HENRY SCHNEIDERMAN, M.D.
To the editor: Dr. Kaye's recent update on prophylaxis against infective endocarditis (1) is well considered and practical. One suggestion therein deserves further exploration: the possible limiting of prophylaxis to those patients with mitral valve prolapse having a holosystolic murmur. Presumably, this proposal assumes that only holosystolic murmurs indicate mitral regurgitation and thereby the predisposition to infection (2). However, the literatures on physical diagnosis and on mitral prolapse (3-5) argue that mitral regurgitation occurs even in patients and cycles having only a late systolic murmur. In these instances, the valve is competent early in systole but "leaks" at end systole.
SCHNEIDERMAN H. Antimicrobial Prophylaxis in Mitral Valve Prolapse. Ann Intern Med. ;105:142. doi: 10.7326/0003-4819-105-1-142_2
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Published: Ann Intern Med. 1986;105(1):142.
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