1. Mitral Valve Prolapse is Common and Usually Harmless
Mitral valve prolapse (MVP) is a very common condition. In the past, many patients (especially women) were told they had MVP if they had palpitations of any form of anxiety. In fact, many people who had echocardiograms done for palpitations or chest pain were told they had MVP and should start taking antibiotics if they went to the dentist to get their teeth cleaned. On a daily basis, I see new patients that have been told they had MVP 30 years ago and still are mortified by the belief that they will ultimately have some complication related to this diagnosis. The reality is that most people who actually have it never have any problem with it.
2. Prolapse Can Result in Signifcant Problems in Some Patients
On physical examination the presence of a loud murmur may indicate actual dysfunction associated with MVP. Symptoms of palpitations and shortness of breath with MVP may be a problem if mitral regururitaiton is present. In cases where the valve is incompetent and actually allows blood to flow into the left atrium, dilatation of the chamber can develop. As the atrium grows, it stretches the electrical fibers which can lead to atrial fibrillation. As the pressure increases and is transmitted to the lungs, breathing difficulty and damage to the lung tissue can result.
3. Antibiotics are Not Needed
Current recommendations have changed in the last year with regards to antibiotics and MVP. There is no evidence to suggest that MVP leads to endocarditis (heart valve infection) after visiting the dentist. In fact, it is no longer recommended to use prophylactic antibiotics for MVP even with mitral regurgitation. Right now, only take antibiotics if you have undergone surgery to replace or repair the valve, or have a history of previous heart valve infection
4. Significant Leaking of the Mitral Valve in MVP Requires Specific Treatment
Medications are used to reduce the regurgitation into the left atrium in cases of MVP where significant leaking is seen. By lowering the blood pressure with angiotensin converting enzyme inhibitors and beta blockers there is less resistance to forward flow and therefore less regurgitation. Surgery to repair a prolapsing valve is often successful and doesn’t require the implantation of a new valve. In many cases, the surgeon can resect redundant tissue and “cinch down” areas that are responsible for the leaking. When it is not repairable a new valve must be implanted. New technologies are currently under evaluation that allow for repair of the mitral valve without sawing the breast bone open rather through the leg veins or via small openings in the chest wall with the help of a robot assist device.
5. Stay Calm if You Have MVP
If you are told you have MVP on an echocardiogram, don’t panic. The most important thing to find out is how much regurgitation is present and how well is the heart pumping. Severe leaking only needs to be fixed if there are symptoms of breathing problems, a drop in the efficiency of the heart’s pumping function (Ejection Fraction), atrial fibrillation, and enlargement of the heart. If you were told you had MVP 20 years ago after an echocardiogram or by your GP after a physical exam expect that you probably don’t have it by the criteria we use today. Our imaging quality has improved so much and the diagnostic criteria have evolved, such that many patients that have lived years with this diagnosis and are surprised to find that there is now nothing wrong with their valve.
About this Author
Dr Aragon, a LIVESTRONG Cardiology expert, is board certified in Cardiology and Interventional Cardiology. He specializes in the treatment of complex coronary artery disease, structural heart disease and peripheral arterial disease with non-surgical catheter based technologies. He is in practice in Santa Barbara, California.
