Managing Mitral Valve Prolapse

Mitral valve prolapse (MVP) is a relatively common and usually harmless problem. MVP is an improper closing of a heart valve that may allow some leakage of blood back toward the heart. In the 1970s and '80s, it was a common diagnosis for symptoms such as shortness of breath, dizziness, and either "skipping" or "racing" heartbeats.

MVP occurs in less than 3 percent of Americans, according to the National Heart, Lung, and Blood Institute, and men are affected as often as women. Of those who have MVP, most have no symptoms because the condition is so mild. Many people are astounded to learn they have the problem.

The mitral valve

The mitral valve is the heart valve between the left atrium (the top chamber that receives oxygen-rich blood from the lungs) and left ventricle (the chamber that pumps blood into the body through the aorta). The valve has two flaps, called leaflets or cusps, which open when the left atrium of the heart contracts (beats), and close when the left ventricle contracts (and the atrium rests). The left atrium pumps blood into the left ventricle. When the atrium contracts, the mitral valve opens, allowing blood to flow to the left ventricle. As the atrium relaxes and the left ventricle begins to contract, the mitral valve snaps closed, preventing blood from flowing back into the atrium. When pressure in the left ventricle rises, the aortic valve opens, and blood flows into the aorta and then to the body.

MVP is a condition in which one or both of the valve leaflets are abnormally long and floppy, or the structures that support the leaflets are too long. In MVP, one or both leaflets may bulge into the atrium. The bulge, which can vary from just a bit to a great deal, prevents the valve from closing completely. This allows blood to leak back into the left atrium. This leakage is called mitral valve regurgitation. If a large amount of blood leaks back, it can cause the symptoms of MVP. Mitral valve prolapse can be a progressive condition, getting worse with age. However, in many people the amount of leakage and the symptoms never get worse.

MVP can be an inherited condition or it can be caused by disorders such as Marfan syndrome that affect connective tissues.

Symptoms

Most people with MVP do not have any symptoms. If symptoms do occur, they can vary from mild to severe. Symptoms are similar to those of other heart conditions. People with MVP may feel shortness of breath, dizziness, either "skipping" or "racing" heartbeats, chest pains, and sometimes panic attacks.

How is it diagnosed?

If the mitral valve doesn't close completely, your health care provider can hear a "click" sound while listening to your heart with a stethoscope.

"Just because you have a click doesn't make you sick," says Robert Levine, M.D., a Boston cardiologist.

A click may indicate only minor MVP symptoms. If blood is leaking back into the atrium, a "swosh" sound, called a murmur, can be heard. But even this symptom does not greatly endanger most MVP patients. Only 1 percent of MVP patients must make dramatic lifestyle changes to accommodate the syndrome, because of severe leakage and possible panic attacks, according to the National Heart, Lung, and Blood Institute.

An echocardiogram, or ultrasound exam of the heart, is used to diagnose the severity of the blood leakage through the valve.

How is it treated?

People who have no or mild symptoms do not need treatment. Your health care provider may recommend an annual physical exam and an echocardiogram every five years. If the symptoms are uncomfortable or if your health care provider recommends it, medications can be prescribed. Medications called beta blockers are effective in treating the symptoms in some people. If symptoms disappear, you may be able to stop using the drugs. Sometimes medications are used in people with MVP who have chest pain or abnormal heart rhythms.

In addition, certain lifestyle changes may help:

• Get regular exercise. People with MVP often fall into a vicious cycle. Symptoms such as irregular heartbeat and chest pain discourage them from exercising, which aggravates symptoms of weakness and fatigue. "Patients with the most symptoms are generally in the poorest [physical] condition," says Philip Watkins, M.D., a cardiologist in Birmingham, Ala. Instead, you should aim for a minimum of 30 minutes a day, five days a week, of vigorous aerobic exercise such as walking, biking, or swimming. This will help get the blood pumping and oxygen-handling systems in better shape, increase endurance, and perhaps reduce adrenaline surges.

• Eliminate caffeine. Caffeine appears to aggravate symptoms, causing adrenaline surges, so Dr. Watkins tells patients to give up caffeine in coffee, tea, soft drinks, and chocolate.

• Increase fluids. Dr. Watkins recommends at least eight glasses of noncaffeinated liquids a day to boost the volume of body fluids, which are typically lower than normal in people with MVP.

Warning signs

Serious but rare complications of MVP are an infection called endocarditis, cerebral embolism, arrhythmia, heart failure, and sudden heart death. Bacterial endocarditis is a relatively common complication.  

Damaged heart valves are more likely to become infected with bacteria that commonly enter the bloodstream but are usually rapidly eliminated in someone without MVP. A type of Streptococcal bacteria normally found in the mouth, for instance, is frequently found in the blood immediately after eating, brushing the teeth, flossing, or dental procedures. It is therefore important for people with MVP to take good care of their teeth to prevent oral cavity infections.