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Question:
Is mitral valve prolapse (MVP) reversible?
I have MVP with mild leakage. Is MVP reversible and what can I do to help my situation? I do get palpitations but am not sure if they are real or in my head, due to constantly worrying about them and the MVP. I felt my heart pounding fast one day at work and quivering, but a nurse felt it and said the beats were 80 and normal. How can this be?
submitted by Kim from Massachusetts on 6/27/09
Answer:
by Texas Heart Institute cardiologist, Jose G. Diez, MD
Mitral valve prolapse (also known as "click murmur syndrome" and "Barlow's syndrome") is the most common heart valve abnormality, affecting 5-10% of the world population. A normal mitral valve consists of two thin leaflets, located between the left atrium and the left ventricle of the heart. Mitral valve leaflets, shaped like parachutes, are attached to the inner wall of the left ventricle by a series of strings called "chordae." When the ventricles contract, the mitral valve leaflets close snugly and prevent the backflow of blood from the left ventricle into the left atrium. When the ventricles relax, the valves open to allow oxygenated blood from the lungs to fill the left ventricle.
In patients with mitral valve prolapse, the mitral apparatus (valve leaflets and chordae) becomes affected by a process called myxomatous degeneration. In myxomatous degeneration, the structural protein collagen forms abnormally and causes thickening, enlargement, and redundancy of the leaflets and chordae. When the ventricles contract, the redundant leaflets prolapse (flop backwards) into the left atrium, sometimes allowing leakage of blood through the valve opening (mitral regurgitation). Although most patients with mitral valve prolapse require no treatment or treatment with oral medications, in very rare cases, surgery (mitral valve replacement or repair) may be required. Patients who require surgery usually have severe mitral regurgitation causing worsening heart failure and progressive heart enlargement.
Follow up with echocardiography is important to evaluate and monitor the degree of leakage through the valve. Most patients are totally unaware of the prolapsing of the mitral valve. Others may experience a number of symptoms discussed below. Palpitations are sensations of fast or irregular heartbeats. In most patients with mitral valve prolapse, palpitations are harmless. In very rare cases, potentially serious heart rhythm abnormalities may underlie palpitations which require further evaluation and treatment. Abnormally rapid or irregular heart rhythms can occur in patients with mitral valve prolapse, causing palpitations. A Holter monitor is a continuous cassette recording of the patient's heart rhythm as the patient carries on his/her daily activities. Abnormal rhythms occurring during the test period are captured on tape and analyzed at a later date. If abnormal rhythms do not occur every day, the Holter recording may fail to capture the abnormal rhythms. These patients then can be fitted with a small "event-recorder" to be worn for up to several weeks. When the patient senses a palpitation, an event button can be pressed to record the heart rhythm prior to, during, and after the palpitations. If there are significant problems with the rhythm, your physician would suggest further evaluation or to initiate medications (usually a beta blocker agent).
Sharp chest pains are reported in some patients with mitral valve prolapse which can be prolonged. But it is very different in nature from the pain from coronary artery disease (blockages). The risk for blockages is given by the presence of: high blood pressure, high cholesterol, family history, diabetes, obesity, and smoking. Your physician will guide you in reference to monitoring, further evaluation and treatment.
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Updated June 2009
