Mechanism of chest pain in mitral valve prolapse include
- Mitral valve has pain fibers , the myxomatous degeneration of the valve tissue generates pain .* (Not much evidence )
- Mitral valve stress, strain , stretch and bending.
- Mechanical stretch of papillary muscle or LV free wall (dimple ? ) as the mitral valve prolapse into LA.
- It is a central pain perception disorder .Panicky and anxiety reactions included
- It is not chest pain at all it is simply a feeling of palpitation .
- Associated ischemic heart disease
The commonest mechanisms are response 4 and 5 .
The evidence lies in the fact , many of these people begin to complain of chest pain only after being aware this problem. MVPS is often a fancy entity created by cardiologists which unfortunately has labeled many of the normal general population as cardiac patients. Barlow who described this entity decades ago would have never imagined it would be so popular and subjected to mis-use . We have proposed a solution for this . The diagnosis of MVPS shall not be mentioned unless it is obvious and fulfill a strict criteria . The commonest error we make is an elongated , redundant , hyper mobile mitral leaflet at as MVPS.
It is expected , true MVPS must have all of the following three criteria
- Thickened leaflets
- Clear prolapse of at least one leaflet in long axis view beyond the plane of mitral annulus
- At least some degree of mitral regurgitation must be present
Dr.S.Venkatesan MD 