MITRAL VALVE PROLAPSE

Mitral valve prolapse (MVP) is also called click-murmur syndrome, floppy mitral valve syndrome, and Barlow syndrome after the doctor who first described MVP.

It occurs when the valve between your heart’s left upper chamber (left atrium) and the left lower chamber (left ventricle) doesn’t close properly.

During mitral valve prolapse, the leaflets of the mitral valve bulge (prolapse) upward or back into the left atrium as the heart contracts.

Much of the time, MVP doesn’t cause any problems. Rarely, blood can leak the wrong way through the floppy valve. This can lead to palpitations, shortness of breath, chest pain, and other symptoms. (Palpitations are feelings that your heart is skipping a beat, fluttering, or beating too hard or too fast.)

Mitral valve prolapse is the most common cause of mitral regurgitation. That’s a condition in which some blood flows backward through the mitral valve with each heartbeat. Over years, moderate or severe mitral regurgitation can cause weakness of the heart muscle, known as congestive heart failure.

Most people with mitral valve prolapse have no symptoms. They also never experience any health problems due to mitral valve prolapse.

Symptoms may include:

  • A racing or irregular heartbeat (arrhythmia)
  • Dizziness or lightheadedness
  • Difficulty breathing or shortness of breath, often when lying flat or during physical activity
  • Fatigue
  • Chest pain that’s not caused by a heart attack or coronary artery disease

When these symptoms occur together, they are sometimes called mitral valve prolapse syndrome. However, experts don’t know if mitral valve prolapse itself causes these symptoms. Since these symptoms and mitral valve prolapse are so common, they could often occur together by chance.

DIAGNOSIS

Doctors may diagnose mitral valve prolapse at any age. Your doctor is most likely to diagnose mitral valve prolapse during a physical examination.

To detect mitral valve prolapse, your doctor will listen to your heart using a stethoscope. If you have mitral valve prolapse, your doctor may hear clicking sounds, which are common in mitral valve prolapse. Your doctor may also hear a heart murmur if you have blood leaking backward through your mitral valve (mitral valve regurgitation).

Other tests to diagnose mitral valve prolapse may include:

  • Echocardiogram. An echocardiogram is usually done to confirm the diagnosis. An echocardiogram is a noninvasive ultrasound evaluation of your heart.
  • Chest X-ray. A chest X-ray shows a picture of your heart, lungs and blood vessels and can help your doctor make a diagnosis. It can help show if your heart is enlarged.
  • Electrocardiogram (ECG). In this noninvasive test, a technician will place probes on your chest that record the electrical impulses that make your heart beat.
An ECG records these electrical signals and can help your doctor detect irregularities in your heart’s rhythm and structure, including mitral valve prolapse.
  • Stress test. Your doctor may order a stress test to see if mitral valve regurgitation limits your ability to exercise. In a stress test, you exercise or take certain medications to increase your heart rate and make your heart work harder.
You may also have a stress test if your doctor is trying to determine if you have another condition such as coronary artery disease.
  • Coronary angiogram and cardiac catheterization. A coronary angiogram and cardiac catheterization aren’t generally used to diagnose mitral valve prolapse.

 

RECOMMENDED MEDICATIONS

Most people with mitral valve prolapse, particularly people without symptoms, don’t require treatment.

If you have mitral valve regurgitation but don’t have symptoms, your doctor may suggest you return regularly for follow-up examinations to monitor your condition, depending on the severity of your condition.

However, if you have symptoms and if a significant amount of blood is leaking through the mitral valve, your doctor may recommend medications or surgery, depending on the severity of your condition.

Medications

Some medications you might be prescribed include:

  • Beta blockers. These drugs help prevent irregular heartbeats by making your heart beat more slowly and with less force, which reduces your blood pressure. Beta blockers also help blood vessels relax and open up to improve blood flow.
  • Diuretics. Your doctor may prescribe water pills (diuretics) to drain fluid from your lungs.
  • Heart rhythm medications. Your doctor may prescribe medications such as flecainide (Tambocor), procainamide (Procanbid), sotalol (Betapace) or amiodarone (Cordarone, Pacerone) to control your heart rhythm.
  • Aspirin. If you have mitral valve prolapse and a history of strokes, your doctor might prescribe aspirin to reduce the risk of blood clots.
  • Prescription anticoagulants (blood thinners). These medications — such as warfarin (Coumadin), heparin and dabigatran (Pradaxa) — prevent your blood from clotting if you have had irregular heart rhythms, such as atrial fibrillation.
If you have atrial fibrillation, a history of heart failure or a history of strokes, your doctor may suggest these drugs. They can have dangerous side effects, however, and must be taken exactly as prescribed.

Surgery

Though most people with mitral valve prolapse don’t need surgery, your doctor may suggest surgical treatment if you have severe mitral valve regurgitation with or without symptoms.

Severe mitral valve regurgitation can eventually cause heart failure, preventing your heart from effectively pumping blood. If regurgitation goes on too long, your heart may be too weak for surgery.

If your doctor suggests surgery, your doctor may suggest repairing or replacing the mitral valve. Valve repair and replacement may be performed using open-heart surgery or minimally invasive surgery. Minimally invasive surgery involves smaller incisions and may have less blood loss and a quicker recovery time than open surgery.

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