Heart Valves Like The Swinging Doors Of A Saloon
19 Jun 2006
What’s one of the worst results from visiting a doctor? It’s getting the impression that a serious problem has been diagnosed when the exact opposite is true. It’s called "iatrogenic disease" which means a disease created by a doctor. And when patients are told they have mitral valve prolapse (MVP) it often opens a Pandora’s box of anxiety.
The mitral valve separates the two left chambers of the heart. The valve resembles a tall bishop’s hat called a miter and each time the heart beats it opens like the swinging door of a saloon. But after opening, it then firmly closes while the next beat of the heart pumps blood to the body.
MVP occurs when the valve does not provide a perfect fit. In some cases this allows blood to escape through the valve (mitral regurgitation). MVP then may cause a faint murmur or click.
What causes MVP? Swinging doors of saloons often develop loose rusty hinges. Similarly, the mitral valve is attached to the heart’s muscle by tough cords like those of a parachute. And if the cords become loose and floppy, the valve doesn’t function 100 per cent. But if you are told you have this problem, it’s far from being the end of the world.
Mitral valve prolapse used to be diagnosed more frequently, suggesting it affects 5 per cent of men and 17 per cent of women. But with new techniques such as echocardiograms we now know it’s not so common, affecting only 2.4 per cent of both sexes.
Some people are born with this condition. Studies also show that MVP sometimes occurs in several family members suggesting that genetics play a role in this condition.
The great majority of people with MVP have no idea it’s present. Others complain of shortness of breath, palpitations, fatigue, and panic attacks.
But people without MVP also experience similar symptoms so it’s unclear if MVP is the sole cause of these troubles. What often happens is these symptoms begin after the diagnosis has been made, so anxiety becomes the trigger.
In the past MVP was associated with stroke, abnormal heart rhythms and heart failure. But there is now comforting news for those who receive this diagnosis.
Dr. Brian Griffin, a mitral valve expert at the Cleveland Clinic reports that several studies show that strokes, mini-strokes and disturbances in heart rhythm are rare in patients who have uncomplicated MVP. And that the risk of sudden death from cardiac arrest is similar to that of the general population.
If mitral regurgitation is present, neither is this the end of the world. In these cases a small amount of blood escapes through the swinging door valves with each beat of the heart. This leakage from the left ventricle can continue for many years without causing symptoms.
Mitral regurgitation, however, places more stress on the heart as it has to work harder to compensate for the lost blood. This may cause the heart to enlarge over a period of time. Mitral regurgitation is therefore more likely to cause symptoms than uncomplicated MVP. These patients should be reexamined every three years to see if there’s been any change in the heart’s function.
Most people with MVP require no treatment. But those who have mitral regurgitation are advised to take antibiotics prior to dental procedures, surgery or other invasive treatments. These procedures sometimes result in bacteria being introduced into the bloodstream. The concern is that bacteria may infect a weakened valve causing infection of the heart valve and lining of the heart, a condition called endocarditis, a potentially fatal infection. A small number of patients with severe MVP and regurgitation may eventually need an operation to repair or replace the valve.
Patients diagnosed with MVP should remember that few things in life are perfect. I often tell patients that the definition of a well patient is one who hasn’t seen enough doctors or had enough tests done. Technology has advanced to the point where some abnormality can be found in all of us if one looks hard enough. So there’s no need for the majority of people with MVP to have sleepless nights.
