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.
(page 2 of 2)
Though many cases of mitral valve prolapse are detected during routine physical exams, the problem can be missed, especially if the patient is only examined when lying on his or her back.
“The textbooks describe the click, but not many doctors are able to hear it,” Grewal says. “A lot of doctors don’t even hear the murmur. It all depends on how thorough you are in your examination.”
An echocardiogram is the most useful test for diagnosing mitral valve prolapse, says Dr. Kenneth P. Sunnergren of Cardiology Consultants and Beebe Medical Center in Lewes. Echocardiography uses sound waves to create a moving picture of the heart, providing information about its size and shape and how well the chambers and valves function.
A special type of echocardiogram, a transesophageal echocardiogram, inserts a tube through the esophagus to get a closer look at the mitral valve. Chest X-rays and stress tests are also used to diagnose mitral valve prolapse.
Persons with mitral valve prolapse who are asymptomatic should be reevaluated every two to three years. Those with leaky valves should be monitored annually to make sure the regurgitation is not worsening, says Dr. Michael J. Pasquale, medical director of non-invasive cardiac imaging at the Center for Heart and Vascular Health at Christiana Hospital.
Though most people with mitral valve prolapse never have problems, complications can occur, especially in men over 50, Grewal says.
The most common problem is mitral valve regurgitation, a condition in which the valve is especially leaky. Regurgitation can lead to heart enlargement, heart failure, arrhythmias, and clots that can, in rare cases, cause stroke or lead to sudden death. High blood pressure and being overweight increase the risk of mitral valve regurgitation, Pasquale says.
A poorly functioning valve can also increase the risk of developing endocarditis, an infection of the innermost layer of tissue that lines the chambers of the heart.
Severe mitral valve regurgitation requires surgery to repair or replace the valve to prevent enlargement of the left ventricle, the heart’s main pumping chamber. “Now we are opting for earlier mitral valve surgery because of the good clinical outcomes,” Sunnergren says.
Valve repair rather than replacement is the better option for patients who require surgery, according to the American Heart Association. Surgeons repair the valve by reconnecting the valve leaflets to the heart muscle or by removing excess tissue so the valve can close tightly. Sometimes the ring that connects the valve to the heart muscle is replaced or tightened as well.
Valve replacement is performed when the valve is badly damaged or the patient is in cardiac shock. “Mitral valve repair is a time-consuming operation, so the patients have to be stable,” Sunnergren says.
Both Hollingsworth and Tooley underwent valve repair surgery. Hollingsworth had the procedure in April, Tooley in October 2007. Two months after the surgery, Hollingsworth was pretty much recovered. “I feel good,” she says. ‘I can exercise, I can walk, and I’m not out of breath. I’m glad I had that lung infection. It saved my life.”
Tooley returned to work a couple of months after surgery. Though she feels better, she still suffers from an enlarged heart.
“I can’t do what I used to do, even walking long distances,” she says. “So I gear to what I can do.”
Patients with abnormal rhythms, significant palpitations or chest pains can be treated with medications called beta-blockers, which cause the heart to beat more slowly and less forcefully, thus reducing blood pressure.
Some doctors caution against the use of beta-blockers in women during childbearing years. “Their blood pressure is already on the low side and they’re young and they’re going to get pregnant, so we like to stay away from the medications,” Grewal says.
There are no guidelines for preventing mitral valve prolapse, but maintaining a healthy lifestyle helps to manage symptoms and reduce the risk of complications.
Exercise is encouraged except for those with severe mitral regurgitation. “We try to keep them as active as possible to keep them in good general health, so there’s no restriction on those patients,” Pasquale says. “But those who have a lot of leakiness in the valve should avoid resistance exercises like rowing or weight-lifting.”
Good oral hygiene is also important to prevent bacteria from entering the bloodstream, which can cause endocarditis.
Despite the complications that could occur, most patients with mitral valve prolapse have an excellent prognosis. They usually require no more treatment than a strong dose of reassurance.
“There are many patients who have mitral valve prolapse who are very anxious and they get into panic attacks, they get palpitations, they get shortness of breath,” Pasquale says. “Knowing they have mitral valve prolapse makes them concentrate more on what their heart is doing, so it can feed upon itself. It is more of a psychological barrier to overcome than it is a physiological barrier.”