If a patient has mitral prolapse evident through auscultation and angiography but a normal resting echocardiogram, what should be done next?

In cases where a patient has mitral valve prolapse identified through auscultation and angiography, yet presents a normal resting echocardiogram, there can still be concerns about the nature and severity of the mitral valve prolapse that may not be apparent in a resting state. The prolapse may manifest more clearly when the hemodynamic status of the patient changes, such as during standing or increased activity.

Performing an echocardiogram in the standing position can elicit changes in the hemodynamics and volume status of the heart, potentially revealing dynamic changes in the mitral valve function that are not seen during rest. This position allows for better visualization and assessment of the mitral valve during activities that could provoke or exacerbate the prolapse.

This approach is valuable for determining whether the patient's condition genuinely warrants further clinical intervention or engineering a management plan based on dynamic observations. Understanding the behavior of the mitral valve in different positions can provide crucial insights into the patient's cardiovascular health and risk factors that may not be evident in a standard echocardiogram performed in a reclined position.