Mitral Valve Prolapse

1 What is Mitral Valve Prolapse?

Mitral valve prolapse (MVP) is a condition in which one or both the flaps of the mitral valve (the valve between your heart's left upper chamber and the left lower chamber)enlarge resulting in the incomplete closure of the valve. The flaps of the may bulge (prolapse) upward or back into the left upper chamber as the heart contracts. This leads to backward flow of blood into the left atrium, a condition called mitral valve regurgitation.

MVP is also called click -murmur syndrome because a clicking sound which is followed by a murmur is heard when the valve fails to close properly.

In most people, MVP does not cause complications, and does not require any treatment or lifestyle changes. Some people MVP, however, do require treatment.

2 Symptoms

Most of the time, mitral valve prolapse does not cause any symptoms, despite of it being a lifelong disorder. When this condition is discovered, it might be surprising for some people to be aware of their heart condition.

If signs and symptoms occur, it may be due to the blood flowing backward through the valve (regurgitation). Mitral valve prolapse symptoms differ from one person to another. They develop slowly and tend to be mild. Symptoms may include:

  • Palpitations or racing/skipped, irregular heartbeat (arrhythmia)
  • Feeling short of breath, particularly in the lying down position
  • Difficulty in breathing following a physical activity
  • Feeling dizzy or lightheaded
  • Intense fatigue
  • Sharp pain in the chest

When to see a Doctor?

If you believe that you have some of the above problems, make an appointment with your doctor. There are several other conditions with symptoms similar to that of mitral valve prolapse, therefore only your doctor may be able to evaluate the cause of your symptoms. If you have an intense chest pain, and you suspect it to be a heart attack, seek immediate medical care.

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3 Causes

The cause of mitral valve prolapse is obscure, but most people with this condition have it since their birth. MVP may be inherited from your parents, meaning, it runs in families.

It occurs commonly in people with congenital connective tissue disorders such as Marfan syndrome. In some people with MVP, the mitral valve may function abnormally in the following ways:

  • One or both flaps of the mitral valve may be thick and very large
  • Flaps of the valve may flop or bulge back into the atrium
  • The valve opening may stretch

These problems prevent the complete closure of the valve, and when the blood regurgitates back into the atrium, it is called mitral regurgitation. This may not cause a problem if the amount of blood that leaks is very less.

Other names to describe mitral valve prolapse include:

  • Barlow's syndrome
  • Floppy valve syndrome
  • Balloon mitral valve
  • Billowing mitral valve
  • Myxomatous mitral valve
  • Prolapsing mitral valve syndrome

4 Making a Diagnosis

You can schedule an appointment with your doctor, if you think you have symptoms of mitral valve prolapse to receive a diagnosis. As these appointments could be brief, and there is often a lot to discuss, it is good to be prepared for your appointment. The following information may help you get ready for your appointment and know what to expect from your doctor.

What you can do?

  • Be aware of any pre-appointment restrictions. At the time you schedule the appointment, remember to ask if there is anything you need to do in advance.
  • Make a list of symptoms that you are experiencing, including those that seem unrelated to mitral valve prolapse.
  • Write down your key personal information, including a family history of heart disease, heart defects, genetic disorders, stroke, high blood pressure or diabetes, and any major stresses or recent life changes.
  • Make a list of all current medications, vitamins or supplements.
  • Let a family member or a close friend accompany you, if possible. Sometimes, it becomes hard to remember all the information provided to you during the appointment. Therefore, the person who accompanies you may remember something that you missed or forgot.
  • Discuss your diet and exercise habits if you do not already follow a diet or exercise routine.

Write down questions to ask your doctor. Preparing a list of questions will help you make the most of your time together. For mitral valve prolapse, some basic questions to ask your doctor include:

  • What is the likely cause of my symptoms?
  • What kind of diagnostic tests will I need?
  • What kind of treatment do I need?
  • Are there any alternatives to the primary approach?
  • I have other health conditions. How can I best manage them together?
  • Are there any restrictions to be followed?

What to expect from your doctor. Your doctor may ask you various questions such as:

  • When did you first begin experiencing your symptoms?
  • Do your symptoms appear occasionally or are they continuous?
  • What is the severity of your symptoms?
  • Does anything seem to improve or make your symptoms worse?

Your doctor will diagnose mitral valve prolapse during a physical examination. Your doctor uses a stethoscope to listen to your heartbeat. If you have mitral valve prolapse, your doctor may hear clicking sounds. Your doctor may also hear a heart murmur if there is backward flow of blood through your mitral valve (mitral valve regurgitation). The physical signs such as ankle edema, which is suggestive of ankle edema are checked during a physical examination. Other tests that are done to diagnose mitral valve prolapse may include:

  • Echocardiogram: An echocardiogram is a noninvasive ultrasound evaluation of your heart, which is done as a confirmatory test. High-frequency sound waves are used to create pictures of your heart and its structures, including the mitral valve, and the flow of blood through it. A transesophageal echocardiogram may be done in which your doctor inserts a flexible tube with a small device (transducer) attached to its end, into your throat and down into your esophagus. A transesophageal echocardiogram gives a clear, detailed ultrasound image of your heart and the mitral valve. This test may be used to examine the mitral valve before surgery. During an echocardiogram, a Doppler ultrasound may be done to assess the blood flow and measure the amount of blood leakage (regurgitation). This test helps doctors to determine the severity of your condition.
  • Chest X-ray: A chest X-ray reveals the picture of your heart, lungs and blood vessels, and can help your doctor to derive a diagnosis. It can show if your there is enlargement of heart.
  • Electrocardiogram (ECG): This is a simple, noninvasive test that can detect as well as record the heart’s electrical activity. A technician will place probes on your chest that can record the electrical impulses of your heart beat. An ECG is a record of these electrical signals that help your doctor to detect irregularities in your heart's rhythm and structure, including mitral valve prolapse. It can also detect an irregular heartbeat.
  • Stress test: Your doctor may order a stress test to check whether mitral valve regurgitation limits your ability to exercise. It can assess the severity of mitral valve disease. During this test, the patient is asked to exercise or take certain medications that increase heart rate so that his/her heart works hard and beats faster. At this time, various heart tests and imaging are performed.
  • Coronary angiogram and cardiac catheterization: A coronary angiogram and cardiac catheterization generally are not for the diagnosis of mitral valve prolapse. If other tests present inconsistent results about the severity of mitral valve regurgitation, a coronary angiogram and cardiac catheterization may be recommended to determine the severity of your condition. You may also have cardiac catheterization if your doctor decides that you will require a heart valve surgery. During cardiac catheterization, a long, flexible tube is inserted into a blood vessel in the arm, groin, or neck and passed to reach the heart under the X-ray guidance. Your doctor will perform diagnostic tests and imaging through this tube. Doctors then inject a special dye into the blood vessels of your heart to make them evident under X-ray imaging (coronary angiogram). These tests reveal how backflow occurs through the valve.

5 Treatment

Most people with mitral valve prolapse, especially those who are unsymptomatic, do not require any treatment. If you have mitral valve regurgitation without symptoms, your doctor may suggest regular follow-up examinations to monitor your condition.

However, if you have symptoms and a significant amount of blood gets leaked through the mitral valve, your doctor may advise medications or surgery, depending on the severity of your condition:

  • Medications: Your doctor will prescribe certain medications to treat mitral valve prolapse-related chest pain, heart rhythm abnormalities or other complications. Some medications that may be prescribed include:
  • Beta blockers: These drugs help prevent irregular heartbeats by slowing down your heartbeat, which reduces your blood pressure. Beta blockers cause relaxation of blood vessels to improve blood flow.
  • Diuretics: Your doctor may prescribe diuretics to drain the fluid in the tissues and bloodstream, and thereby decrease the workload of the heart.
  • Heart rhythm medications: Your doctor may prescribe medications such as flecainide (Tambocor), procainamide (Procanbid), sotalol (Betapace) or amiodarone (Cordarone, Pacerone) to control your heart rhythm, and to restore a normal pumping rhythm of your heart.
  • Aspirin: If you have mitral valve prolapse and a past history of stroke, your doctor may recommend aspirin to reduce the risk of blood clots.
  • Prescription anticoagulants (blood thinners): These medications include warfarin (Coumadin), heparin and dabigatran (Pradaxa). These can reduce your risk of developing blood clots as a result of poor circulation of the blood around the faulty heart valves. If you have atrial fibrillation and a past history of heart failure or stroke, your doctor may prescribe these drugs. They can have serious side effects, however, and therefore should be taken exactly as directed by your doctor.
  • Surgery: Although most people with mitral valve prolapse do not require surgical treatment, your doctor may recommend surgery if you have severe mitral valve regurgitation with or without symptoms. Severe form of mitral valve regurgitation can lead to heart failure, preventing your heart from effectively pumping blood. The surgical treatment for mitral valve prolapse may include repair or replacement of the mitral valve. Valve repair and replacement may be done through open-heart surgery or minimally invasive surgery. Minimally invasive surgery involves smaller incisions, and results in lesser blood loss and a faster recovery than open surgery.
  • Valve repair: Most people with mitral valve prolapse undergo this surgery in which their own valve is preserved and repaired. The mitral valve normally consists of two triangular-shaped flaps of tissue called leaflets. The leaflets of the mitral valve are connected to the heart muscle through a ring called the annulus. Your surgeon will modify the original valve through a procedure called valvuloplasty to prevent backward blood flow. Surgeons may also repair the valve by reconnecting valve leaflets or by removing excess valve tissue so as to allow the leaflets to close tightly. Sometimes, valve repair may be done by tightening or replacing the annulus. This procedure is called an annuloplasty.
  • Valve replacement: Your surgeon may perform a valve replacement in cases where valve repair is not possible. In valve replacement surgery, the damaged mitral valve is replaced by an artificial (prosthetic) valve. Artificial valves may be mechanical or biological (tissue) valves.
  • Mechanical valves: These are made up of materials such as plastic, metal, or carbon. These are stronger and last for a long time. As blood has a tendency to stick to these valves and form clots, patients with these valves are advised to take blood-thinning medications, such as warfarin (Coumadin) regularly. If a blood clot forms on the valve and breaks free, it could travel to your brain and cause a stroke.
  • Biological (Tissue) valves: These can be prepared from animal tissue such as a pig or cow valve (xenograft) or taken from the tissue of a donated human heart (allograft/homograft). These types of valves are called bioprosthesis. In some cases, the patient’s own tissues are used for valve replacement, which is called an autograft. Patients with their heart valves replaced with the biological valves need not take regular anticoagulants or blood-thinning medicines. These valves are not strong enough as mechanical valves, and should be replaced every 10 years.
  • Research in new methods: Research is ongoing on the newer techniques to repair or replace a valve using a tube (catheter) inserted in a blood vessel in your groin, which is then guided to your heart.
  • Antibiotics are seldom recommended: Earlier, doctors advised people with mitral valve prolapse to take prophylactic antibiotics before undergoing certain dental or medical procedures to prevent endocarditis. According to the American Heart Association, antibiotics are no longer necessary in most cases for people with mitral valve regurgitation or mitral valve prolapse. However, if you have been told to take antibiotics before undergoing any procedures in the past, please make sure whether that is still necessary.

6 Prevention

Mitral valve prolapse is a disorder that is not preventable.

Most people with MVP are born with the defect. However, you can lower your chances of developing the complications associated with it such as arrhythmias and infective endocarditis by taking your regular medications as directed by your physician.

7 Lifestyle and Coping

A majoity of people diagnosed with mitral valve prolapse lead a completely normal, productive, and symptom-free life.

Generally, there will not be any restrictions in your lifestyle or any limitations regarding your exercise or dietary program. However, discuss with your doctor if any changes to your lifestyle are required.

If you have a severe mitral valve regurgitation, your doctor may recommend you to avoid certain exercises that could worsen your condition, such as weightlifting.

Your doctor may advise regular follow-up visits in order to evaluate your condition.

8 Risks and Complications

There are several risks and complications associated with mitral valve prolapse.

Mitral valve prolapse may occur in any person, at any age. Serious symptoms of mitral valve prolapse most often occurs in men above 50 years of age.

Mitral valve prolapse tends to run in families, and may be associated with several other conditions, such as:

Although most people with mitral valve prolapse never have any symptoms, complications do occur. These include:

  • Mitral valve regurgitation: The most common complication in which there is leakage of blood back into the left atrium. Being male or high blood pressure level increases the risk of developing mitral valve regurgitation. If the regurgitation is very severe, surgery to repair or replace the mitral valve may be considered to prevent further complications such as stroke.
  • Heart rhythm problems (arrhythmias): Irregular heartbeat may occur in people with mitral valve prolapse. These most often occur in the upper chambers of the heart. This is not life-threatening. Serious rhythm problems that affect blood flow through the heart may occur in people with severe mitral valve regurgitation or severe deformity of their mitral valve.
  • Heart valve infection (infective endocarditis): The inner portion of your heart consists of four chambers and four valves that is lined by a thin membrane called the endocardium. Endocarditis is an infection of this inner lining. An abnormality in the mitral valve enhances your risk of developing an endocarditis from bacteria, which can further cause damage the mitral valve. The risk is greater in elderly men. Doctors used to recommend people with mitral valve prolapse to take a prophylactic dose of antibiotics before undergoing certain dental or medical procedures to prevent endocarditis, but not anymore. The American Heart Association has advised that antibiotics are no longer required in most cases with mitral valve regurgitation or mitral valve prolapse.
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