Mitral Valve Prolapse: Symptoms, Diagnosis and Treatment

The heart is divided into four major chambers, the left atrium, left ventricle, right atrium, and the right ventricle. The valve present between the left atrium and the left ventricle is called the mitral valve. The valve present between the right atrium and the right ventricle is called the tricuspid valve. Ballooning of the flaps of the mitral valve into the left atrium is called mitral valve prolapse (MVP). MVP is the most common cause of Mitral valve regurgitation.

Causes of Mitral Valve Prolapse

MVP is caused due to degeneration in the leaflets of the mitral valve. The degeneration makes it weak and hence it bulges into the left atrium during the contraction of the left ventricles. The bulging makes the approximation of the leaflets incomplete and leads to the backflow of blood from the ventricle to the atrium. The weakening of the leaflets can be due to genetic disorders like:

• Marfan syndrome
• Ehler Danlos Syndrome
• Osteogenesis imperfecta v

Symptoms of Mitral Valve Prolapse

Most of the individuals with mitral valve prolapsed are asymptomatic. If you have a mitral valve prolapsed you may experience:

• Rapid and erratic heartbeats
• Fatigue
• Shortness of breath after mild exertion
• Pain in the chest

Diagnosis of Mitral Valve Prolapse

To confirm the diagnosis of mitral valve prolapse your doctor will like to perform a thorough physical examination, after which your doctor might order some tests.

In the physical examination, your doctor would like to hear your heart sounds, the presence of a ‘murmur’ may indicate the presence of a mitral valve prolapsed.

• Echocardiography: a rod-like probe will be placed on your chest. This probe produces sound waves and will help your doctor look for a ballooning leaflet of the mitral valve. It can also be used to assess the flow of blood through your heart. This procedure helps in identifying the severity of the disease.
• Transesophageal echocardiogram: your doctor will insert a flexible tube into your food pipe via your mouth. The tube has a transducer that produces sound waves and is used for detailed imaging of the heart and its valves.
• Electrocardiogram: by placing small probes on your chest a reading of the electrical activity of your heart is obtained. This helps your doctor know if your heart is beating regularly or not.
• Chest X-ray: an X-ray of your chest will tell your doctor about the size of your heart and its chambers.

Complications of Mitral Valve Prolapse

Mitral valve prolapsed can proceed to cause or predispose you to

• Mitral regurgitation: back flow of blood in the heart. The symptoms aren’t felt until it is severe.
• Endocarditis: the inside of the heart is lined by a thin layer called the endocardium. Damage to this layer as in the mitral valve prolapsed may increase the risk of the valve getting infected by bacterium. This can manifest as fever and fatigue.
• Atrial fibrillation: the increase in the size of the left atrium increases the chances of sporadic spells of rapid and erratic heartbeats.
• Stroke: individuals with atrial fibrillation are prone to the formation of blood clots in the atrium. The clot may dislodge from the atrium and circulate into the body only to get lodged into a blood vessel in the brain leading to a stroke.

Treatment of Mitral Valve Prolapse

The treatment for MP depends on the severity of the symptoms. If you don’t have severe symptoms your doctor might suggest that you take some medications to prevent complications and have regular visits for a check-up. But on the other hand, if you have debilitating symptoms your doctor might suggest that you opt for a surgical repair or replacement of the valve.

• Medical management: Blood thinners to prevent stroke
• Antiarrhythmic: to prevent irregular heartbeats
• Medications to control your blood pressure
• Mitral valve repair: an open heart surgery will be undertaken to repair your mitral valve. Your cardiologist might remove parts of the damaged valve and reconnect the healthy parts together or they may remodel the original valve. Sometimes the annulus on which the valve leaflets are present has to be replaced to ensure that there is no backflow.
• Mitral valve replacement: in this procedure, your surgeon will replace your damaged valve with the healthy valve from pig, cow or human. These valves undergo a natural degradation and need to be replaced over a period of a few years. If you undergo this procedure, you will be on blood thinners to prevent clot formation on this foreign object in your body.

Resources:

• American Heart Association
• http://www.acc.org/guidelines