Mitral valve prolapse

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at April 26, 2016
StartDiseasesMitral valve prolapse

Mitral valve prolapse or MVP is a common abnormality of the heart valve. It has a tendency to run in families although a specific gene has not been found. According to the American Heart Association, MVP affects 2 to 3 percent of the population. Mitral valve prolapse is also referred to as floppy valve syndrome, click-murmur syndrome, and Barlow syndrome.

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Definition & Facts

There are two valve flaps on the mitral valve, and when they do not close properly, it produces a condition called mitral valve prolapse, or MVP. The mitral valve lets blood flow from the upper to the lower chamber on the left side of the heart. When the valve is prolapsed, one of both of the flaps slide back into the left chamber or atrium. As a result, the valve cannot seal tightly, and allows blood to leak back into the atrium. Sometimes this causes regurgitation or back flow. Cases of MVP are usually mild and don't require treatment.

Symptoms & Complaints

Usually there are no symptoms, but it's possible to have some signs of MVP when the body is subjected to stress from life situations, illness, or pregnancy. Patients may complain of dizziness, weakness, shortness of breath, or have heart palpitations or chest pain. If untreated, MVP may become mitral valve regurgitation or MVR, with more severe symptoms.

If swollen legs, irregular heartbeat, or a recent weight gain or weight loss are experienced, it may mean the pumping power of the heart muscles have been affected. This represents another chronic condition called congestive heart failure. At this point the heart loses its ability to pump efficiently and allows fluid to build up around it. Valve replacement surgery is sometimes required, but only in the most severe cases.

Causes

Some people are born with the genetic predisposition for developing mitral valve prolapse, and it is commonly passed down through family members. Patients likely to get this disorder have had physical changes to the heart valve, such as abnormal thickening. Some medical disorders can also cause MVP, namely connective tissue diseases. One such disorder, Marfan syndrome, is hereditary and produces an abnormality in the body's connective tissue. About 75 percent of people who have this syndrome have MVP.

Rheumatic fever is sometimes associated with mitral valve prolapse. This is an inflammatory disease that causes pain and inflammation in the joints. Usually it follows an episode of streptococcal infection. Rheumatic fever can affect a number of valves of the heart, including the mitral valve. Damage is caused when small blood clots develop along the valve closure, eventually thickening it and causing scarring.

Diagnosis & Tests

A diagnosis of mitral valve prolapse is usually determined during a routine physical examination. The doctor detects it by listening to the heart with a stethoscope and listening for a specific heart sound when the valve closes. If a whooshing sound is also detected, it is a sign that blood is leaking into the left atrium. It is possible that the doctor won't detect a heart murmur at this time since abnormal heart sounds aren't always detectable. Other tests and procedures can then be ordered to facilitate a diagnosis. These may include:

  • Magnetic resonance imaging (MRI) produces comprehensive images of the heart and is used to get an exact view of the heart valves and muscle
  • Cardiac catheterization (angiogram) - used when heart valve surgery is indicated and to determine the severity of the condition
  • Echocardiogram- a common test for diagnosing MVP, it uses high-frequency sound waves to create an image of the mitral valve and the blood flowing through it
  • Electrocardiogram - records the electrical activity of the heart and shows both the rhythm and how fast the heart is beating
  • CT scan of the chest - will show disorders of the heart
  • Chest X-ray - looks for fluid in the lungs and determines if the heart is enlarged

Treatment & Therapy

Treatment for mitral valve prolapse is often not necessary. Even patients who have symptoms may not have enough blood backflow into the mitral valve to warrant treatment. Patients with no blood backflow problem but suffering from heart palpitations may be prescribed beta blockers. For issues with backflow, the doctor may recommend medications or cardiac surgery.

Medications the doctor may prescribe include digoxin to strengthen the contractions of the heart muscle; flecainide or procainamide to regulate heart rhythms; diuretics to eliminate any extra sodium and fluid in the body; vasodilators to lighten the workload on the heart; or blood thinners to avoid blood clots.

Surgery is a necessity only if blood is returning back to the atrium and the mitral valve shows a significant abnormality. The mitral valve will either be replaced or repaired. There are advantages to repairing the valve. The heart is less likely to be weakened and the risk of infections is lowered. If a replacement is necessary, either a mechanical or biological valve is used.

Mechanical valves do not need to be replaced, but require the patient to take blood thinning medicine for a lifetime. Biological valves are made from pig, cow or human tissue. They need to be replaced in about 10 years, but do not require the accompaniment of blood thinners. Whatever type of valve is used, mitral valve surgery reduces the risk of heart failure and improves symptoms.

Prevention & Prophylaxis

It is not possible to prevent MVP, but it is possible to keep it under control. Untreated mitral valve prolapse can lead to endocarditis, an infection that damages the heart valves. To prevent this, be sure to communicate with medical professionals that there is a diagnosis of valve disease.

Report any possible infections, fever, or sore throat to the doctor. Practice good oral hygiene daily by tooth brushing and flossing, visiting the dentist every six months, and ensuring that dentures fit properly. Most people with MVP are able to live their lives without medication or problems.