Mitral Valve Prolapse

About Your Diagnosis
The mitral valve is in the heart between the left atrium and left ventricle. Prolapse refers to a slight abnormality in the valve that makes it floppy. The
mitral valve opens normally when the left atrium pumps blood into the ventricle. It closes to prevent the blood from going back into the atrium as the ventricle pumps blood out of the heart. If blood leaks back into the atrium from the ventricle, this is called regurgitation. If the valve bulges back into the atrium this is called prolapse. Prolapse can cause some degree of regurgitation. Severe regurgitation occurs among about 15% of persons with prolapse. This means the left ventricle must do more work to move the blood, and over time the heart may fail in its function. Mitral valve prolapse is relatively common, affecting about 5% of the population. It affects women more than men. It may be caused by any damage to the mitral valve. This may be a congenital abnormality (one that is present at birth) or may come from a heart attack (myocardial infarction, in which parts of the heart muscle or valve die because they do not have enough blood supply). Other causes include infections such as rheumatic fever (from streptococcal infections such as strep throat), connective tissue disorders, and inherited conditions such as Marfan syndrome. Blood moving against the valve in mitral valve prolapse produces an abnormal sound called a murmur. The murmur is best heard when the heart is examined with a stethoscope. The timing of the murmur in the cardiac cycle and the location of the murmur help determine which valve is affected.

Living With Your Diagnosis
Often patients live for years without ever knowing they have this condition. They generally do well and never have symptoms if the defect is small. Symptoms may develop after a few years and usually include palpitations (rapid heartbeat), fatigue, chest pain, or difficulty breathing. Arrhythmias such as atrial fibrillation) may occur if the changes in the atrium affect the electrical system of the heart.

Treatment
Management of mitral valve prolapse varies depending on severity. If there are no symptoms and no evidence of mitral regurgitation, no treatment is needed. If there is regurgitation, attempts are made to prevent possible complications. An abnormally functioning valve may be a target for infection in
the heart called endocarditis. Antibiotics are routinely given to patients with known mitral regurgitation for dental or surgical procedures and for bacterial
infections. Digitalis (digoxin) may be given for atrial fibrillation and heart failure. Some patients with atrial fibrillation take anticoagulant medications to try to prevent a blood clot from forming in the atrium. If there is evidence of heart failure, diuretics are sometimes used to reduce the fluid volume in the blood so the heart does not have to work as hard. Vasodilators such as nitrates, hydralazine, captopril, and enalapril may be used when heart failure becomes prominent. If heart failure becomes unmanageable with medication or the ability of the heart to keep working is threatened, heart valve replacement may be needed. Side effects of the medications include allergies
to antibiotics or other drugs. Digoxin levels in the blood are checked periodically. Diuretics cause frequent urination and can cause dehydration and electrolyte (salt) abnormalities. You may have to take extra potassium pills if you are taking diuretics, and the potassium may cause nausea, vomiting, or diarrhea. Nitrate medications may cause headaches or dizziness, and the other vasodilators may cause lightheadedness, fatigue, and intestinal problems.

The DOs
•Restrict fluid and salt in your diet if symptoms of heart failure have begun.
•Take antibiotics as prescribed before and after dental or surgical treatments, including tooth cleanings.
•Exercise as tolerated.
The DON’Ts
•Do not forget to take your medications as scheduled.
•Do not use too much caffeine, because excess caffeine may worsen your symptoms.
When to Call Your Doctor
•If you have side effects from your medications.
•If you experience new or worsening symptoms, especially chest pain, shortness of breath or difficulty breathing at rest, lightheadedness, palpi-
tations or rapid heartbeat, or new swelling in your feet or legs.