Living with mitral valve prolapse

by Tina Coleman

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?

Living With 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 (and many don't), those symptoms can usually be controlled with medication, diet, and exercise. Such patients are not likely to develop further complications, according to Dr. Sharonne Hayes, assistant professor of medicine and cardiovascular diseases at the Mayo Clinic. Hayes estimates that only about 5% of patients with MVP may be at risk for developing further complications and require closer follow up.

What is it?

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). 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 this opening and closing that produces the "lub-dub" heart sound 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 detected, says Hayes, when your health care provider hears a murmur, a click, or both.

"Mitral valve prolapse may be associated with various degrees of leakage of the valve. Or, it may not leak at all," says 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 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 there is any leakage occurring and, if so, how much. If there is significant leakage of blood through the valve, you're at greater risk for endocarditis, or infection of the valve, she says, because leakage can allow bacteria to spend more time in the heart than usual. To prevent infection, most physicians recommend antibiotic prophylaxis. This simply means that you will be given a prescribed antibiotic regimen to take any time you require dental work or minor surgery.

Patients diagnosed with MVP who are sensitive to antibiotics, or those who fear they may have difficulty obtaining health insurance coverage due to MVP may also want to request an echocardiogram. As a tool, an echocardiogram 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, says Hayes, should be assessed and monitored by a cardiologist. If the leak is significant, valve 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. "It's one of the most benign studies that a patient will ever have to undergo in a hospital," says Karen Eberman, chief tech and department manager at the Hospital of the University of Pennsylvania's echo lab.

The patient, gowned and laying on a padded table, may be given an injection of shaken, sterile salt water (to better define the size and function of the heart) through an intravenous catheter. Electrocardiogram monitoring may also take place during an echocardiogram. A gel is applied to the area of the chest where the transducer (a small, microphone-like device) will be placed. Different views of the heart are obtained by a technician moving the transducer over the chest. An echocardiogram can take anywhere from 20 minutes to an hour to perform.

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