Adult Echocardiography Practice Exam

Mitral valve prolapse may be augmented by which action?

1. Having the patient lie very flat

2. Having the patient perform a Valsalva maneuver

3. Having the patient inhale

4. Injecting contrast into the venous system

The correct answer is: Having the patient perform a Valsalva maneuver

Mitral valve prolapse (MVP) is a condition characterized by improper closure of the mitral valve, which can lead to a backflow of blood from the left ventricle into the left atrium. The Valsalva maneuver, which involves a forced exhalation against a closed airway (like when you’re trying to breathe out with your mouth and nose closed), increases intrathoracic pressure and reduces venous return to the heart. This decreased preload can lead to an accentuated prolapse of the mitral valve leaflets due to reduced tension on the chordae tendineae. During the Valsalva maneuver, there may be a transient drop in left ventricular volume, which in some patients with MVP can cause more pronounced movement of the valve leaflets. This provocative maneuver is commonly used in clinical practice to augment the mitral valve prolapse and can be helpful for diagnosing the condition or assessing its severity. Other actions, such as having the patient lie very flat, inhaling, or injecting contrast into the venous system, do not lead to the same physiological changes in intrathoracic pressure or preload that would enhance the manifestation of mitral valve prolapse. Thus, the Valsalva maneuver is