WBR0832

Author	Neeraja Danda M.B.B.S
Exam Type	USMLE Step 2 CK
Main Category	Internal medicine
Sub Category	Cardiovascular
Prompt	A 32-year-old female presents to the physician for concern over several “scary” episodes over the past two months. During these episodes she reports feeling her heart race, nausea, difficulty breathing and numbness throughout her body. Her pulse rate is 76/min, blood pressure is 110/70 mm hg and respiratory rate is 16/minute. Cardiac auscultation reveals a mid-systolic click with a murmur that decreases in intensity on hand grip. What is the best initial treatment for this patient’s symptoms?
Answer A	Valve repair surgery
Answer A Explanation	Incorrect Tightening of valve can be accomplished through valve repair but it is not the best initial treatment.
Answer B	Beta blockers
Answer B Explanation	Beta blockers are the preferred initial treatment in a symptomatic patient with mitral valve prolapse.
Answer C	Aspirin
Answer C Explanation	Incorrect Aspirin is the initial treatment of choice in myocardial infarction
Answer D	Warfarin
Answer D Explanation	Incorrect Warfarin is used for anticoagulation in patients after valve replacement. It is not the initial treatment in mitral valve prolapse
Answer E	No treatment needed.
Answer E Explanation	Incorrect When mitral valve prolapse is asymptomatic, treatment may not be necessary, but when symptomatic beta blockers are used
Right Answer	B
Explanation	The episodes described in the question are most likely associated with a panic attack. Panic attacks and palpitations accompanied by a mid-systolic click suggest mitral valve prolapse as the diagnosis in this patient. Mitral valve prolapse is mostly asymptomatic but sometimes presents with atypical chest pain, palpitations and panic attacks. Squatting and handgrip which increase left ventricular chamber size diminish the murmur of mitral valve prolapse. Conversely, valsalva maneuver or standing decrease venous return and thereby worsen the murmur. Beta blockers are the preferred initial treatment in a symptomatic patient with mitral valve prolapse. Educational Objective: Symptomatic mitral valve prolapse presents with panic attacks, palpitations and atypical chest pain. Beta blockers are the mainstay of initial treatment. References: Page 91, 92 Master the boards step 2 CK second edition. Educational Objective: References:
Approved	Yes
Keyword	Mitral valve prolapse, panic attack, Beta blockers
Linked Question
Order in Linked Questions