Heart Valves: Like Swinging the Doors of a Saloon

W. Gifford-Jones, M.D.

PureInsight | July 2, 2006

[The Epoch Times] What's one of the worst results from visiting a
doctor? It's getting the impression that a serious problem has been
diagnosed when the exact opposite is true. It's called "iatrogenic
disease," which means a disease created by a doctor. And when patients
are told they have mitral valve prolapse (MVP), it often opens a
Pandora's box of anxiety.

The mitral valve separates the two left chambers of the heart. The
valve resembles a tall bishop's hat called a miter, and each time the
heart beats, it opens like the swinging door of a saloon. But after
opening, it then firmly closes while the next beat of the heart pumps
blood to the body.

MVP occurs when the valve does not provide a perfect fit when the heart
beats. In some cases this allows blood to leak through the valve to the
upper chamber of the heart, the left atrium - a condition known as
mitral regurgitation. MVP may then cause a faint murmur or click.

What causes MVP? A saloon's swinging doors often develop loose, rusty
hinges. Similarly, the mitral valve is attached to the heart's muscle
by tough cords and if the cords become loose and floppy, the valve
doesn't function 100 percent. But if you are told you have this
problem, it's far from being the end of the world.

Mitral valve prolapse used to be diagnosed more frequently, suggesting
it affects 5 percent of men and 17 percent of women. But with new
techniques such as echocardiograms, we now know it's not so common and
affects only 2.4 percent of both sexes.

Some people are born with this condition. Studies also show that MVP
sometimes occurs in several family members, suggesting that genetics
play a role.

The great majority of people with MVP have no idea it's present. Others
complain of shortness of breath, palpitations, fatigue and panic

But people without MVP also experience similar symptoms, so it's
unclear if MVP is the sole cause of these troubles. What often happens
is that these symptoms begin after the diagnosis has been made, so
anxiety becomes the trigger.

 In the past, MVP was associated with stroke, abnormal heart
rhythms and heart failure. But now, there is comforting news for those
who receive this diagnosis.

Dr. Brian Griffin, a mitral valve expert at the Cleveland Clinic,
reports that several studies have shown that strokes, mini-strokes and
disturbances in heart rhythm are rare in patients who have
uncomplicated MVP. Furthermore, the risk of sudden death from cardiac
arrest is similar to that of the general population.

If mitral regurgitation is present, a small amount of blood escapes
through the swinging-door valves with each beat of the heart. This
leakage from the left ventricle can continue for many years without
causing symptoms.

Mitral regurgitation, however, places more stress on the heart since it
has to work harder to compensate for the backward flow of blood. This
may cause the heart to enlarge over a period of time. Mitral
regurgitation is therefore more likely to cause symptoms than
uncomplicated MVP. These patients should be reexamined every three
years to see if there's been any change in heart function.

Most people with MVP require no treatment. But those who have mitral
regurgitation are advised to take antibiotics prior to dental
procedures, surgery or other invasive treatments. These procedures
sometimes result in bacteria being introduced into the bloodstream. The
concern is that bacteria may infect a weakened valve, causing infection
of the heart valve and lining of the heart - a condition called
endocarditis, a potentially fatal infection.

A small number of patients with severe MVP and regurgitation may eventually need an operation to repair or replace the valve.

Patients diagnosed with MVP should remember that few things in life are
perfect. I often tell patients that the definition of a well patient is
one who hasn't seen enough doctors or had enough tests done. Technology
has advanced to the point where some abnormality can be found in all of
us if one looks hard enough. So there's no need for the majority of
people with MVP to have sleepless nights.

Dr. Gifford-Jones is a medical
journalist with a private medical practice in Toronto. His articles
appear in numerous newspapers.

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