Ever since Barlow reported this entity , mitral valve prolapse was made a fascinating disease of the heart . Cardiologist’s honeymoon with this disorder lasted for too long . . . four decades ?. It is probably the most common valvular disease physicians diagnose .The importance of which was exaggerated and at one point of time the term was getting abused.
So the criterias were made strict in later decades . Now unless MR is present along with valve thickening MVPS should not be diagnosed.
Atypical chest pain
Asymptomatic pre excitation
Anxiety state including panic attacks (More common after informing the patient about MVPS.)
Here is Monograph with excellent Images.I think this is available free with Google Books.
Classical finding is mid systolic click with late systolic murmur.
But in reality, It can present with any of the following
- Early -mid systolic click, with murmur
- Only murmur
- Only click
- No click, no murmur -Only Echo evidence of MVPS
- Clinical Click but no MVPS in echo*
The timing of click and murmur depends on the LV volume and the contractile force.Status of pap muscle is also important.There are studies which show dehydration can induce MVPS and hydration corrects it .One can guess the anatomical importance of this entity.
Currently myxamatous valves with clear prolapse with at least grade 1 MR (Not the often reported trivial MR !) only be labelled as MVPS.All other forms increase patient anxiety , lead to unnecessary echocardiogram and of course promotes physician affluence !
This was first described by Reid .A redundant lengthy chrordae folds unfolds making a noise. Mitral valve as such may not prolapse into LA and hence echocardiogram would be normal.
Origin of chest pain in MVPS
It is still a mystery out there regarding the origin of chest pain in MVPS.
It is thought to be a mechanical pain from any of the following
- Myocardial stretch
- Ischemic unlikely
*currently it is believed to be a pain perception problem at cortical level.
- Non specific T wave inversions in inferior and lateral leads common
- Early repolarization patterns are common
- WPW has a rare association
False positives excercise stress tests are reported often .
- Echo is to be primarily blamed for the rampant diagnosis of this entity .
- In deserving patients Echo is vital to define valve anatomy and MR assessment.
- TEE will help us the exactly identify culprit scallops (Commonly P2 A2) and facilitate the surgeon during repair.
Many of the MVPS patients end up in inappropriate CAGs ( Decent term for guideline violation !).As a rule , almost all will have normal coronary angiogram.
Incidence of Ventricular arrhythmias
VPDs can be common in MVPS. ( Myocardial /Pap muscle Stretch induced ?)
Sudden cardiac death is no more common than general population .So no worries .
Generally not required unless significant MR present
Most( 99.9%) will require no treatment . Only reassurance .This , if properly done shall be a one time process.There are many young persons who report to the physicians periodically to get reassured (Each time spending 500 Rs !) This is called reassurance failure .Here , the physician needs to be urgently changed.
Many times , parents , spouse and relatives will require more counselling than the victim of mvps !
Few with progressive MR will need close monitoring (Eg Associated Marfan )
Tall, thin individuals will require aortic size monitoring as well.
Highly anxious persons will do well with beta blockers. Panicky individuals require sedatives as well.
Very severe MR needs surgery .Surgeons are encouraged to repair a myxamatous valve than to replace it .
(MVPS in association with other structural disease like Ischemic, RHD, Infective endocarditis are important pathological entities that need to be discussed separately )
MVPS is a benign disorder (Rather it can be called as a variation in mitral valve morphology ). Only In a fraction of population it can take a true pathological course. Cardiologist and physicians should disseminate this message widely to their draining population.Unfortunately in the current state of affairs , MVPS seem to be less dangerous for human community than the events that follow the misplaced diagnosis of this entity. In the name of health awareness huge costs , time and resources are wasted in dealing with this almost . . .non entity !