Mitral valve prolapse


Mitral valve prolapse

Description, Causes and Risk Factors:

Excessive retrograde movement of one or both mitral valve leaflets into the left atrium during left ventricular systole, often allowing mitral regurgitation; responsible for the click-murmur of Barlow syndrome, and rarely may be due to rheumatic carditis, a connective tissue disorder such as Marfan syndrome, or ruptured chorda tendinea ("flail mitral leaflet").

The mitral valve is located between the left atrium and the left ventricle and is composed of two flaps. Normally the flaps are held tightly closed during left ventricular contraction (systole) by the chordae tendineae (small tendon "cords" that connect the flaps to the muscles of the heart). In MVP, the flaps enlarge and stretch inward toward the left atrium, sometimes "snapping" during systole, and may allow some backflow of blood into the left atrium (regurgitation).

Types:

    Primary MVP - Primary MVP is distinguished by thickening of one or both valve flaps. Other effects are fibrosis (scarring) of the flap surface, thinning or lengthening of the chordae tendineae, and fibrin deposits on the flaps. The primary form of MVP is seen frequently in persons with Marfan's syndrome or other inherited connective tissue diseases, but is most often seen in persons with no other form of heart disease.

  • Secondary MVP - In secondary MVP, the flaps are not thickened. The prolapse may be due to ischemic damage (caused by decreased blood flow as a result of coronary artery disease) to the papillary muscles attached to the chordae tendineae or to functional changes in the myocardium. Secondary MVP may result from damage to valvular structures during acute myocardial infarction, rheumatic heart disease, or hypertrophic cardiomyopathy (occurs when the muscle mass of the left ventricle of the heart is larger than normal).

Certain conditions increase the risk for MVP, including:

    Connective tissue disorders, such as Marfan syndrome.

  • Scoliosis and other skeletal problems.

  • Some types of muscular dystrophy.

  • Graves' disease.

Symptoms:

Generally noticeable symptoms,

    Chest pain (not caused by coronary artery disease or a heart attack).

  • Dizziness.

  • Fatigue.

  • Panic attacks.

  • Sensation of feeling the heart beat (palpitations).

  • Shortness of breath with activity or when lying flat (orthopnea).

Diagnosis:

Diagnosis is based on complete medical history and physical examination, diagnostic procedures for MVP may include any, or a combination, of the following:

    Electrocardiogram (ECG or EKG) - a test that records the electrical activity of the heart, shows abnormal rhythms (arrhythmias or dysrhythmias), and detects heart muscle damage.

  • Echocardiogram (Also called ECHO.) - a noninvasive test that uses sound waves to produce a study of the motion of the heart's chambers and valves. The echo sound waves create an image on the monitor as an ultrasound transducer is passed over the heart. Echocardiography is the most useful diagnostic test for MVP.

In some situations where symptoms are more severe, additional diagnostic procedures may be performed. Additional procedures may include:

Stress test (Also called treadmill or exercise ECG.) - A test that is performed while a patient walks on a treadmill to monitor the heart during exercise. Breathing and blood pressure rates are also monitored.

Cardiac catheterization - with this procedure, x-rays are taken after a contrast agent is injected into an artery to locate the narrowing, occlusions, and other abnormalities of specific arteries. In addition, the function of the heart and the valves may be assessed.

Treatment:

Treatment is not usually necessary as MVP is rarely a serious condition. Regular check-ups with a physician are advised. Persons with rhythm disturbances may need to be treated with beta blockers or other medications to control tachycardias (fast heart rhythms). In most cases, limiting stimulants such as caffeine and cigarettes is all that is needed to control symptoms.

If atrial fibrillation or severe left atrial enlargement is present, treatment with an anticoagulant may be recommended. This can be in the form of aspirin or warfarin (Coumadin®) therapy.

For the person with symptoms of dizziness or fainting, maintaining adequate hydration (fluid volume in the blood vessels) with liberal salt and fluid intake is important. Support stockings may be beneficial.

If severe mitral regurgitation resulting from a floppy mitral leaflet, rupture of the chordae tendineae, or extreme lengthening of the valve should occur, surgical repair may be indicated.

NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.

DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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