Mitral Valve Prolapse
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Mitral Valve Prolapse
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Mitral valve prolapse
Mitral valve prolapse is one of the most common cardiac vices. It is most often characterized by a favorable flow, but is sometimes complicated by mitral regurgitation, which has important clinical significance. In such cases, no special treatment can be avoided; otherwise, infectious endocarditis, sudden coronary death, or cerebrovascular insufficiency develops.
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The mitral valve prolapse (PMP) is characterized primarily by myxomatous degeneration of the mitral valve valves. Young people are more likely to have a complete loss of both the anterior and the posterior folds and chord components. This is the extreme form of myoxomatous degeneration, known as Barlow's syndrome. However, in the elderly, PMK is characterized by fibro-elastic disturbance, sometimes with a combined chordal fracture due to lack of connective tissue support. These anatomical anomalies lead to incomplete closure of the mitral valve openings during systole, which leads to regurgitation.
The mitral valve prolapse is defined by about 2-3% of the population in the United States. [1 - Freed LA; Levy D; Levine RA; Larson MG; Evans JC; Fuller DL; Lehman B; Benjamin EJ Prevalence and clinical outcome of mitral-valve prolapse. N Engl J Med. 1999; 341 (1): 1-7]
Over time, the expansion of the mitral ring may develop, which leads to further progression of mitral regurgitation (MR). Acute severe MI leads to symptoms of congestive heart failure without dilatation of the left ventricle. Conversely, chronic or progressive-severe MI can lead to dilatation and ventricular dysfunction, neurohormonal activation and heart failure. Increased pressure in the left atrium can lead to hypertrophy of the left atrium, atrial fibrillation, stagnation of blood in the lungs and pulmonary hypertension.
Video: Mitral valve prolapse: heart disease, which is vital in time to recognize!
The mitral valve is one of four heart valves. It opens and closes to control the blood flow between the left atrium and the left ventricle. The valve consists of two valves - front and rear.
With mitral valve prolapse, one or both valves of the valve have too large dimensions or chords (bundles attached to the lower side of the valves and connected to the ventricular wall) are too long. Due to such a violation, the valve bends back or "sucks" to the left atrium, taking the form of a parachute. Additionally, during each heart contraction, the closure of the valve is not sufficiently tight, which results in the return of a portion of blood from the ventricle to the atrium.
The mitral valve prolapse is also called the flexible mitral valve syndrome and the Barlow syndrome in the name of the doctor who first described the PMC.
The deflection of the valve flap into the cavity of the left atrium up to 3 mm is considered to be within the normal range.
With a prolapse, a very small amount of blood can flow, moving back from the ventricle into the atrium. At the same time, the valve, as a rule, still works well, and the heart normally pumps blood.
Only 2% of people have other structural problems with the heart along with mitral valve prolapse.
It was previously thought that the mitral valve prolapse is present in a significant proportion of the population, mainly determined by women. Today, with newer and more accurate echocardiographic criteria, it is established that the anomaly affects a very small percentage of the population, and is most often diagnosed in people aged 20-40 years.
Video: Work of the heart with mitral valve prolapse
The mitral valve prolapse usually develops as an isolated pathology, most often on the background of hereditary connective tissue disorders, including Marfan syndrome, Ehlers-Danlos syndrome, incomplete osteogenesis, and elasticity of the pseudoksanthoma. In fact, 75% of patients with Marfan syndrome have PMC due to excessive mitral valve secretion as a result of their myxomatous degeneration. The PMC is also described together with a defect in the interstitial septum and hypertrophic cardiomyopathy.
The mitral valve prolapse is considered a hereditary disease with increased gene expression in male patients (2: 1). The most common form of inheritance is the autosomal dominant, but X-linked inheritance is also described.
Data from a study by the Framingham Heart community showed that PMC occurs in 2.4% of the population.
Demographics related to age and gender:
Most people with mitral valve prolapse have no symptoms. However, in some cases, the following symptoms are noted:
Some patients experience more pronounced symptoms of dystonia, which may be considered:
Symptoms associated with concomitant illnesses, such as Marfan's syndrome or hyperthyroidism (elevated thyroid hormones) may also be determined.
When to seek medical help with mitral valve prolapse
Emergency care should be sought immediately in the following cases:
If there are typical signs of a mitral valve prolapse, the doctor will ask questions about the symptoms, the general state of health, lifestyle and medications.
Physical examination does not always help to identify signs that indicate a mitral valve prolapse. In particular, with auscultation, a "click" can be noted with each opening of the valve or a heart-shaped noise like the "feline mucus".
Diagnostic tests help to eliminate serious heart disease, also help to evaluate the contractile function of the heart and the working capacity of the valves. These tests are non-invasive, painless and fast. The most commonly used diagnostic methods are:
The mitral valve prolapse usually does not require special treatment, except for a calm condition, since most people do not have a concomitant serious heart disease. There are no special dietary restrictions. However, in some cases you need to adhere to the following recommendations:
If a patient with PMK often develops arrhythmias, a rapid heartbeat is observed, then beta-blockers may be required.
In rare cases, progression of mitral regurgitation or excessive prolapse (greater than 12 mm) may require surgical intervention. In this case, the valve is reconstructed. Improvements in heart surgery over the past 10 years have shown a lesser need for replacing a mitral valve with an artificial prototype.
The mitral valve prolapse has a widely varying prognostic conclusion, although most patients with PMP remain asymptomatic with almost normal life expectancy. Approximately 5-10% of the cases progresses to severe mitral regurgitation. In general, in young patients (under the age of 50) with normal left ventricular function and absence of symptoms, the quality of life is practically not reduced.
The prognostic conclusion is favorable in the absence or minimization of the following risk factors:
There is an increased (up to 50-60%) risk of atrial and ventricular arrhythmias in patients with myxomatous PMC. In such cases, the risk of sudden death is 0.4-2%, with an increase in it, when patients have signs of dilatation and left ventricular dysfunction, severe MR, or increased thickness of the mitral valve.
With mitral valve prolapse, the following complications may occur:
The most commonly encountered is mitral regurgitation. The heavy flowing MR is mainly related to the rupture of chord components.
Risk of development of MR increases in the following cases:
MR, diagnosed on the basis of the presence of systolic noise, is associated with an increased risk of adverse events, including progressive valve dysfunction, infective endocarditis, and sudden death.
It is important to keep in mind that the heart muscle becomes stronger when exercising, but like other muscles in the body. For example, aerobics can help strengthen the heart, so they are recommended to people with mitral valve prolapse. Walking, swimming, cycling and jogging for no more than 30 minutes at a time are also considered safe and helpful. If a person with BMI exercises and while feeling tired or experiencing any other symptoms, you need to slow down or take a break.
Video: Mitral valve prolapse. An illness of superfluid people
The valvular heart apparatus consists of four components, among which the mitral valve is of particular importance. The quality of his work depends on hemodynamics for a large range of blood circulation. In the case of the definition of the mitral valve disease, treatment is mandatory, mainly in the surgical way, which allows improving the quality and duration of the patient's life.
Among all heart defects, prolapse of the mitral valve is quite common. The disease is of three degrees of severity, and the most favorable prognosis is given by the prolapse of the mitral valve of the 1st degree. For proper treatment and prevention of disease, its symptoms should be properly identified.
Mitral regurgitation is associated with cardiac malformation and can occur at any age, both in adults and in children. Depending on the course, a milder or more severe symptomatology is indicated. In the latter case, surgical intervention is mandatory, which helps to improve the quality of life of the patient.
У мене діагностували пролапс мітрального клапана 2 степені.Я змалку був слабовитим, схильним до вірусних захворювань.Аж тут я раптом захопився спортом.Набридло бути слабаком.Я почав з 14 років займатися спортом.Я починав від маленького.Було важко, я поступово пробував,став ходити у тренажерні зали,ходив на турніках займатися.І відчув результат.Я став набагато краще почуватися.Сеце взагалі мене не турбувало.Я не слухав,того,що лікарі говорили,я збільшував нагрузку.Раніше я пробігав до 350 м.і здихав,тобто захекувався.А тут я збільшував дистанцію, по 20-30 м.І диво,уже через пів року я пробігав 900м.без сильноі задишки.Ще через пів року, я вже бігав,по 1500 м, і навіть 2 км.
Я ставав усе менше задихуватися.Я загартувався.Я боровся з холодом, я заставляв себе через неможу. І став менше,тобто взагалі уже не хворів.Час від часу невеличка задишка,все ще траплялася, та я займався, і плавав,взимку на лижах пробігав по 5 км
Я запросто міг довгий час ганяти з хлопцями в футбол,баскетбол, волейбол. Бо раніше,не міг,через задишку і запамороченість.Я сприятливо переносив зміну будь якоі погоди. Я уже віджимався від підлоги 75-85 раз.На турніку робив гімнастичні вправи.Вів здоровий спосіб життя.Я майже кожен день робив кардіотренування.І вже у 18 років, я почував себе повністю здоровим,я взагалі перестав задихуватися, і мене уже не лякали ніякі фізичні нагрузки. У 20 років,під час обстеження у військоматі( я 6 років ретельно у кардіолога не обстежувався), мене признали повністю здоровим.Я вже не був худощавим астеніком,мій зріст становив 193 см.,а вага 88 кг. А вади серця ніякоі не знайшли.Я ретельно обстежувався у кількох клініках,і там не повірили,дивлячись мою медичну картку обліку з дитячих років.Ніякого пролапсу немає,ви можете спокійно іти в армію, серцю взагалі нічого не загрожує. А пролапс,який колись діагностували, зіслали,на медичну помилку,для лікарів зникнення вродженоі вади серця залишилося загадкою.Після коледжу я відслужив рік в військовій розвідці,а пізніше вступив до військового училища на спеціальність військова артилерія.Зараз служу офіцером і є цілком здоровою людиною.
Отож не панікуйте, пролапс,це не вирок,
коли є бажання і сила волі,все можливе,все стає реальним. Коли внушати,я хворий, я невиліковний і налаштовуватися на погане,так воно і буде.А коли йти вштик своій недузі і внушити позитив, викинути всякі смутні думки, все,що кажуть.І налаштувати себе,що все добре,я сильна,здорова людина,я все зможу то так воно і буде і навіть найсташніша і невиліковна хвороба втече геть.Це доказано.А думки і
налаштованість мають здатність матеріалізуватися.
Не варто брати смутне в голову і все буде добре.Сам на своєму досвіді переконався.
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Problem: Mitral Valve Prolapse | American Heart Association
Mitral valve prolapse
Mitral valve prolapse - Symptoms and causes - Mayo Clinic
Mitral Valve Prolapse and Regurgitation, Animation - YouTube
Mitral Valve Prolapse : Symptoms, Causes, and Treatment
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Pislaru S, et al. Definition and diagnosis of mitral valve prolapse. https://www.uptodate.com/contents/search. Accessed Dec. 4, 2019.
Mitral valve prolapse. National Heart, Lung, and Blood Institute. http://www.nhlbi.nih.gov/health/health-topics/topics/mvp/. Accessed Dec. 4, 2019.
Ferri FF. Mitral valve prolapse. In: Ferri's Clinical Advisor 2020. Elsevier; 2020. https://www.clinicalkey.com. Accessed Dec. 4, 2019.
Kellerman RD, et al. Mitral valve prolapse. In: Conn's Current Therapy 2019. Elsevier; 2019. https://www.clinicalkey.com. Accessed Dec. 4, 2019.
Nishimura RA, et al. 2017 AHA/ACC focused update of the 2014 AHA/ACC guideline for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Journal of the American College of Cardiology. 2017; doi:10.1016/j.jacc.2017.03.011.
Problem: Mitral valve prolapse. American Heart Association. http://www.heart.org/HEARTORG/Conditions/More/HeartValveProblemsandDisease/Problem-Mitral-Valve-Prolapse_UCM_450441_Article.jsp#.WDJJF9UrJ0w. Accessed Dec. 4, 2019.
Atrial fibrillation medications. American Heart Association. http://www.heart.org/HEARTORG/Conditions/Arrhythmia/AboutArrhythmia/Atrial-Fibrillation-Medications_UCM_423781_Article.jsp#.WDJKytUrJ0w. Accessed Dec. 4, 2019.
Warning signs of a heart attack. American Heart Association. https://www.heart.org/en/health-topics/heart-attack/warning-signs-of-a-heart-attack. Accessed Dec. 4, 2019.
Shiota T. Role of echocardiography for catheter-based management of valvular heart disease. Journal of Cardiology. 2017; doi:10.1016/j.jjcc2016.09.015.
AskMayoExpert. Mitral regurgitation (adult). Mayo Clinic; 2018.
Nalliah CJ, et al. Mitral valve prolapse and sudden cardiac death: A systematic review and meta-analysis. Heart. 2019; doi:10.1136/heartjnl-2017-312932.
Mazine A, et al. Systematic review and meta-analysis of chordal replacement versus leaflet resection for posterior mitral leaflet prolapse. Journal of Thoracic and Cardiovascular Surgery. 2018; doi:10.1016/j.jtcvs.2017.07.078.
Connolly HM (expert opinion). Mayo Clinic. Jan. 5, 2020.
Mitral valve prolapse and regurgitation
Associated Procedures
Cardiac catheterization
Chest X-rays
Coronary angiogram
Echocardiogram
Electrocardiogram (ECG or EKG)
Heart valve surgery
Mitral valve repair and mitral valve replacement
Stress test
Show more associated procedures
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The mitral valve separates the two chambers (atrium and ventricle) of the left side of the heart. In mitral valve prolapse, the leaflets of the mitral valve bulge (prolapse) into the left atrium like a parachute during the heart's contraction. Sometimes mitral valve prolapse causes blood to leak back into the atrium from the ventricle, which is called mitral valve regurgitation.
Mitral valve prolapse occurs when the flaps (leaflets) of the heart's mitral valve bulge (prolapse) like a parachute into the heart's left upper chamber (left atrium) as the heart contracts.
Mitral (MY-trul) valve prolapse sometimes leads to blood leaking backward into the left atrium, a condition called mitral valve regurgitation.
In most people, mitral valve prolapse isn't life-threatening and doesn't require treatment or changes in lifestyle. Some people with mitral valve prolapse, however, require treatment.
Although mitral valve prolapse is usually a lifelong disorder, many people with this condition never have symptoms. When diagnosed, people may be surprised to learn that they have a heart condition.
When signs and symptoms do occur, it may be because blood is leaking backward through the valve. Mitral valve prolapse symptoms can vary widely from one person to another. They tend to be mild and develop gradually. Symptoms may include:
If you think you have any of the above symptoms, make an appointment with your doctor. Many other conditions cause the same symptoms as mitral valve prolapse, so only a visit to your doctor can determine the cause of your symptoms.
If you're having chest pain and you're unsure if it could be a heart attack, seek emergency medical care immediately.
If you've already been diagnosed with mitral valve prolapse, see your doctor if your symptoms worsen.
The mitral valve controls the flow of blood between the upper and lower chambers of the left side of the heart. When your heart is working properly, the mitral valve closes completely when the heart pumps and prevents blood from flowing back into the upper left chamber (left atrium).
But in some people with mitral valve prolapse, one or both of the mitral valve leaflets have extra tissue or stretch more than normal, which causes them to bulge like a parachute into the left atrium each time the heart contracts.
The bulging may keep the valve from closing tightly. In some cases, blood may leak backward through the valve (mitral valve regurgitation).
This may not cause problems if only a small amount of blood leaks back into the left atrium. More severe mitral valve regurgitation can cause symptoms such as shortness of breath, fatigue or lightheadedness.
Another name for mitral valve prolapse is click-murmur syndrome. When a doctor listens to your heart using a stethoscope, he or she may hear a clicking sound as the valve's leaflets billow back, followed by a whooshing sound (murmur) resulting from blood flowing back into the atrium.
Other names to describe mitral valve prolapse include:
Mitral valve prolapse can develop in any person at any age. Serious symptoms of mitral valve prolapse tend to occur most often in men older than 50.
Mitral valve prolapse can run in families and may be linked to several other conditions, such as:
Although most people with mitral valve prolapse never have problems, complications can occur. They may include:
Mitral valve regurgitation. The most common complication is a condition in which the valve leaks blood back into the left atrium.
Being male or having high blood pressure increases your risk of mitral valve regurgitation.
If regurgitation is severe, you may need surgery to repair or replace the valve in order to prevent heart failure.
Heart rhythm problems (arrhythmias). Irregular heart rhythms most commonly occur in the upper chambers of the heart. They may be bothersome, but aren't usually life-threatening.
People with severe mitral valve regurgitation or severe deformity of their mitral valve are most at risk of having rhythm problems, which can affect blood flow through the heart.
Heart valve infection (endocarditis). The inside of your heart is lined by a thin membrane called the endocardium. Endocarditis is an infection of this inner lining.
An abnormal mitral valve increases your chance of getting endocarditis from bacteria, which can further damage the mitral valve.
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