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Mitral valve prolapse is a dysfunction of the mitral valve in which one or both of its leaflets invade the left atrium during ventricular contraction. Mitral valve prolapse may be associated with varying degrees of valve regurgitation. Significant valve regurgitation, which may lead to the development of serious heart problems, is diagnosed relatively rarely. People with lobe prolapse often complain of troublesome symptoms that make them fearful and suspect a serious heart disease. Are these concerns justified?
Dr. Katarzyna Cybulska, cardiologist, head of the Allenort Cardiology Center in Warsaw, answers.
– Speaking of the consequences of mitral valve prolapse, two forms of this defect must be distinguished. One of them is the classic form, in which we find a thickening of the valve leaflets by at least 5 mm, and their inversion into the left atrium exceeds the line of the valve annulus by at least 2 mm. Thickened valve leaflets show signs of myxomatous degeneration and significant regurgitation is more common in this form. Patients with the classic form more often develop a serious heart defect, heart failure and dangerous arrhythmias. The second type of the disease is the non-classical form, which also shows that the petals are indented into the left atrium by at least 2 mm, but the leaf thickness is smaller and does not exceed 5 mm. This form of leaflet prolapse, without significant valvular regurgitation associated with it, is benign in nature and usually does not require specific monitoring.
— How is mitral valve prolapse diagnosed?
– People with mitral valve prolapse often have various, often very bothersome symptoms suggesting a serious heart disease. Patients complain of unusual chest pain, shortness of breath and palpitations. They often feel weak, prone to dizziness and fainting. Emotional hyperactivity and anxiety attacks are also quite typical. This is why people with lobe prolapse generally seek medical advice. The doctor, of course, tries to explain the cause of the malaise. The symptom description itself, and sometimes the characteristic appearance of the patient, are suspected; the loss of a petal is more common in tall, thin people with slender hands and fingers. Another clue leading to the diagnosis of this disease is auscultation of the chest with a stethoscope. Auscultationally, the doctor notes a characteristic intravenous click, and then, mainly in patients with regurgitation, a late systolic murmur. The ECG may be normal, but there may also be nonspecific ST-T changes and arrhythmias. The diagnosis is mainly determined by echocardiography, which shows a systolic prolapse of one or two mitral valve leaflets into the left atrium (symptom of a hammock) and the regurgitation of blood from the left ventricle to the left atrium (it is best visible in a color Doppler examination).
— When do symptoms related to this defect require treatment?
Among people with mitral valve prolapse, a group of patients at risk of developing serious complications such as: heart failure, life-threatening arrhythmias, infectious endocarditis and transient cerebral ischemia should be distinguished. These are mainly people with classic lobe prolapse and significant valve insufficiency. These people require systematic medical control and should be treated as patients with a heart defect. However, there are relatively few such patients, because the above-mentioned changes are found only in about 20% of all people with lobe prolapse. Other people are at low risk of complications and require medical attention only if they have troublesome heart symptoms (chest pain, shortness of breath, palpitations, fainting, restlessness). In such individuals, oral administration of magnesium preparations may be effective. It is worth saying here that the correct result of the determination of the concentration of magnesium in the blood does not exclude the intracellular deficiency of this element, therefore it is always worth assessing the clinical effect of magnesium treatment. In some patients, the use of drugs from the group of beta-blockers brings good results. These drugs are especially effective in people with a fast heart beat and arrhythmias. Sedatives are often prescribed in patients with high levels of anxiety. Due to the risk of addiction, I personally avoid the long-term use of drugs from this group, especially strong drugs prescribed by prescription. Weaker, over-the-counter preparations may be helpful.
– What could the Doctor advise people suffering from lobe prolapse?
– First of all, I encourage you to contact your doctor and for diagnostic tests. The worst thing is to fuel anxiety for no apparent reason. These patients should simply get tested.
Suspicion of leaflet prolapse must be confirmed by echocardiography, which will allow the assessment of changes in the valve leaflets and the severity of its regurgitation. Other diagnostic tests, such as ECG, Holter test, blood tests, and sometimes also an exercise test, will allow you to assess the occurrence of cardiac arrhythmias, as well as to exclude other diseases that may cause similar ailments. After performing these tests, the doctor will be able to objectively assess the risk of complications and plan appropriate management. I would like to emphasize that in most people, lobe loss is mild, and the symptoms can be effectively alleviated by regular intake of magnesium supplements and / or the use of beta-blockers. People prone to fainting should remember to drink enough fluids (1,5 – 2 liters a day) and avoid sudden changes in body position. In patients with lobe prolapse without significant valve insufficiency, there are no indications for limiting physical activity. However, as with other cardiac patients, I would recommend starting with less intense exercise and gradually increasing it as exercise capacity improves. Relaxation exercises, yoga, tai-chi or meditation can also be beneficial.
Text: Barbara Skrzypińska