Delaware
Woman Magazine
Award Winner, Delaware Press Association––Second
Place
"MVP: The Heart of the
Matter"
Most people give little thought to their heart as
it goes about steadily pumping blood through their bodies. But those
diagnosed with Mitral Valve Prolapse (MVP)––or suffering
the fatigue, shortness of breath, anxiety, and even panic attacks
associated with Mitral Valve Prolapse Syndrome (MVPS)––are
as attuned to the staccato of their hearts as they are of a full bladder
or a rumbling stomach.
Sixty percent of those with MVP––also
known as Barlow’s syndrome, systolic click-murmur syndrome or
floppy valve syndrome––will never realize it, as they
lack symptoms. By chance, they may discover their heart’s mitral
valve is structurally abnormal. The condition is quite common, affecting
approximately 2 to 4 percent of the population. In most cases it does
not affect heart function. But some with MVP experience recurrent
chest pain, dizziness, and migraine headaches. Even worse, 1 percent
of the 15 million people estimated to have MVPS find their quality
of life so diminished they require medication and/or surgery to repair
or replace the mitral valve.
Cause and Effect?
There is considerable debate within the medical community as to whether
the tiny valve is the catalyst behind the symptoms. Dr. Ehsam Rahman,
a cardiologist with Christiana Care, is unconvinced. “Sometimes
patients with MVP have shortness of breath and panic attacks, which
we can’t quite explain by the amount of valve problem that we
see,” he says.
What is agreed upon is how the mitral valve channels
blood flow through the heart. The right side of the heart receives
blood from the body and pumps it to the lungs to pick up oxygen. When
the blood reaches the left side of the heart, it passes from the upper
(atrium) chamber to the lower (ventricle) chamber via the two fibrous
leaflets that form the mitral valve.
Think of the valve as a parachute. When the ventricle
chamber contracts, pushing the blood into the body, the leaflets are
supposed to snap shut. But if the leaflets are too large (too much
fabric in the parachute), or if the “strings” that connect
the parachute are too long, the leaflets bulge or prolapse, preventing
a tight seal. So those with MVP may feel palpitations or tachycardia
(faster heart rate than normal) even when they are at rest.
But there’s good news: prolapsing mitral valves do not tend
to degenerate over time, says Rahman. “MVP is not dangerous.
If an irregular heartbeat is connected to the MVP, it is not a serious
condition.”
Heart palpitations can be caused by many factors other
than MVP, including medication, anxiety, caffeine, appetite suppressants,
congenital heart disease, an overactive thyroid, and even nicotine.
Chest pain associated with MVP may be sharp or dull and last from
a few seconds to several hours.
Using a stethoscope, doctors will hear a telltale “click”
if the leaflets are closing improperly. An echocardiogram, a simple
non-invasive test that uses high-frequency sound waves to visualize
the anatomy and function of the heart, will confirm the diagnosis.
Sensitive Wiring?
There is speculation that MVPS is tied to the autonomic nervous system
(ANS). Symptoms often first occur with childbirth, a severe viral
illness or an emotional stressor such as change in marital status
or job pressure, says the Mitral Valve Prolapse Center of Alabama.
It’s interesting that the ANS (which manages
our cardiovascular system, gastrointestinal, urinary and bowel functions,
temperature regulation, reproduction, and metabolic and endocrine
systems) is also responsible for our “flight or fight”
response to stress. When the ‘gas’ or ‘brake’
components of the ANS get out of whack, dysfunction follows.
Those with MVP seem somehow to be wired differently;
their autonomic response can be much more volatile and unstable, explains
Ronald Hoffman, author of Natural Therapies for Mitral Valve Prolapse:
How Diet and Nutritional Supplements Can Ease the Symptoms of This
Common Disorder. “If your sympathetic system is aroused, you
can suddenly feel crushing chest pain with your heartbeat racing and
pounding,” he writes. “Certain people with [MVP] sometimes
experience this with no apparent warning or immediate threat.”
Those who become overly sensitive to their heartbeats
may set in motion a circle of fear that leads to recurring panic attacks
and full-blown depression. “We refer to this as somatic preoccupation,”
says Lyn Frederickson, MSN, author of Confronting Mitral Valve Prolapse
Syndrome. “The goal of patients with MVP is to break this cycle
by whatever means possible,” she says. This may include change
of diet, adding aerobic exercise and adopting a positive mental attitude.
Pam Carlson, a 42-year-old professional living in
Claymont, has MVP. She first noticed rapid heartbeats during high
school. Pam has recurrent gastro-intestinal problems, fatigue, and
headaches. She has experienced five debilitating panic attacks, the
last one in 1993, but therapy and medication restored her quality
of life.
“I thought I was losing my mind; I had a sense
of impending doom,” she says. “The doctors didn’t
seem to be doing a lot back then (early 80s), so I went to a psychologist.
It took me years to get over the fear of having panic attacks.”
Carlson is a tall, slender woman, as are most MVP
patients. Connective tissue may be the reason, explains Rahman. “Connective
tissue is what determines if we’re tall or fat. The mitral valve
is made of connective tissue.”
Lurking Danger
If you are diagnosed as having MVP, ask your doctor if you also have
“mitral regurgitation.” This means your “leaky”
mitral valve is allowing blood to leak back into the atrium chamber.
If so, you are at risk of developing endocarditis, an infection of
the heart’s inner lining or valves.
Mitral regurgitation affects only 5 to 7 percent of
women between the ages of 14 and 30, but it occurs in roughly two
out of every 1,000 people. Mitral regurgitation requires the use of
antibiotics before dental or surgical procedures that may cause bleeding,
cautions the American Medical Association. The standard medication
prior to dental work is 2 grams of Amoxicillin orally one hour before
procedure, or 600 mg. of Clindamycin for those allergic to penicillin.
Allan Goldfeder, DMD, estimates that 1 to 2 percent
of his patients take antibiotics before dental cleanings, due to the
bacteria that enters the bloodstream as plaque is pushed around. “The
rule is that if you have MVP without regurgitation, you’re okay,”
adds John Burke, DDS, from his Wilmington office. “Some patients
come in saying, ‘I have a heart murmur.’ We say, ‘When
was your last checkup?’ If it wasn’t recent, we say they
need to get some testing before we do any work on them. Heart valve
infections are a lot more common than people realize.”
Three to 5 percent of his patients are pre-medicated
for cleanings, extractions, and root canals. Burke also stresses the
importance of maintaining good oral health through regular brushing
and flossing.
Endocarditis may develop suddenly or over time. A
running fever is often the first symptom, followed by loss of appetite,
headache, and night sweats. And small, dark lines called splinter
hemorrhages may appear under the fingernails, says the National Library
of Medicine.
With significant backflow, the heart may pump harder
to try to compensate for the decreased blood flow to the body. If
severe enough, mitral regurgitation can lead to enlargement of the
cardiac chambers, weakening of the heart muscle, and ultimately, to
heart failure.
Fortunately, this does not affect the majority of
MVP patients.
