Mitral and Tricuspid Valve Issues: Symptoms, Risks, and Management - Cardiology

Dr. He Dongjin reply Cardiology

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Mitral valve prolapse (MVP) is a condition that requires an understanding of the heart's structure.
The heart consists of four chambers: the right and left atria and the right and left ventricles, separated by valves that function like doors between rooms, allowing blood to flow in one direction and preventing backflow.
The mitral valve, located between the left atrium and left ventricle, resembles a bishop's miter, hence its alternative name, the bicuspid valve.
During diastole, blood flows from the left atrium through the open mitral valve into the left ventricle.
When the left ventricle is filled with blood from the left atrium and enters systole, the mitral valve automatically closes, allowing blood to be pumped from the left ventricle into the aorta and preventing backflow into the left atrium.
Mitral valve prolapse occurs when congenital or acquired factors cause the annulus of the mitral valve (analogous to a door frame) to enlarge, resulting in a relative reduction in the size of the mitral valve (the frame being larger than the door), leading to incomplete closure and part of the valve drooping into the left atrium.
Alternatively, the mitral valve may undergo degenerative myxomatous changes or become elongated (the door being larger than the frame), causing part of the valve to be forced back into the left atrium during closure, which is referred to as mitral valve prolapse.
It is estimated that about 5-10% of the population has MVP, with an unclear etiology, but it is predominantly associated with genetic factors.
It is more common in females than in males, with a ratio of approximately 3:1.
Most patients are asymptomatic and discover their MVP incidentally during routine examinations or evaluations for other conditions.
Those who do experience symptoms often present with at least two of the following: chest pain, palpitations, fatigue, shortness of breath, dizziness, insomnia, anxiety, panic attacks, or even syncope.
These symptoms are not directly caused by the heart but are due to excessive sympathetic nervous system activation, leading to a syndrome often referred to as autonomic dysregulation syndrome.
Mitral valve prolapse is merely another manifestation of this syndrome and does not have a causal relationship with other symptoms.
In some patients, the mitral valve's inability to close tightly leads to some blood flowing backward into the left atrium during left ventricular contraction, clinically referred to as mitral regurgitation.
Mitral valve prolapse, when complicated by regurgitation, can lead to left atrial enlargement and may also increase the risk of young-onset stroke, infective endocarditis, or even sudden death, making it a condition that should not be taken lightly.
Diagnosis of mitral valve prolapse is primarily based on clinical auscultation, where characteristic clicks or murmurs may be heard; however, electrocardiograms and chest X-rays have limited diagnostic value.
The most important diagnostic tool is echocardiography, which can visualize mitral valve prolapse and assess for mitral regurgitation or other associated conditions such as rheumatic heart disease or ischemic heart disease.
The frequency, timing, triggers, and severity of symptoms in patients with mitral valve prolapse can vary widely.
Some individuals may experience episodes weekly, while others may have them only every few months or even years.
Symptoms can last from a day or two to several weeks.
Triggers are diverse and can include: colds, menstruation, emotional stress, lack of sleep, delayed meals, excessive fatigue, engaging in unfamiliar physical activities, prolonged exposure to hot and dry environments, dehydration from excessive sweating, or the consumption of stimulants such as tobacco, alcohol, caffeine, or drugs.
Most patients can tolerate these symptoms, but a small number may experience severe discomfort, leading to frequent emergency room visits, overwhelming emergency physicians, and disrupting their daily lives, resulting in what is termed a life crisis.
There are instances where patients, due to severe chest pain, are diagnosed with angina and undergo cardiac catheterization, but fatalities due to life-threatening complications are rare.
Medications can only provide symptomatic relief and do not cure mitral valve prolapse.
Surgical intervention is typically reserved for cases with significant mitral regurgitation affecting cardiac function or for those with infective endocarditis, and it does not alleviate the aforementioned symptoms.
Fortunately, the number of cases requiring surgery is relatively low, and most patients can achieve some degree of symptom relief through medication.
Patients should also come to terms with living with this condition, accepting it as an invisible defect of the body.
If individuals suspect they have mitral valve prolapse due to the symptoms described, they should consult a cardiologist for evaluation.
If echocardiography confirms the diagnosis, patients should be aware of situations that may trigger their symptoms and strive to avoid them.
With appropriate medication prescribed by their physician, most symptoms can be well controlled.
If moderate or severe regurgitation is present, patients should inform their physician about the need for prophylactic antibiotics during invasive procedures or dental extractions to reduce the risk of infective endocarditis.
Unless there is significant regurgitation affecting cardiac function, the vast majority of patients can have children.
As for the safety of exercise, opinions vary.
If exercise triggers symptoms, patients should consult their cardiologist for an assessment of what types of exercise are appropriate.
Changhua Hospital cares about your health.

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Reply Date: 2006/06/30