Healing Hearts and Minds
Your heart murmur may be a symptom of a serious condition, but chances are that the treatment you need most is simple reassurance that it’s not as bad as you think.
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When Michelle Hollingsworth visited Bayhealth Medical Center’s walk-in treatment facility in Dover one weekend a year ago, she was hoping to find relief from a cough that had been nagging her for weeks.
But when the doctor pressed a stethoscope to Hollingsworth’s chest, he discovered something far more troubling than a respiratory infection: With every lub-dub of a normal heartbeat, there came a wooshing sound.
Hollingsworth had learned she had a murmur while a teenager in her native France, but because she’d always been healthy, she dismissed it as harmless.
The Bayhealth doctor told Hollingsworth to see her internist, who referred her to a cardiologist, who sent her for an echocardiogram. A few days later Hollingsworth got the bad news: A complication from a condition known as mitral valve prolapse was allowing an excessive amount of blood to leak into the left atrium of her heart. She would need surgery to repair the valve.
The sudden rush to surgery was a shock to the 63-year-old retiree.
“I had no symptoms,” she says. “That was the scary part.”
Mitral valve prolapse, also known as click-murmur syndrome or Barlow’s syndrome, is a common, usually benign heart problem. About 2 percent of the population has the condition. Women are twice as likely to be affected as men.
The mitral valve is one of four valves in the heart. It opens and closes to create one-way blood flow between the left atrium and left ventricle. The mitral valve has two flaps, or leaflets. In mitral valve prolapse, one or both of the leaflets are too large or the strings that connect them to the ventricular wall are too long. The result is an uneven closure of the valve during each heartbeat. The bad closure causes the valve to bulge, or prolapse, into the left atrium like a parachute, sometimes allowing blood to leak through the valve back into the atrium.
The cause of mitral valve prolapse is unknown, but it appears to be an inherited condition. People with connective tissue disorders such as Marfan syndrome and Ehlers-Danlos syndrome have an increased incidence of mitral valve prolapse, as do those with tall, thin builds, chest-wall deformities or thin chest diameter, and straight-back syndrome.
The disorder is most commonly seen in women between the ages of 20 and 40 but it also occurs in men. Most people who have mitral valve prolapse are surprised to learn they have the abnormality. Those who do experience symptoms typically complain of fatigue, sharp chest pain, irregular heart beats, shortness of breath, dizziness or lightheadedness.
Hollingsworth experienced palpitations when she laid down, but nothing remarkable. Because she’d just lost her husband, she attributed the irregular heartbeats to stress.
But it’s possible that the malfunctioning valve contributed to the persistent respiratory infection she suffered last winter, says Dr. Harjinder S. Grewal, a cardiologist at Kent General Hospital in Dover.
A variety of symptoms led Marcia Tooley to suspect that her valve problem was getting worse. “I was getting pretty tired,” says Tooley, a pediatric physical therapist. “I had leg cramps, and I’d actually wake up at night and feel that I wasn’t breathing.”
Tooley, a breast cancer survivor, learned she had a heart murmur 10 years ago from her oncologist. She remained stable for a few years. Then signs of severe leakage or regurgitation began to appear. Like Hollingsworth, Tooley needed surgery to repair her mitral valve.
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