Mitral valve prolapse

Description
The valves inside the heart help direct blood flow in and out of the heart. The valves also regulate the movement of blood between the heart's chambers. The mitral valve connects the left atrium (the left upper chamber of the heart) to the left ventricle (the left lower chamber of the heart). A mitral valve prolapse (MVP) occurs when the tissues that make up the valve bulge out of place.

Causes/associated factors
In many cases, the cause of mitral valve prolapse is unknown. The condition can be caused by various heart or connective tissue diseases, and heredity may also play a role. About 2 to 5 percent of Americans develop mitral valve prolapse. The condition is most common in young to middle-aged women, especially those who have skeletal problems (such as scoliosis, an abnormal curvature of the spine).

Signs/symptoms
Mitral valve prolapse usually has no symptoms. If symptoms appear, they may include:
chest pain
palpitations
dizziness
fainting or near fainting
fatigue
anxiety
shortness of breath
rarely, transcient ischemic attack (TIA, a temporary but reversible reduction or blockage in blood flow to the brain)
New studies seem to support that the symptoms often associated with mitral valve prolapse actually occur at the same rate for the general population, however, and may or may not be related to the mitral valve.


Diagnosis
Mitral valve prolapse is often found during a routine physical exam while your doctor listens to your heart with a stethoscope. The bulging valve tissue often creates a clicking sound. If the valve doesn't close completely, mitral regurgitation (the backward flow of blood into the upper chamber) may occur, causing a murmur.
If your doctor hears a murmur, further testing can help determine if there is any leakage and the extent of the leakage. Your doctor may suggest the following tests:

echocardiogram (a test that uses sound waves to study the heart)
electrocardiogram (a test that records the heart's electrical activity)
Holter monitoring (continuously recording the heart's electrical activity for 24 hours through a small battery-powered device worn by the patient)

Treatment
Most people who have mitral valve prolapse have a mild, nonprogressive form, which allows them to lead normal lives without treatment. However, close monitoring (usually by a cardiologist) and treatment is needed for a more severe mitral valve prolapse. Medications such as beta blockers may be prescribed to help control symptoms such as chest pain or abnormal heart rhythms. Aspirin or the anticoagulant coumadin may be recommended to treat TIAs. If you have significant mitral regurgitation, you may need to avoid vigorous sports or other strenuous activities, as well as take preventive antibiotics for dental work and certain other procedures. Although uncommon, medications or even surgery may be needed if the valve leakage is severe.

Complications
You're more likely to develop mitral valve prolapse if you have a connective tissue disease or a family history of the condition. Although not common, leakage of the valve may trap bacteria and lead to bacterial endocarditis (an infection of the lining of the heart's chambers and valves).
For a small percentage of people, more serious complications can develop. These include heart failure, stroke or heart beat irregularities that may be suddenly life-threatening.


Pregnancy-specific information
Although most women with mitral valve prolapse have normal, uneventful pregnancies, it's important to discuss pregnancy in advance with your doctor if you have a history of the condition.

Senior-specific information
After age 50, men become more susceptible to the complications of mitral valve prolapse.

Prevention
Although mitral valve prolapse can't be prevented, you can minimize the risk of complications. Start with simple measures such as daily oral hygiene and regular dental checkups. To prevent bacterial endocarditis, your doctor may recommend taking antibiotics before dental work or certain medical procedures. (Preventive antibiotics are typically prescribed for people who have heart murmurs or changes on an echocardiogram that reveal significant mitral regurgitation.) If you have heart palpitations, avoid caffeine, alcohol, cigarettes and other stimulants, such as decongestants. If you've had a TIA or stroke, avoid birth control pills and cigarettes.
Take any medications your doctor prescribes, and carefully follow your doctor's instructions. If you have a more severe form of mitral valve prolapse, your activity level may be restricted.