M I T R A L V A L V E P R O L A P S E
What symptoms do patients with MVP experience?
Most patients with MVP are unaware of the condition. It is difficult to explain why some patients will develop symptoms at some point when we know the condition has been present for many, many years. Furthermore, the symptoms which occur in patients with MVP also occur commonly in the population without MVP as well. All of this, combined with the facts that it is difficult to treat symptoms if present and that the prognosis is so good leads to the potential friction in the patient-physician relationship. Often, the patient is viewed as "too worried" while the physician appears to "blow off" the patient's symptoms.
With this in mind, patients symptoms generally fall into the following broad categories:
Chest pain -- chest pain is very common in the population at large, and is most frequently due to causes other than pain from the heart. The pains associated with MVP often are short, sharp, or stabbing pains which occur predominantly at rest and occasionally with exercise. This is precisely the type of pain experienced by most people without MVP or cardiac disease. Some physicians feel that these types of pain with MVP might be secondary to stretching of the supporting structures (chordae & papillary muscles) with the prolapsing of the valve. These pains may be responsive to medications such as beta-blockers or certain calcium-blockers. [Also see section on chest pain].
Palpitations -- palpitations (awareness of the heart beating) is also very common in the population as a whole, as well as frequently seen in persons with MVP. This is very similar to the situation as described above for chest pain, and they may respond to exactly the same medications [Also see section on palpitations].
Fatigue may be present. This is certainly one of the very most common symptoms in our society as a whole, and is by far most frequently not associated with any medical problem. Due to its high frequency, fatigue is bound to be common with MVP as well. Recently, it has become apparent that some patients with MVP also have associated abnormalities of the autonomic nervous system as well (this is the portion of the nervous system that regulates various functions of our body over which we don't have conscious control). This "dysautonomia" appears to play a role in fatigue, lightheadedness, and the occasional patient with MVP and frequent headaches. It may respond to a high-salt diet or other measures to increase the blood volume done under the supervision of a physician.
Panic disorders, depression, and anxiety are also found commonly with MVP (and are common in the general population as well).
Can MVP be serious?
We have emphasized so far that MVP is usually a benign process. There are several important considerations, however.
- Progressive valve deterioration. In rare cases, there is progressive weakening of the valve structure, which can lead to severe leakage of blood backward through the valve into the left atrium. This leakage, termed mitral regurgitation, can cause the development of congestive heart failure.
Rarely (this is estimated to occur in about 1 in 10,000- 1 in 100,000 cases), there is the sudden rupture of one of the supporting structures of the valve (the chordae) which leads to the sudden development of leakage (acute mitral regurgitation). In both cases, the valve generally must be repaired or replaced.
- Infection of the heart valve. Endocarditis is infection of a structure on the inside of the heart, in this case referring to the mitral valve. This can occur because of mild abnormalities of the valve structure, allowing bacteria or other organisms to "set up shop" on the valve.Organisms can gain access to the blood stream at a variety of times, including normally when we chew or have a bowel movement for example. In these cases, the number of bacteria is small. However, larger numbers can gain access during certain dental procedures (such as cleaning) as well as some medical procedures. There is no clear evidence that all patients with MVP should receive preventative medications ("prophylactic antibiotics"), but most cardiologists advise at least some of their patients to take medications prior to some of these procedures.
- There are also some even rarer conditions in which MVP may be associated with sudden death. This exceedingly unusual association is not well understood since it happens so very rarely. Patients at risk for this often have distinctly abnormal electrocardiograms or other clues.
While I think it is only fair that people with MVP know of these serious possibilities, I also urge them not to dwell on them since they are so very unusual. Seek evaluation from a qualified physician to understand your case fully.
What is the treatment for MVP?
- There is really no treatment for the prolapsing mitral valve itself, only the symptoms or problems it produces. There is no way to cure the underlying laxity of the supporting structures.
- Most cardiologists in my experience feel that a good exercise program, a good diet, and dealing with the stresses in one's life leads to improvement in a patient's sense of well-being, and thus their associated symptoms.
- Most often, the symptoms "disappear as mysteriously as they appeared". It is very common to have "hills and valleys" in this more than perhaps any other cardiac condition.
- Finally, it is important to realize from the outset that a complete control of symptoms is not very often possible. The goal of therapy is improvement.
©COPY 1997 HeartPoint Updated July 1997
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