Mitral Valve Prolapse (MVP)
Mitral valve prolapse (also known as “click murmur syndrome” and “Barlow’s syndrome”) is the most common heart valve abnormality, affecting five to ten percent of the world population. A normal mitral valve consists of two thin leaflets, located between the left atrium and the left ventricle of the heart. Mitral valve leaflets, shaped like parachutes, are attached to the inner wall of the left ventricle by a series of strings called “chordae.” When the ventricles contract, the mitral valve leaflets close snugly and prevent the backflow of blood from the left ventricle into the left atrium. When the ventricles relax, the valves open to allow oxygenated blood from the lungs to fill the left ventricle.
In patients with mitral valve prolapse, the mitral apparatus (valve leaflets and chordae) becomes affected by a process called myxomatous degeneration. In myxomatous degeneration, the structural protein collagen forms abnormally and causes thickening, enlargement, and redundancy of the leaflets and chordae. When the ventricles contract, the redundant leaflets prolapse (flop backwards) into the left atrium, sometimes allowing leakage of blood through the valve opening (mitral regurgitation). When severe, mitral regurgitation can lead to heart failure and abnormal heart rhythms. Most patients are totally unaware of the prolapsing of the mitral valve. Others may experience a number of symptoms discussed below.
The mitral valve prolapse (MVP) syndrome has a strong hereditary tendency, although the exact cause is unknown. Affected family members are often tall, thin, with long arms and fingers, and straight backs. It is seen most commonly in women from 20 to 40 years old, but also occurs in men.
What are the signs and symptoms of mitral valve prolapse?
Most people with mitral valve prolapse have no symptoms, however, those who do commonly complain of symptoms such as fatigue, palpitations, chest pain, anxiety, and migraine headaches. Stroke is a very rare complication of mitral valve prolapse.
Fatigue is the most common complaint, although the reason for fatigue is not understood. Patients with mitral valve prolapse may have imbalances in their autonomic nervous system, which regulates heart rate and breathing. Such imbalances may cause inadequate blood oxygen delivery to the working muscles during exercise, thereby causing fatigue.
Palpitations are sensations of fast or irregular heart beats. In most patients with mitral valve prolapse, palpitations are harmless. In very rare cases, potentially serious heart rhythm abnormalities may underlie palpitations which require further evaluation and treatment.
Sharp chest pains are reported in some patients with mitral valve prolapse, which can be prolonged. Unlike angina, chest pain with mitral valve prolapse rarely occurs during or after exercise, and may not respond to nitroglycerin.
Anxiety, panic attacks, and depression may be associated with mitral valve prolapse. Like fatigue, these symptoms are believed to be related to imbalances of the autonomic nervous system.
Migraine headaches have been occasionally linked to mitral valve prolapse. They are probably related to abnormal nervous system control of the tension in the blood vessels in the brain.
Mitral valve prolapse may be rarely associated with strokes occurring in young patients. These patients appear to have increased blood clotting tendencies due to abnormally sticky blood clotting elements, called platelets.
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