Mitral Valve Prolapse
Introduction
Mitral valve prolapse (MVP) is a disorder that affects one of your heart's valves — the mitral valve. It occurs when the valve doesn't close correctly, allowing backward leaking of blood in your heart.
Mitral valve prolapse affects slightly more than 2 percent of the adult population in the United States. Men and women appear to develop MVP in similar numbers.
In most people, MVP is harmless and doesn't require any changes in lifestyle. It also doesn't shorten your life expectancy. In some people with mitral valve prolapse, however, the progression of the disease requires treatment.
Signs and symptoms
Although mitral valve prolapse is a lifetime disorder, many people with this condition never have signs and symptoms. When diagnosed, people may be surprised to learn that they have a heart abnormality because of the absence of signs and symptoms.
When signs and symptoms do occur with mitral valve prolapse, they can vary widely from one person to another. They tend to be mild, develop gradually and may include:
- A racing or irregular heartbeat (arrhythmia)
- Dizziness, lightheadedness
- Difficulty breathing or shortness of breath, often when lying flat or after physical exertion
- Fatigue
- Chest pain that's not associated with a heart attack or coronary artery disease
Causes
When your heart is working properly, the mitral valve opens and closes to regulate the movement of blood between your heart's upper left chamber (left atrium, or holding chamber) and the lower left chamber (left ventricle, or pumping chamber). But in some people, their mitral valve malfunctions, bulging (prolapsing) like a parachute into their left atrium each time the heart pumps or contracts. The bulging may keep the valve from closing tightly. As a result, rather than all of the blood flowing normally in one direction, some blood may leak back into the atrium.
Another name for mitral valve prolapse is click-murmur syndrome. When a doctor listens to your heart using a stethoscope, he or she may hear a clicking sound as the valve's leaflets billow out, as well as a murmur resulting from blood flowing back into the atrium. Doctors also use other names to describe MVP, including:
- Barlow's syndrome
- Floppy valve syndrome
- Ballooning mitral valve syndrome
If you have mitral valve prolapse, the flaps of your mitral valve may be oversized or thickened. Women who develop MVP are often thin and have curvature of the spine (scoliosis) or minor skeletal abnormalities of the chest wall. Some also may have a hole in the walls separating the upper heart chambers, a condition called atrial septal defect.
Complications
Although most people with mitral valve prolapse never have problems, complications can occur. Complications tend to occur in middle-aged or older adults. They may include:
- Mitral valve regurgitation. The most common problem is mitral valve regurgitation (mitral insufficiency) — a condition in which the valve is particularly leaky and allows excessive blood back into the left atrium. If the regurgitation is severe, surgery may be recommended to repair or even replace the valve in order to prevent the development of complications, such as congestive heart failure. This regurgitation of blood also increases the likelihood of acquiring an infection called bacterial endocarditis, which can affect the mitral valve or the heart's lining. Because of the risk of developing bacterial endocarditis, antibiotics are given to people with mitral valve prolapse who have also been diagnosed with significant mitral valve regurgitation around the time of dental procedures and certain types of surgery.
- Rhythm problems. Irregular heart rhythms can occur in people with mitral valve prolapse. These most commonly occur in the upper chambers of the heart and while they may be bothersome, they are not usually life-threatening. Doctors have reported cases of sudden cardiac death associated with mitral valve prolapse; however, such fatalities are extremely rare and are not necessarily related to the valve problem. When fatalities do occur, these sudden deaths appear to result from an arrhythmia. People with severe mitral regurgitation, or severe deformity of their mitral valve, are most susceptible to serious rhythm problems.
Treatment
Most people with mitral valve prolapse, particularly people without any symptoms of mitral valve prolapse, don't require treatment.
If you develop symptoms, your doctor might prescribe certain medications to treat mitral valve prolapse-related chest pain or heart rhythm abnormalities. For example, doctors sometimes recommend drugs called beta blockers for irregular heartbeats, fast heartbeats or chest discomfort. Never stop taking these medications or change their dose without your doctor's approval.
Keeping others informed
Make sure your dentist or dental hygienist knows that you have mitral valve prolapse if you need to undergo dental work likely to cause gum bleeding, including routine cleaning. Also, tell your surgeon about your mitral valve prolapse before operations such as tonsillectomies, gallbladder surgery or prostate surgery. You may need to take a course of antibiotics before the treatment or surgery in order to reduce the risks of an infection. The prophylactic use of antibiotics destroys most of the bacteria that enter and travel through your bloodstream, thus preventing an infection of the heart valve. Amoxicillin is one of the most commonly prescribed medications for this use, but if you're allergic to the penicillin family of drugs, your doctor can choose other antibiotics instead, such as clindamycin, clarithromycin or azithromycin.
Precautions during pregnancy
If you're pregnant and have mitral valve prolapse, your chances of a successful, uncomplicated pregnancy are good. Even so, doctors sometimes recommend antibiotics during childbirth if there's a risk of an infection that could affect the mitral valve.
If you don't have MVP-associated signs or symptoms, and thus aren't receiving any treatment for this disorder, your doctor may still advise being rechecked every three to five years to monitor whether the condition has progressed to frank mitral regurgitation.
Prevention
You can't prevent mitral valve prolapse. However, you can lower your chances of developing the complications associated with it — particularly bacterial infections that may occur during surgery or dental treatments — by letting your doctor or dentist know that you have mitral valve prolapse. When appropriate, you'll receive prophylactic antibiotics before any procedures. If you develop any signs and symptoms of a bacterial infection — including fever, chills or headaches — or if you develop shortness of breath, contact your doctor.
Informations obtained from National Institute of Health.