John Barlow: mitral valve prolapse

Fragile X syndrome: A review of clinical management

The fragile X mental retardation 1 gene, which codes for the fragile X mental retardation 1 protein, usually has 5 to 40 CGG repeats in the 5' untranslated promoter. The full mutation is the almost always the cause of fragile X syndrome (FXS). The prevalence of FXS is about 1 in 4,000 to 1 in 7,000 in the general population although the prevalence varies in different regions of the world. FXS is the most common inherited cause of intellectual disability and autism. The understanding of the neurobiology of FXS has led to many targeted treatments, but none have cured this disorder. The treatment of the medical problems and associated behaviors remain the most useful intervention for children with FXS. In this review, we focus on the non-pharmacological and pharmacological management of medical and behavioral problems associated with FXS as well as current recommendations for follow-up and surveillance.

Supernumerary nipple as a cutaneous marker of mitral valve prolapse in Asian Indians

We studied 68 Asian Indians from South India with supernumerary nipple (SN) and 49 age- and sex- matched controls without SN for evidence of mitral valve prolapse (MVP) and associated features. We found that MVP and its forme fruste were more common in the SN group (odds ratio 6.0, 95% confidence intervals 2.16 to 16.63), indicating an association of SN with MVP.

Is mitral valve prolapse a manifestation of adolescent growth spurt?

The exact aetiology of mitral valve prolapse (MVP) is unknown, although this is the most common cardiac valvular abnormality currently detected. MVP has high incidence in young individuals, particularly during the second and third decades. These individuals are usually of a slender body habitus indicating higher rates of linear growth, reflective of the adolescent growth spurt. MVP might represent the imbalance in the growth dynamics of the mitral valve apparatus especially between the leaflets, chordae tendineae and the rest of the heart. Several reports suggest the transient nature of MVP and even complete disappearance. MVP with systolic click, but without a systolic murmur signifying regurgitation may be considered as a manifestation of adolescent growth spurt and a normal variant transiently occurring during particular periods of lives of otherwise normal individuals. Strategies of identification of subsets of individuals likely to harbor the more sinister and progressive form of MVP are important and need to be developed.

Managing recurrent nonischemic chest pain in the emergency department

Many patients who seek emergency evaluation for recurrent chest pain have had negative cardiac evaluations, sometimes including normal coronary angiograms. Despite reassurance, many of these patients return to emergency departments with complaints of chest pain. Studies have shown that one third to one half of these patients suffer from panic disorder characterized by attacks of intense fear accompanied by chest pain or discomfort, nausea, and shortness of breath. If panic disorder is identified, it can be successfully treated. This article explores the causes of recurrent nonischemic chest pain and offers treatment recommendations.