Mitral valve prolapse

Mitral valve prolapse (MVP) is a cardiac issue that leads to a host of problems for sufferers and can even be life-threatening in some cases. Find out all about the disease, including its causes, symptoms, diagnosis and treatment options.

What is Mitral valve prolapse?

It is a cardiac problem that is characterized by an inability of the mitral valve to close properly. The mitral valve is situated between the left ventricle and left atrium. It divides the lower and upper chambers of the left section of the heart.

It is abbreviated as MVP.

Mitral valve prolapse History

The condition was described in 1966 for the first time by John Brereton Barlow. Due to this reason, it is also often referred to as Barlow’s Syndrome or simply as Barlow Syndrome. Subsequently, it was named by J. Michael Criley as Mitral Valve Prolapse.

Mitral valve prolapse Synonyms

The disorder is also referred to by various other names like:

Picture 1 – Mitral valve prolapse

• Barlow syndrome
• Floppy mitral valve
• Myxomatous mitral valve
• Billowing mitral valve
• Systolic click-murmur syndrome
• Prolapsing mitral leaflet syndrome

The name Click-murmur syndrome comes from the fact that doctors may hear a clicking sound while listening to the heart with a stethoscope. The clicking, which occurs as the leaflets of the valve billow out, is followed by a murmur that occurs due to backflow of blood into the atrium.

Mitral valve prolapse Incidence

The disease is said to affect around 2-3% of the population. It affects both males and females in equal measure. There is no sexual predilection in case of this condition.

Mitral valve prolapse Symptoms

Most patients with this condition are found to be asymptomatic. In other words, they do not exhibit any health issues. However, certain affected individuals display problems like:

• Fatigue
• Lightheadedness or dizziness
• Panic attacks
• Shortness of breath during work or even while lying flat (Orthopnea)
• Palpitations or irregular heart beat (Arrhythmia)
• Chest pain, not resulting due to a cardiac attack or coronary artery disease

The symptoms, when they occur, are usually the result of leaking of blood backward (regurgitation) through the valve. The problems may widely vary from one sufferer to another. The issues are usually mild in nature and gradually develop over a period of time.

If you suspect yourself to be suffering from any of the symptoms of the condition, get in touch with your physician on an immediate basis. As many other disorders give rise to symptoms similar to MVP, it is necessary to visit a professional healthcare provider and make sure that the symptoms are not indicative of any emergency medical problem, such as a heart attack. In case you have already been diagnosed with the condition, get in touch with your doctor before your health takes a turn for the worse.

What Happens in Mitral valve prolapse?

The mitral valve lets the blood in the left section of the heart flow in a single direction. When the heart contracts while beating, it closes to restrict the blood from moving backwards. When it is prolapsed, the valve fails to close properly. This gives rise to a host of health issues in sufferers.

In most cases, MVP does not affect the health of sufferers. Patients are not even aware of having an underlying health problem.

What Causes Mitral valve prolapse?

In people with this condition, the flaps of the mitral valve have extra tissue with prolapsed into the left atrium every time the heart contracts. This prolapsing may restrict the valve from closing tightly. When the blood flows backwards through the valve, the occurrence is known as Mitral Valve Regurgitation. This may not lead to any health issues if the amount of blood leaking back into the atrium is small. In case of a severer regurgitation, patients are likely to suffer from coughs, fatigue, shortness of breath, lightheadedness and other problems.

Mitral valve prolapse Risk Factors

MVP can affect individuals of any age group, although it is observed most frequently in men who are over 50 years old. Some forms of this condition are often found to affect generations of the same family. It may also be associated to rare genetic disorders or connective tissue ailments like:

• Adult polycystic kidney disease
• Marfan syndrome
• Scoliosis
• Ebstein’s anomaly
• Ehlers-Danlos syndrome

The disease is often seen to affect women who are of thin build and suffer from scoliosis, moderate deformities of chest wall or other similar conditions.

Mitral valve prolapse Diagnosis

The initial diagnosis of the condition involves a physical examination and listening to cardiac and lung sounds with the help of a stethoscope. Physicians try to hear a heart murmur (midsystolic click) and feel a vibration over the heart of sufferers. The click gets louder and longer as a patient stands up. A prolapsed valve is the cause of click sounds whereas leaking of blood backwards is the reason why heart murmurs can be heard.

The diagnostic tests for the disorder usually involve an Echocardiogram. Doctors may also use any of these tests to detect a leaky mitral valve:

• Chest X-ray
• ECG (which may help detect arrhythmias like Atrial fibrillation
• Cardiac MRI
• Cardiac catheterization
• Ct scan of the chest
• Electrocardiogram (ECG)

In some cases, physicians may also ask patients to undergo a stress test. Sufferers are generally asked to exercise over a treadmill under the watchful eyes of a doctor who observes whether MVP affects their ability to work out. Physicians also recommend this type of test if patients complain of chest pain. Physicians use this exam in an attempt to ascertain whether an affected individual is suffering from MVP or coronary artery disease.

MVP can be detected at any age. In case a patient is diagnosed with the disorder but is asymptomatic, he or she may be advised to undergo one or more of the abovementioned tests after every 3-5 years to let doctors monitor the health status. This, of course, actually depends on the seriousness of the condition.

Mitral valve prolapse Differential Diagnosis

The differential diagnosis of the disease should aim at separating its symptoms from those of:

• Atrial myxoma
• Bicuspid aortic stenosis
• Pericarditis
• Chordae or redundant leaflets, even in the absence of echocardiographic prolapse

Mitral valve prolapse Treatment

In most cases, patients of MVP do not exhibit any symptoms. Naturally, treatment is not required. In case of those exhibiting symptoms, physicians may recommend use of drugs or surgery – depending upon the severity of the disorder.

Picture 2 – Mitral valve prolapse Image

Medications

When cardiac problems like Mitral Regurgitation are present, a number of drugs may be prescribed. These include:

Aspirins

These may be recommended to prevent the risk of blood clots in patients having a family or medical history of strokes or suffering from MVP.

Blood thinners

Prescription coagulants, such as Warfarin (Coumadin), are commonly used to prevent the clotting of blood. These medicines are suggested in case of atrial fibrillation or a history of strokes or heart failure. However, such drugs can give rise to dangerous side-effects.

Beta blockers

These medicines make the heart beat at a slower pace and with greater force. This prevents irregular heartbeats and lowers blood pressure. These also improve the flow of blood by helping the blood vessels relax and open up.

Surgery

Most patients do not require surgical treatment. Operative cure is only suggested to individuals suffering from severe cases of Mitral Valve Regurgitation. Acute cases of regurgitation can eventually lead to heart failure and prevent the heart from pumping blood effectively. If regurgitation continues for too long, the heart may be too weak to undergo surgery.

Surgical treatment for MVP may involve either mitral valve repair or replacement. Both procedures require Open Heart Surgery and need significant time for recovery.

Mitral Valve Repair

It is used to preserve the valve of sufferers. This is the most preferred surgical treatment option for most MVP patients. The objective of the technique is to modify the original valve and eliminate the backward flow of blood. The valve can also be repaired by removing excess tissue from the valve or reconnecting valve leaflets to make the latter close tightly.

In some cases, valve repairing involves replacing or tightening the ring around the valve through Annuloplasty. This is important to make sure that the operation is carried out only by an experienced surgeon.

Mitral Valve Replacement

This is performed when surgeons find it impossible to repair the valve in any way. During this surgery, a prosthetic (artificial) valve is used to replace the damaged one.

There are two types of artificial valves:

Mechanical valves – These are long-lasting in nature. But in case these are used, a patient has to use an anticoagulant drug (such as Warfarin) for as long as he/she is alive to prevent the formation of blood clots on the valve. If a clot develops on the valve and gets isolated, it may reach the brain and lead to a stroke.

Tissue valves – These do not last as long and may wear out over time, to require replacement. These are made from the tissues of an animal, such as a pig. Such valves are also known as Bioprostheses. However, these are advantageous to be used in the sense that patients do not need to use anticoagulants on a long-term basis.

Mitral valve prolapse and Antibiotics

Earlier, those suffering problems in cardiac valve were administered with antibiotics prior to dental work or invasive techniques like Colonoscopy. Patients were provided with these medications to prevent the damaged heart from getting infected. These days, however, antibiotics are administered only in a few cases. MVP sufferers should consult their health care providers to know whether they require such medications. As per the American Heart Association, most patients of MVP or Mitral Regurgitation do not require antibiotics.

Mitral valve prolapse and Pregnancy

The condition does not generally complicate pregnancy. Pregnant women with MVP are likely to have a successful delivery without any complications. In any case however, doctors sometimes recommend use of antibiotics during childbirth. This is true in cases where there is a risk of infection that can damage the mitral valve in any way.

Mitral valve prolapse Prognosis

The condition usually has a good outcome. In most cases, the condition is harmless. In MVP patients, some cases of abnormal heartbeats may give rise to fatal consequences. In case of severe valve leakage, the prognosis may be similar to that of individuals suffering from mitral regurgitation due to any other factor.

Mitral valve prolapse Complications

Most people with MVP do not suffer from any health issues. However, there is risk of having complications – especially those in the middle-age group or higher. Such problems may include:

Arrhythmia

This refers to irregular heart rhythms that affect the upper cardiac chambers most frequently. While this is discomforting, the condition is not generally life-threatening. Those with severe mitral valve deformity or regurgitation are at higher risk of suffering from serious cardiac rhythm abnormalities which affect the flow of blood through the heart.

Mitral valve regurgitation

In this condition, there is leakage of blood into the left atrium from the valve. Obesity or high blood pressure increases the risk of regurgitation. In case of a severe regurgitation, surgical repairing or replacement of valve is needed to prevent the risk of complications such as heart failure.

This is the most common type of complication in MVP sufferers.

Endocarditis

It refers to infection of the inner lining of the heart valve known as the Endocardium that lines four valves and chambers. The risk of acquiring Endocarditis from bacteria increases due to abnormalities in the mitral valve. Endocarditis can lead to further damage of the mitral valve.

Mitral valve prolapse Prevention

The condition cannot actually be prevented. However, the risk of development of complications associated to MVP can be lowered by taking medications strictly as directed.

If you suspect yourself to be suffering from MVP, make a list of all the symptoms that you are having and contact a professional healthcare provider. Proper and timely diagnosis and treatment will help you avoid regurgitation and all other possible complications related to this disease.

References:

Mitral valve prolapse. Lancet. 2005 Feb 5-11;365(9458):507-18. [abstract]

Valvular and structural heart disease: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest. 2008 Jun;133(6 Suppl):593S-629S. [abstract]

American College of Cardiology/American Heart Association Task Force on Practice Guidelines