patients manifesting with valvular heart diseases like: |

| |Mitral stenosis |

| |Aortic stenosis |

| |Aortic regurgitation |

| |Tricuspid stenosis |

| |Tricuspid regurgitation |

| |Data Analysis: Data will be analyzed by frequency , percentage , mean, standard deviation and Chi-Square test. |

| |7.3 Does the study require any investigations or interventions to be conducted on patients or other humans or animals? |

| |YES |

| |The following investigations will be done |

| |ECG , 2 D ECHO |

| |7.4 Has ethical clearance been obtained from your institution in case of 7.3 |

| |Yes |

|8. |LIST OF REFERENCES: |

| |Sutton John St Martin,Weyman E.Mathur.Mitral valve prolapse prevalence and complications An ongoing dialogue:AHA journal |

| |circulation 2002;106:1305-07 |

| |Gokhale S G,Gokhale S,High prevalence of 'Mitral valve prolapse syndrome' (MVPS) amon older children and adolescents in a contained|

| |population:Int J cardiol 2013 April; |

| |Avierinos JE,Inamo J,Grigioni F,Shub C,Enriquez-Sarano M,Sex differences in the morphology and outcomes of mitral valve prolapsed:A|

| |cohort study:Ann Intern Med 2008 December 2;149(11):787-95 |

| |Avierinos JF,Gersh Bernard J,Melton Joseph L,Bailey Kent R,Shub Clarence,Nishimura Rick A,Tajik A Jamil,Maurice Sarano |

| |Enriquez.Natural history of asymptomatic mitral valve prolapse in the community:AHA journal circulation 2002;106:1355-61 |

| |Theal M,Sleik K,Yi Q,Yusuf s,Lonn E.Prevalence of mitral valve prolapsed in ethnic groups:Can J cardiol 2004 Apr;20(5):511-5 |

| |Griffin Brian,Hayek Emil.Mitral valve prolapse:old beliefs yield to new knowledge:Ccjm 2002 Nov;69(5):889-96 |

| |Kumar UK,Sahasranam KV.Mitral valve prolapsed syndrome and associated thoracic skeletal abnormalities:J Assoc Physicians India 1991|

| |Jul;39(7):536-9 |

| |Negi PC,Kaul U,Dev V,Bahl VK,Bajaj R.Arrhythmias and conduction defects in patients with mitral valve prolapse:a study based on |

| |ambulatory monitoring and electrophysiologic studies:J Assoc Physicians India 1992 Jun; 40(6):367-70 |

|9. |Signature of candidate | |

|10. |Remarks of the guide | |

|11. |Name and Designation of |DR. NARASIMHA HEGDE, MD |

| |11.1 Guide |PROFESSOR DEPARTMENT OF MEDICINE |

| | |FATHER MULLER MEDICAL COLLEGE |

| | |KANKANADY |

| | |MANGALORE |

| | | |

| |11.2 Signature | |

| |11.3 Co guide |DR SAYYID M,MD DNB |

| | |ASSOCIATE PROFESSOR |

| | |DEPARTMENT OF MEDICINE |

| | |FATHER MULLER MEDICAL COLLEGE |

| | |KANKANADY |

| | |MANGALORE |

| | | |

| |11.4 Signature | |

| |11.3 Head of Department |DR. VENKATESH B M , MD |

| | |PROFESSOR AND HOD OF MEDICINE |

| | |DEPARTMENT OF GENERAL MEDICINE |

| | |FATHER MULLER MEDICAL COLLEGE |

| | |KANKANADY, MANGALORE – 575002 |

| | | |

| |11.4 Signature | |

|12 |12.1 Remarks of chairman & principal | |

| | | |

| | | |

| | | |

| |12.2 Signature | |

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