Mitral valve prolapse syndrome refers to a congenital malformation of the heart at the mitral valve apparatus. This results in a bulging of the mitral valve portions.
What is mitral valve prolapse syndrome?
In mitral valve prolapse syndrome or mitral valve prolapse, there is folding over or balloon-like distension of the posterior mitral valve leaflet into the left atrium of the heart. However, both mitral valves may be affected. Mitral valve prolapse is one of the most common changes in heart valves in adults. The prolapse is more common in females than in males. The first description of mitral valve prolapse syndrome was made in 1963 by the heart specialist John B. Barlow from South Africa. Therefore, the disease is also called Barlow’s disease or Barlow’s syndrome. About five percent of all adults worldwide are affected by mitral valve prolapse. In Germany, the rate is between one and two percent. Most cases of prolapse occur between the ages of 20 and 40. In principle, however, mitral valve prolapse syndrome can occur at any age. The mitral valve is located between the left ventricle and the left atrium of the heart. It helps the heart to pump oxygenated blood via the left atrium into the left ventricle. From there, it continues to the organism. The mitral valve opens when blood flows from the left atrium to the left ventricle. When the chamber contracts, the valve closes. The name mitral valve is due to the similarity of the valve to a mitre, a bishop’s mitre.
Causes
Mitral valve prolapse syndrome is caused by a connective tissue disorder. However, it has not yet been possible to clarify the reasons for this. It is suspected that genetic influences have an effect. In some people, it can occur due to hereditary diseases of the connective tissue, which include, for example, Marfan syndrome. Such diseases result in overstretching, thickening, enlarging or loosening of the mitral valve. Sometimes, however, mitral valve prolapse also occurs after a heart attack. Not infrequently, there is damage to the papillary muscles. These are where the tendon filaments of the mitral valve originate.
Symptoms, complaints, and signs
Often, the symptoms that occur with mitral valve prolapse syndrome are very nonspecific. For example, they may be cardiac arrhythmias or discomfort resembling angina. Patients often also experience feelings of shortness of breath, restlessness, anxiety and fatigue. Furthermore, stabbing pain occurs in the chest. Only rarely does severe symptomatic mitral regurgitation present. The same applies to an abrupt loss of consciousness. However, in many affected individuals, no symptoms are noticed at all.
Diagnosis and disease progression
If symptoms do not occur, mitral valve prolapse syndrome can usually be discovered by the physician only by chance. Listening to the heart (auscultation) and echocardiography are performed to confirm the diagnosis. During auscultation, a systolic click can be heard, which is considered to be an expression of systolic valve leaflet protrusion toward the left atrium. If the patient also suffers from mitral regurgitation, a systolic murmur can also be identified. When echocardiography is performed, the thickened valve leaflets are conspicuous. The same applies to their systolic protrusion. If mitral regurgitation is suspected, it can be diagnosed by Doppler echocardiography. An ECG examination usually yields normal results. Sometimes, however, it is suitable for detecting possible cardiac arrhythmias. A long-term ECG, which the patient carries with him for 24 hours, is considered helpful for this purpose. In most cases, the course of mitral valve prolapse syndrome is considered positive. Only about three percent of all affected patients experience serious complications. These include heart failure, arterial thromboembolism, and severe cardiac arrhythmias, which in the worst case can lead to sudden cardiac death.
Complications
Mitral valve prolapse syndrome primarily causes discomfort to the heart.These complaints can have a very negative effect on the patient’s life expectancy and reduce it significantly. In most cases, the patient experiences inner restlessness and shortness of breath. Furthermore, those affected can also suffer from a fear of death and experience severe fatigue. In most cases, the mitral valve prolapse syndrome makes it impossible for the patient to perform strenuous activities or sports. The result is fatigue and the patient’s ability to cope with stress is reduced. The shortness of breath can also lead to a loss of consciousness, which can further lead to various complaints or injuries. In the worst case, the patient dies of sudden cardiac death. If acute emergencies occur, treatment with the help of medication is necessary. Complications do not usually occur. However, not all symptoms can be completely eliminated, so in some cases surgical intervention is necessary. In most cases, mitral valve prolapse syndrome is associated with a reduction in life expectancy.
When should you see a doctor?
Because mitral valve prolapse syndrome is a congenital disorder, the first irregularities may appear shortly after birth. Intensive examination is necessary as soon as abnormalities of the heart rhythm occur. If the heartbeat is interrupted, the heart races or there are strong palpitations, a visit to the doctor should be made. Normally, newborns are examined in routine examinations immediately after delivery. If the symptoms of the disease are already pronounced at this stage, they are automatically noticed by the attending pediatricians. Further tests take place to enable a diagnosis to be made. Parents should consult a physician if no special features are detected in the initial examinations, but the symptoms become apparent during the first months or years of life. If the resilience of the growing child is reduced in direct comparison with peers, the observations should be discussed with a physician. If respiratory distress, a restlessness or increased fatigue occurs, a physician is needed. In the event of acute respiratory distress, an ambulance should be alerted. At the same time, first aid measures are to be administered by persons present so that sufficient medical care is provided until the arrival of the emergency physician. Reduced performance, lack of motivation, fatigue and sluggishness are indications of impaired health. A visit to the doctor is necessary as soon as the complaints persist or increase.
Treatment and therapy
If mitral valve prolapse does not cause symptoms, medical treatment may not be necessary. If mitral valve prolapse syndrome is present and results in symptoms, medical therapy for cardiac arrhythmias or angina pectoris symptoms is possible. In this case, the patient receives either antiarrhythmic drugs or beta-blockers. If mitral valve prolapse leads to valve insufficiency, extensive medical therapy is required. This must be accompanied by close medical supervision. A malfunction of the mitral valve can be compensated by the heart for a certain period of time, as it has a reinforcing effect on its performance. However, rupture of an overstressed optic nerve may abruptly worsen the condition of the valve function, resulting in acute respiratory distress. In such cases, emergency medical treatment is required. Furthermore, there is a change in the affected ventricle due to increased stress. While the volume of the ventricle expands, its musculature thickens at the same time. This threatens to lead to cardiac insufficiency, which can no longer be remedied. In most cases, surgery of the mitral valve is then necessary. This usually takes place in a minimally invasive way. Sometimes the mitral valve is completely replaced. If a pronounced mitral valve prolapse syndrome is present, antibiotics should always be given as a preventive measure before minor surgical procedures or dental treatment. Even if there are no symptoms due to mitral valve prolapse, doctors recommend check-ups every three to five years. In the context of mitral valve insufficiency, check-ups must be performed every six to twelve months.
Outlook and prognosis
The prognosis for mitral valve prolapse syndrome is generally very good. In most cases, no symptoms occur at all, which is why patients can forgo therapy. Only occasional control examinations are due. One presentation every few years is sufficient. The quality of life is not affected. Life expectancy remains at the previous level. Statistically, three percent of all patients suffer complications. These are not infrequently severe. One reason for the life-threatening situations is that an adverse change was detected too late. Indeed, a late-stage diagnosis significantly worsens the outlook. Specifically, the risks include endocarditis, cardiac arrhythmias, and mitral valve regurgitation. As will be seen, deteriorations in health extend to the heart, which explains the existential dimension of mitral valve prolapse syndrome. If a patient survives a complication, long-term limitations cannot be ruled out. Thus, permanent treatment may be indicated. In everyday life, changes have to be accepted. Contrary to what is sometimes assumed, mitral valve prolapse syndrome is not an age-related phenomenon. Most patients are between the ages of 20 and 40. Women are considered a little more susceptible compared with men.
Prevention
There is no specific prevention of mitral valve prolapse syndrome. Thus, the precipitating causes are still unknown.
Follow-up
Since mitral valve prolapse syndrome is a congenital disease, there are usually no special measures of aftercare available to the affected person in this case. Therefore, the patient should ideally consult a physician at an early stage in order to avoid complications or other complaints in the further course of the disease. If the patient or parents wish to have children, genetic testing and counseling should be performed to prevent recurrence of the syndrome. Most sufferers of this disease are dependent on taking various medications that can alleviate and limit the symptoms. The affected person should pay attention to a regular intake and also to the correct dosage of the medication in order to alleviate and limit the symptoms. Regular checks of the internal organs are also very important, and the heart in particular should be checked. In general, a healthy lifestyle can also have a positive effect on the course of mitral valve prolapse syndrome, and a balanced diet should also be observed. Further measures of aftercare are usually not available to the affected person with this disease. Possibly, the life expectancy is reduced by this disease.
This is what you can do yourself
Mitral valve prolapse syndrome carries very different risks depending on its manifestations. Low-grade mitral valve prolapse often goes undetected and causes no or only mild symptoms, so there is no adjustment in everyday life. In cases where the functional abnormality of the mitral valve is detected but minimally invasive or surgical intervention is not (yet) recommended, an adjustment of behavior in everyday life and self-help measures can improve the general condition subjectively and also objectively. In principle, physical and psychological stress peaks should be avoided, because a sudden flooding of the body with stress hormones leads to an abrupt increase in blood pressure during the beating phase (systole) of the ventricles. The protrusion of one or both leaflets of the valve into the left atrium may be increased as a result. On the other hand, it is quite helpful to stimulate the heart to strengthen by light to moderate endurance exercise. Relaxation exercises such as autogenic training, breathing exercises, yoga and other techniques are well suited for dealing with acute stress situations in a way that is gentle on the heart. In terms of sporting activities, endurance sports such as Nordic walking, swimming, cross-country skiing and golfing are helpful in strengthening the heart without causing irreversible thickening of the heart walls. It is also important to be attentive to the subjective state of mind when exercising, without being fixated and focused on it.