MITRAL VALVE PROLAPSE

MITRAL VALVE PROLAPSE

DEFINITION

Mitral valve prolapse is a deformity that usually produces no symptoms.

Mitral valve prolapse (MVP) occurs when the leaflets of the mitral valve bulge (prolapse) into the heart's left upper chamber (left atrium) like a parachute during the heart's contraction.

Mitral valve prolapse sometimes leads to blood leaking backward into the left atrium, a condition called mitral valve regurgitation.

CAUSES

The causes for mitral valve prolapse may be an inherited connective tissue disorder resulting in enlargement of one or both of the mitral valve leaflets, but in many cases the cause is unknown.

RISK FACTORS

Mitral valve prolapse can develop in any person at any age.

Serious symptoms of mitral valve prolapse tend to occur most often in men older than 50.

Mitral valve prolapse can run in families and may be linked to several other conditions, such as:

·        Marfan syndrome

·        Ehlers-Danlos syndrome

·        Ebstein's anomaly

·        Muscular dystrophy

·        Graves' disease

·        Scoliosis

CLINICAL MANIFESTATION

Although mitral valve prolapse is usually a lifelong disorder, many people with this condition never have symptoms. When diagnosed, people may be surprised to learn that they have a heart condition.

When signs and symptoms do occur, it may be because blood is leaking backward through the valve (regurgitation). Mitral valve prolapse symptoms can vary widely from one person to another. They tend to be mild and develop gradually. Symptoms may include:

·        A racing or irregular heartbeat (arrhythmia)

·        Dizziness or lightheadedness

·        Difficulty breathing or shortness of breath, often when lying flat or during physical activity

·        Fatigue

·        Chest pain that's not caused by a heart attack or coronary artery disease

·        Anxiety

DIAGNOSTIC FINDINGS

·        Echocardiogram : An echocardiogram is usually done to confirm the diagnosis and determine the severity of the condition. An echocardiogram is a noninvasive ultrasound evaluation of the heart.

·        Chest X-ray : A chest X-ray shows a picture of the heart,It can help show if the heart is enlarged.

·        Electrocardiogram (ECG) :To detect irregularities in the heart's rhythm and structure, including mitral valve prolapse

·        Stress test

·        Coronary angiography

PATHOPHYSIOLOGY

In mitral valve prolapse, a portion of one or both mitral valve leaflet balloons back into the atrium during systole.

Rarely,ballooning stretches the leaflet to the point that the valve does not remain closed during systole. Blood then regurgitates from the left ventricle back into the left atrium.

About 15% of patient who develop murmurs eventually experience heart enlargement, atrial fibrillation, pulmonary hypertension, or heart failure.

MANAGEMENT

Ø Medical :-

Medical management is directed at controlling symptoms.

v Beta blockers;For patient having irregular heart beat.

v Diuretics ; These are prescribed to drain fluid from the lungs,if symptoms is due to accumulation of fluid.

v NSAID e.g Aspirin

v Anticoagulants — such as warfarin, heparin,— prevent blood from clotting

v Antibiotic prophylaxis therapy to prevent infection

Ø   NURSING

v Health education of client about the diagnosis and the possibility that the condition is hereditary.Firs degree relatives (e.g parents,siblings) may be advice to have ECG done.

v Health educate patient how to minimize risk and preventive measure to take.

v The patient is educated and counsels on the need for prophylactic antibiotics therapy to prevent infection into the blood stream.

v The nurse explores diet,activity, sleep and other lifestyle factors that may correlate with symptoms.

v Assessment of patient from head to toe and for any signs and symptoms: chest pain,fatigue, dizziness. e.t.c

v The patients heart rate,blood pressure, and respiratory rate are measured. Heart and lung sounds are auscultated and peripheral pulses palpated for record purpose.

v If patient is to undergo any surgical valve replacement or valve repair, the nurse teaches the patience about procedure and anticipated recovery.

Ø Surgery

v Valve repair

v Valve replacement

PREVENTION

You can't prevent mitral valve prolapse. However, you can lower the chances of developing the complications associated with it by making sure the patient take their medications, if any, as directed.

Complications

Although most people with mitral valve prolapse never have problems, complications can occur. They may include:

·        Mitral valve regurgitation. The most common complication is a condition in which the valve leaks blood back into the left atrium (mitral valve regurgitation).

·        Heart rhythm problems (arrhythmias). Irregular heart rhythms most commonly occur in the upper chambers of the heart.

·        Heart valve infection (endocarditis) ; Endocarditis is an infection of the inner lining of the heart.

People at high risk of endocarditis may be prescribed antibiotics before certain dental and medical procedures, to reduce the risk of infection.

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