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Straight Talk from 'Dr. Stephanie' - January 2013
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Mitral Valve Prolapse: It's Not Just for Women
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Stephanie Coulter, MDMitral valve prolapse (MVP) is a common heart condition. MVP often occurs in people who have no other heart problems and is a congenital abnormality, meaning it is something a person can be born with. What makes the story of MVP interesting is that for years it was considered to be a severe condition primarily seen in women. As it turns out, that’s not entirely true.

What is mitral valve prolapse?

The mitral valve is located in the left side of the heart, separating the upper and lower chambers. Normally the mitral valve opens and shuts in a coordinated fashion to allow blood to flow in one direction—from the atrium to the ventricle. In patients with MVP, the mitral valve does not close properly, sometimes allowing small amounts of blood to flow back into the atrium. It is most often diagnosed when a doctor hears a “click-murmur” sound when listening to the heart and is confirmed with an echocardiogram.

A misunderstood condition 

In the past, MVP was not well understood. It was thought that anywhere from 5% to 35% of the population had MVP, most of those being women, and it could cause frequent and serious complications including stroke, atrial fibrillation, and heart failure.

A 1999 study by Drs. Lisa Freed, Daniel Levy, and Robert Levine changed all of that. Their study of 3736 people revealed that MVP had been grossly over-diagnosed for years. Only 2.4% of the population, not 35% has MVP. It is also not gender-specific making it just as likely to occur in men as in women. Furthermore, it is not as serious of a condition as once thought.

Complications due to MVP 

Even though MVP can cause palpitations and chest pain, we now know that most of the time it is not a serious condition. However, MVP can cause two complications:

  1. Mitral regurgitation: When a large amount of blood is leaking backward through the defective valve, which can lead to enlargement of heart walls and even weakening of the heart muscle, caused by the extra pumping the heart must do to make up for the backflow of blood.
  2. Bacterial endocarditis: An infection of the lining of the heart chambers or, in this case, of the heart valves. In those with MVP, bacterial endocarditis can occur when normally harmless microorganisms in the bloodstream become trapped in the heart valve by the body’s immune cells, platelets, and fibrin, which the body uses in an attempt to fix the faulty mitral valve. 

The good news is that most with MVP will never experience significant mitral regurgitation, and endocarditis is extremely rare. It was thought that all people with MVP must take antibiotics before going to the dentist to prevent their heart valve from being exposed to oral plaque bacteria that can cause endocarditis. It was later found that simply brushing your teeth or going to the bathroom posed the same amount of threat to MVP patients. Antibiotics are now only recommended for those most at risk for endocarditis, including those with a history of endocarditis and a history of valve repair. 

Treatment for MVP 

Most patients with MVP do not need treatment. For those that need to manage symptoms like shortness of breath and irregular heartbeat, a doctor may prescribe beta-blockers.

In rare cases, people with MVP need valve surgery. Surgery is recommended if:

  1. The leak is severe AND
  2. Symptoms are severe OR
  3. Ejection fraction (EF) is less than 60% OR
  4. Atrial fibrillation is present OR
  5. There is an increase in lung blood pressure.

If you need surgery for MVP, the valve is best treated by repair, but sometimes replacement is the only option. Only seek medical attention from a center that is highly qualified and does a high volume of valve repairs and replacements. Having a valve replaced does increase your risk for developing bacterial endocarditis.

For more information about MVP, visit the mitral valve prolapse page in Texas Heart Institute’s online Heart Information Center.

Until next time!
Stephanie Coulter, MD, Director of the Center for Women's Heart & Vascular Health
Stephanie Coulter, MD
 

Do you have a topic that you would like to learn more about from Dr. Stephanie? Send us an email at women@texasheart.org and your question may be the next Straight Talk topic!

For additional ways all women can take care of their hearts, visit the Straight Talk archives on the Texas Heart Institute website.

 


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Visit the Center for Women's Heart & Vascular Health at www.texasheart.org/women.

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