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Fort Lauderdale

A lot of thoughts and questions crossed your mind when you were diagnosed with mitral valve prolapse (MVP), right? You are definitely not alone; millions of people have this condition.  To us cardiologists, MVP is an oldie but goodie that has been around for a long time. MVP has been known by a variety of names: floppy mitral valve, irritable heart, soldier's heart, the effort syndrome, Barlow's Syndrome, and DaCosta's Syndrome.

Echocardiography (cardiac ultrasound) can diagnose MVP in 3-4% of the general population (7% in some autopsy series). The prevalence is similar among different ethnic groups, and there tends to be a higher female-to-male ratio of approximately 3:1.  Physical exam is important as always, but the easiest and most commonly used test to diagnose MVP is with an echocardiogram. On exam, patients sometimes may have several physical features associated with MVP. These include: pectus excavatum (a depression of the sternum), scoliosis (curvature of the spine), a straight back, unusual joint flexibility, and auscultation may reveal clicks and murmurs (the latter associated with mitral valve insufficiency).

In general, mitral valve prolapse is initially a benign disorder, but a rather small subpopulation can end up with more significant complications including arrhythmias, mitral regurgitation (leakage), endocarditis (infected valve), and the need for valve surgery (repair or replacement). There is even an association with sudden cardiac death and stroke but, fortunately, this is quite rare.

There has been an evolution on the understanding of MVP and in the 1980’s a classification of MVP led to two groups: anatomic MVP and the MVP Syndrome. The mitral valve apparatus is not just a valve, it is a group of structures that consists of leaflets (two of them), supporting chords, a base (annulus or ring), and supporting muscles called papillary muscles (two of them). Anatomic mitral valve prolapse is an abnormality of the mitral valve apparatus. On the other end of the spectrum, MVP is frequently (but not always) associated with a constellation of symptoms (see list). Individuals with these symptoms are frequently referred to as having MVP syndrome.

One of the better definitions I have read refers to the term MVP syndrome as to the presence of symptoms that cannot be explained on the basis of the valvular abnormality per se. Therefore, it is important to note that symptoms associated with MVP syndrome are not due to the valve itself. There are different theories but these symptoms are sometimes believed to be based on various physiological changes.

•Chest pains
•Fatigue and tiredness
•Dizziness (even fainting)
•Poor exercise tolerance
•Anxiety and/or panic attacks
•Shortness of breath
•Mood swings (depression)

Symptoms truly begin at any age. Most people, however, will notice symptoms during early adulthood. The symptoms can be more intense in several scenarios: emotional stress, extreme tiredness, after unfamiliar physical activities, menopause or menstruation. Oddly enough, it is not unusual for the symptoms to go away for some time only to reappear (even years later) again.

In my years of practice, I have seen many patients who come to the office with MVP syndrome, and sadly they are frequently frightened. I will never forget a young man I saw during my training in Cleveland who had incapacitating palpitations that were described as if a horse would kick his chest every time he felt a premature heart beat; he was very uncomfortable and even depressed with this condition. The good news is that prognosis is usually very good, even with the symptoms described above.

Research supports the concept that several physiological alterations may be responsible for symptoms in MVP syndrome. The problem is that not everyone can be explained by these physiological changes. Some of the theories have described physiological abnormalities that involve the autonomic nervous system, intravascular blood volume, and alterations in the regulation of the hormones renin and aldosterone. Sometimes treatment is needed for the management of MVP syndrome. Like everything we do, treatment needs to be individualized and better discussed with a specialist.

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