By: Prof. Dr. Seyed Saeid Zamanieh Shahri, MD and Prof. Dr. Sonia Sayyedalhosseini, MD
Mitral valve prolapse (MVP):
The mitral valve is a valve that allows blood to flow from one chamber of the heart, the left atrium, to another valve called the left ventricle. This happens when the main muscle of the heart, called the left ventricle, is compressed during the heartbeat. Mitral valve prolapse is different from mitral valve stenosis. In mitral valve stenosis, the mitral valve is stiff and constricted, but in mitral regurgitation, the valve collapses due to abnormal size or damage to the mitral valve tissue. For most people with this problem, the cause is unknown. Mitral valve prolapse can be inherited. Anxiety, stress and mental and emotional pressures are factors that aggravate pain in the chest and heart area. As a result of these factors, people who have mitral valve prolapse, or abnormal relaxation of this heart valve, their symptoms worsen. These patients and their families should follow a normal life away from any worries and stress. Mitral valve prolapse occurs when the lobes of this valve, which lie between the left atrium and the left ventricle cause the valve to open unilaterally with each heartbeat, so bending further into the atrium. These conditions sometimes causes the valve to leak and blood to flow back from the ventricle to the left atrium. In most people, this condition is not life threatening and do not require treatment or lifestyle changes. However, some will need treatment.
Causes of mitral valve prolapse:
Some reasons for mitral valve prolapse can be due to the following situations:
Connective tissue disease, Coronary heart disease, Obstructive hypertrophic cardiomyopathy, Myxoma (tumor near the valve) and Rheumatic heart disease (history of rheumatic fever).
Risk factors for mitral valve prolapse:
Factors that may increase the risk of mitral valve prolapse include: Family history of mitral valve prolapse, Gender (being a woman), Age of people (between 14 to 30 years old), Spinal scoliosis, Being underweight, Abnormal low blood pressure, the deformity of the diaphragm wall.
Signs of mitral valve prolapse:
Although mitral valve prolapse is usually a lifelong disorder, many people with the disease never show symptoms. Sometimes some people are unaware of the disease and the symptoms appear when the blood recede back and there is a possibility of failure. Symptoms of mitral valve prolapse can vary widely from person to person. These symptoms are often mild and gradually spread. Symptoms may include: rapid or irregular heartbeat (cardiac arrhythmia), feeling light-headed or dizzy, shortness of breath or difficulty breathing often while lying on your back or during physical activity, fatigue and chest pain that not caused by a heart attack or coronary artery disease.
Most people with mitral valve prolapse have no symptoms. However, people who have symptoms may experience the following:
Although the cause is not clear, fatigue is the most common symptom of mitral valve prolapse. People with mitral valve prolapse may have abnormalities in their autonomic nervous system, which regulates heart rate and respiration. These imbalances can cause insufficient oxygen supply to the working muscles during exercise, resulting in fatigue. Another symptom of mitral valve prolapse is palpitations. Potential and serious heart abnormalities can rarely lead to heart palpitations, in which case they require further examination and treatment. Anxiety, panic attacks and depression can be associated with mitral valve prolapse. It is believed that these symptoms like fatigue, are related to disorders in the autonomic nervous system. Chest pain that can be persistent and unlike angina. Chest pain in mitral valve prolapse rarely occurs during or after exercise.
Pulmonary edema usually occurs when fluid leaks into the blood vessels into the lungs and out of the arteries, causing the surrounding tissues to swell. Migraine headaches are also sometimes associated with mitral valve prolapse. Migraine headaches are probably related to the abnormal control of the blood vessels in the brain by the autonomic nervous system. In most cases, the severity of symptoms in people with mitral valve prolapse is inversely related to the degree of abnormality in the heart.
Ways to diagnose mitral valve prolapse:
Mitral valve prolapse is often diagnosed during normal exercise. During exercise, the cardiologist listens to the heartbeat with a medical earphone, which hangs from the valve to produce a chill when closing. But if blood leaks back through the mitral valve into the left atrium, your doctor will probably hear a heart murmur or hissing. Because these abnormal heart sounds are not permanent, even if the person has mitral valve prolapse, the cardiologist may not hear these sounds during the test. For this reason, the person must re-perform tests and diagnostic procedures for mitral valve prolapse.
Echocardiography: Echocardiography is the best test to detect mitral valve prolapse. In this painless experiment, sound waves are used to capture the image of the heart.
Ultrasound Doppler: An ultrasound Doppler is part of an echo test. Doppler ultrasound shows the speed and direction of blood flow through the mitral valve.
Chest X-ray: This test is used to show fluid inside the lungs or an enlarged heart.
Electrocardiogram: A simple test that records the electronic activity of your heart. This test can show the heart rate and determine whether the beat is uniform or irregular. The test also records the timing and strength of electrical signals as they pass through the heart.
Complications of mitral valve prolapse:
These side effects may include:
Mitral valve insufficiency: Mitral valve insufficiency is the most common complication in which blood is pumped back into the left atrium due to insufficient valve adequacy. Being a man or having high blood pressure increases this chance. If the prolapse is high, there may be surgery to replace the valve or other measures to prevent heart failure.
Heart rhythm problems (arrhythmias): Irregular heart rhythms often occur in the upper chambers of the heart. They may be unpleasant but usually not life threatening. People with severe mitral regurgitation or severe curvature of their mitral valve are at risk for rhythm problems that can affect the blood flow to the heart.
Heart infection: The inside of the heart is covered by a thin membrane called the endocardium. Endocarditis is an infection of this inner lining. The risk of developing endocarditis by a bacterium in an abnormal mitral valve is greatly increased, which can double the damage to the mitral valve. People who are at risk for endocarditis may be treated with antibiotics before some dental and medical procedures to reduce the risk of infection.
Mitral valve prolapse and pregnancy:
It should be noted that during pregnancy, heart rate increases by about 30 to 50 percent, blood volume by about 40 to 45 percent, heart rate by 30 percent and heart rate by 10 to 20 percent so that with new conditions, the heart can meet the needs of the body and the fetus. It is in the abdomen, so if you have any heart problems, be sure to consult your doctor before pregnancy. Mitral valve prolapse is a relatively common and relatively clumsy problem but can be exacerbated during pregnancy. Especially if this prolapse is associated with mitral valve insufficiency. Of course, women with prolapse can usually have a healthy pregnancy, but a cardiologist and gynecologist should be aware of the disease in order to take timely preventive measures to maintain the health of the mother and the fetus is done. Some experts may prevent people with certain heart conditions from becoming pregnant, as pregnancy may affect their health. Problems such as congenital heart disease, severe mitral and aortic stenosis, increased pulmonary pressure, heart failure with heart pumping below 40%, and Marfan syndrome can threaten maternal health during pregnancy.