Idiopathic enlargement of the heart, 1895.
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Biomedical subjects
Publications and source records attributed to R D Greenwood.
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Mitral valve prolapse is extremely common in children. It is diagnosed by the presence of a nonejection click with or without an associated murmur. In isolated mitral valve prolapse, the prognosis is excellent, but regular office visits are necessary for cardiac status review and infective endocarditis prophylaxis. Patients with significant dysrhythmias represent a small subset with an unknown long-term prognosis.
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Mitral valve prolapse is the most common cardiovascular abnormality in children and is diagnosed by the presence of a nonejection click with or without an associated murmur. Abnormalities are infrequently seen on ECG, but when present they raise concern as to long-term prognosis. Children who have such abnormalities should undergo exercise testing and Holter monitoring. Patients who have dysrhythmia should be followed closely, even if they are asymptomatic, because they may be at risk for morbidity and death. Restrictions on physical activity are required only if it exacerbates chest pain or dysrhythmia.
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The physical examination requires careful palpation of pulses and measurement of blood pressure, evaluation of heart sounds (including detection of the third heart sound) and appreciation of clicks and murmurs. Combined with the chest x-ray and electrocardiographic findings, these steps usually lead to the most common diagnoses: innocent murmur; left-to-right shunt (atrial or ventricular septal defect, patent ductus arteriosus); obstructive lesion (pulmonic or aortic stenosis, coarctation of the aorta), and mitral valve prolapse.
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Infants with extracardiac anomalies or malformation syndromes frequently have associated cardiovascular malformations. Knowledge of these predictable patterns of associations allow rapid diagnosis and treatment of these infants.
Mitral valve prolapse is a common finding in the pediatric population. Five percent (154/3100) of pediatric patients had clinical evidence of mitral valve prolapse. A positive family history and minor abnormalities on electrocardiograms were frequent. The vast majority of patients were asymptomatic and exhibited a benign clinical course.
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