Living With Mitral Valve Prolapse
What is mitral valve prolapse? How concerned should you be if you are diagnosed with it? What is the treatment? Are you any more likely to develop cardiovascular disease if you have mitral valve prolapse?
There is no question about it: being diagnosed with a heart problem is frightening. But the vast majority of patients diagnosed with mitral valve prolapse (MVP) can rest assured that, while they might exhibit some bothersome symptoms (though most don't), those symptoms can usually be controlled with medication, diet, and exercise. Such patients are not likely to develop further complications, according to Sharonne Hayes, MD director of the Mayo Clinic Women's Heart Clinic. Dr. Hayes estimates that only about 5% of patients with MVP may require closer follow up because of increased risk of complications.
What Is MVP?
The mitral valve is one of the four valves of the heart. It separates the left atrium, or upper chamber, from the left ventricle (lower chamber) on the left side of the heart. The heart valves open and close, directing the flow of blood through the heart. The mitral valve opens, allowing blood to flow from the left atrium into the left ventricle, and then closes firmly when the left ventricle contracts, pushing blood out to the body. It is the opening and closing of this valve that produces the "lub-dub" heart sounds heard via the stethoscope.
In patients who have mitral valve prolapse, the mitral valve, instead of shutting firmly, "bends" back into the left atrium when the left ventricle contracts. This can result in a clicking sound. Often, when the mitral valve bends, a small amount of blood leaks backwards into the atrium, causing a murmur. MVP is suspected, says Dr. Hayes, when your health care provider hears a murmur and a click.
"Mitral valve prolapse may be associated with various degrees of leakage of the valve. Or, it may not leak at all," says Dr. Hayes. "In most cases, it leaks just a little."
Some patients may not experience any symptoms at all, and may find out they have mitral valve prolapse only when it's discovered by their health care provider during a routine physical examination. MVP is often diagnosed for the first time during a pregnancy, and may even go away after the delivery. The most common symptoms attributed to MVP include palpitations; lightheadedness when standing upright; rhythm disorders (a feeling that your heart is skipping a beat); or stabbing, intermittent, and non-exertional chest pains. Mitral valve prolapse affects more women than men, she adds, although men who have MVP are often at higher risk for complications.
MVP may be genetic, she says, but having a family history of coronary artery disease (heart attacks) does not make you any more likely to develop MVP, nor does MVP increase your risk of developing coronary artery disease, as the two are unrelated.
If You Have MVP
If your doctor detects a murmur, and especially if you are experiencing symptoms, says Hayes, it's reasonable to undergo an echocardiogram. An echocardiogram can determine whether mitral valve prolapse is present and whether there is any leakage occurring and, if so, how much. If there is significant leakage of blood through the valve, you may be at greater risk for endocarditis, an infection of the valve, she says, because leakage can allow bacteria to spend more time in the heart than usual. Previously physicians routinely recommended antibiotic prophylaxis. Meaning a prescribed antibiotic regimen was given before dental work or certain kinds of medical procedures. However the most recent guidelines from the American Heart Association in 2007 no longer recommend this for most patients with mitral valve prolapse. Your doctor can decide whether you require antibiotic prophylaxis or not.
As a tool, echocardiography is useful in confirming a diagnosis of MVP, in assessing the risk it poses to a particular patient, and in ruling out other causes of any symptoms a patient may be experiencing. Patients who exhibit significant leakage or arrhythmias requiring treatment, may need to be evaluated by a cardiologist. In very rare patients where the valve leak is severe, surgery may be considered.
Is an Echocardiogram Painful?
An echocardiogram is a safe, simple, and painless test that uses high frequency sound waves to produce a picture of a patient's heart. It can be performed in a doctor's office or in a hospital echocardiography (echo) lab.
The patient, gowned and lays on a padded table while a trained sonographer obtains pictures of the heart. Electrocardiogram leads are placed on the chest and gel is applied to the area of the chest where the transducer (a small, microphone-like device) will be placed A trained sonographer moves the tranducer over the chest to obtain different views of the heart. An echocardiogram can take anywhere from 20 minutes to an hour to perform.
Dr. Hayes notes that during the 1980's there was a "pretty major over-diagnosis" of MVP because of the rather vague criteria used by echocardiogram labs. Since then, the criteria for diagnosing mitral valve prolapse have been modified. She suggests that patients diagnosed with MVP during the 1980's be reassessed, particularly if they have had difficulty in obtaining insurance coverage due to their diagnosis.
MVP and Exercise
Although high-risk patients should avoid high-resistance exercise such as heavy weight lifting or powerlifting, Dr. Hayes says that both high- and low-risk people with MVP can benefit from aerobic exercise. In fact, most people who have MVP lead active lives without any restrictions.
In general, Dr. Hayes concludes, the vast majority of MVP patients are either asymptomatic or have controllable symptoms and are not likely to develop further complications. There is only a small subset of MVP patients, identified by examination and echocardiogram, who should be followed more closely because they have a greater likelihood of developing complications.
American Heart Association
National Society for Mitral Valve Prolapse & Dysautonomia
Canadian Cardiovascular Society
Heart and Stroke Foundation of Canada
Wilson et al. Prevention of Infective Endocarditit: Guidelines from the American Heart Association . Circulation 116(15):1736.
Last reviewed May 2008 by ]]>Craig Clark, DO, FACC, FAHA, FASE]]>
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