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Electrocardiographic findings in 125 patients with idiopathic prolapse of the mitral valve studied by angiography

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Abstract

A variety of pathologic conditions has been described as potentially capable of altering the complex structure of the mitral apparatus and causing prolapse of the mitral leaflets. Among them, ischemic heart disease with papillary muscle dysfunction, cardiomyopathies, rheumatic endocarditis, and myxomatous degeneration of the mitral leaflets have been postulated.1–3 One should expect the electrocardiograms of such a heterogenous group of patients to reflect changes due to myocarditis, hypertrophy, ischemia, and other conditions (Fig. 1) depending on the underlying disease. Eventually electrocardiographic changes would have occurred whether or not the mitral apparatus was involved. On the other hand, mid-systolic click or late systolic murmurs or both have been described associated with various pathologic conditions.1, 4–6 Furthermore, the electrocardiographic findings reported in the literature may vary according to the criteria employed for the selection of patients. Barlow et al4 included 90 patients with either a late systolic murmur, a nonejection click or both regardless of the underlying pathology; patients with rheumatic and ischemic heart disease and obstructive cardiomyopathy were also included. In only 28 of the 90 patients was prolapse of the mitral valve (PMV) proved by angiography, and in only two patients was the coronary circulation studied by selective angiography. Jeresaty’s series7 included 100 patients, 77 had a nonejection click or, in the absence of click, a PMV was proved by left ventriculography in 23 patients. Selective coronary arteriography was performed in 27 patients. Using different criteria than Barlow, Jeresaty7 excluded patients with isolated late systolic murmurs because of “non-specificity. . .


 

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