Heart Valve Prolapse: Causes, Risks, and Prevention

Valve elongation

Is having elongated heart valves (without any abnormalities) affected by pressure, stress, and lack of sleep? Can these factors worsen the elongation of the heart valves? How can we prevent further elongation of the heart valves?

WW, 20~29 year old female. Ask Date: 2012/07/02

Dr. He Dongjin reply Cardiology

Hello, relax.
The symptoms caused by stress, anger, and other factors leading to autonomic nervous system imbalance will not persist indefinitely.
Mitral valve prolapse (MVP) is the most common condition we are concerned about at Changhua Hospital.
It is a syndrome that can result from abnormalities in one or more structures of the mitral valve, including the leaflets, chordae tendineae, papillary muscles, or the annulus, and may be associated with mitral regurgitation.
What causes mitral valve prolapse? Some cases of MVP have a genetic predisposition, with a prevalence in females that is twice that of males.
First-degree relatives with MVP, individuals with a lean physique, and those with congenital scoliosis, pectus excavatum, or pectus carinatum are more frequently found to have MVP.
Due to changes in the connective tissue of the mitral valve, there is abnormal hyperplasia of the spongy middle layer, causing the mitral valve to appear thickened and elongated, leading to the prolapse phenomenon during closure, hence the term mitral valve prolapse.
How is the diagnosis of mitral valve prolapse confirmed? Clinically, it often presents with non-specific symptoms such as palpitations, chest discomfort, and easy fatigue, and there is often a tendency towards anxiety and tension.
The physician's stethoscope is the first diagnostic tool, allowing the detection of typical mid-systolic clicks and possible accompanying systolic murmurs.
The definitive diagnostic tool is echocardiography.
Simple mitral valve prolapse must meet the international diagnostic standard of a displacement greater than 2 mm above the mitral valve annulus line.
Other changes, such as valve thickening, can also be used to confirm the diagnosis of MVP.
Overdiagnosis should be avoided to prevent unnecessary psychological burdens and wasteful medical expenses.
Does mitral valve prolapse require surgery? Some changes in the connective tissue of the mitral valve may extend to the chordae tendineae and annulus, leading to chordal rupture and annular dilation or calcification, resulting in moderate to severe mitral regurgitation.
Fortunately, these cases account for only about 10% of all mitral valve prolapse cases.
The management principles and surgical indications for severe mitral prolapse with regurgitation are similar to those for severe regurgitation caused by other reasons.
What are the potential complications of mitral valve prolapse? A small number of cases may develop thromboembolic events such as strokes or retinal artery occlusion due to damage to the endothelial layer of the valve surface; some may also be associated with arrhythmias.
Patients with mitral valve prolapse accompanied by regurgitation and murmurs have a higher risk of infective endocarditis.
Sudden cardiac death is associated with severe mitral regurgitation, significant structural abnormalities of the valve, or associated ventricular arrhythmias.
Pharmacological treatment for mitral valve prolapse includes beta-blockers or anxiolytics, which can improve most symptoms, but the structural changes of the valve will not be altered by medication.
If the patient has arrhythmias or cardiac enlargement due to regurgitation, additional antiarrhythmic medications or cardiac drugs may be necessary.
How often should mitral valve prolapse be monitored? For individuals with normal mitral valve function and no specific symptoms, due to the good prognosis, it is advisable to maintain a normal lifestyle and undergo echocardiography every 3 to 5 years.
If there are significant systolic murmurs and mitral regurgitation, prophylactic antibiotics for endocarditis become necessary; these patients should be monitored more frequently, approximately once a year with echocardiography.
In summary, we have gained a deeper understanding of mitral valve prolapse.
Remember, most cases of mitral valve prolapse are benign, usually with a good prognosis, requiring only observation and echocardiographic follow-up every few years.
If you have any questions, please consult with a physician in our cardiology outpatient department.
Don't let mitral valve prolapse become a psychological burden; you can still enjoy a healthy and active life like everyone else.

Reply Date: 2012/07/02

More Info

Heart valve prolapse, particularly mitral valve prolapse (MVP), is a condition where the leaflets of the mitral valve bulge (prolapse) into the left atrium during the heart's contraction. This can lead to mitral regurgitation, where blood leaks backward into the left atrium. Understanding the causes, risks, and prevention strategies for this condition is crucial for managing heart health.

Causes of Mitral Valve Prolapse
MVP is often idiopathic, meaning the exact cause is unknown. However, several factors can contribute to its development:
1. Genetic Factors: MVP can run in families, suggesting a genetic predisposition. Connective tissue disorders, such as Marfan syndrome or Ehlers-Danlos syndrome, can also increase the risk.

2. Structural Abnormalities: Abnormalities in the structure of the heart or the connective tissue that supports the valves can lead to prolapse.

3. Age and Gender: MVP is more common in women and often diagnosed in younger individuals, though it can occur at any age.

4. Other Medical Conditions: Conditions such as hyperthyroidism or certain types of heart disease can also be associated with MVP.

Risks Associated with Mitral Valve Prolapse
While many individuals with MVP experience no symptoms and lead normal lives, some may face complications, including:
1. Mitral Regurgitation: This is the most common complication, where the backward flow of blood can lead to heart enlargement and heart failure over time.

2. Arrhythmias: Some individuals may experience irregular heartbeats, which can lead to palpitations or more serious heart rhythm disorders.

3. Endocarditis: This is an infection of the heart lining that can occur if bacteria enter the bloodstream and attach to the abnormal valve.

4. Stroke: In rare cases, blood clots can form on the valve and lead to a stroke.

Prevention Strategies
Preventing the progression of MVP and its complications involves several lifestyle and medical strategies:
1. Regular Monitoring: Individuals diagnosed with MVP should have regular check-ups with a cardiologist to monitor heart function and valve condition.

2. Healthy Lifestyle Choices: Maintaining a healthy diet, engaging in regular physical activity, and avoiding smoking can help reduce the risk of heart disease and complications associated with MVP.

3. Stress Management: High levels of stress and anxiety can exacerbate symptoms of MVP. Techniques such as mindfulness, yoga, and adequate sleep can help manage stress levels.

4. Medication: In some cases, medications may be prescribed to manage symptoms or complications, such as beta-blockers for palpitations or anticoagulants if there is a risk of blood clots.

5. Avoiding Excessive Caffeine and Stimulants: These can exacerbate symptoms of MVP and should be consumed in moderation.

Impact of Stress and Sleep on MVP
Regarding your question about whether stress, anxiety, and lack of sleep can exacerbate mitral valve prolapse, the answer is yes. Stress can lead to increased heart rate and blood pressure, which may put additional strain on the heart and exacerbate symptoms. Chronic sleep deprivation can also affect heart health, leading to increased blood pressure and heart rate, potentially worsening the condition.

Conclusion
In summary, while mitral valve prolapse is often benign, it is essential to understand its causes, associated risks, and preventive measures. Regular monitoring and a healthy lifestyle can significantly impact the management of MVP. If you have concerns about your condition or symptoms, it is crucial to discuss them with your healthcare provider for personalized advice and management strategies.

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