Congenital valve malformations of the heart have an estimated prevalence of around 5% of newborns, and are present in 20% to 30% of congenital cardiovascular malformation cases. The mitral valve is often affected. The more moderate and symptomless mitral valve prolapse (or Barlow syndrome ) is also common in the general population, affecting 1 in 40 individuals of all ages. Congenital non-syndromic mitral valve prolapse results from an abnormality in the embryonic development of this valve . However, for most affected subjects, its consequences on cardiac function are not observed until adulthood.
What is a mitral prolapse?
Mitral valve prolapse (MVP) is a common disorder that affects one of the heart valves. The valve cannot close properly and is therefore ballooning in the left atrium; this bloating is thus called “prolapse”.
The malformation leading to mitral valve prolapse results from excessive secretion of extracellular matrix proteins by interstitial cells in the valve leaflets, resulting in myxomatous or fibro-elastic degeneration of the valve. Leakage of blood to the left atrium during ventricular contraction (mitral regurgitation) gradually impairs the function of the left ventricle, requiring surgery to repair or change the valve.
What are the symptoms of mitral prolapse?
Sometimes asymptomatic, mitral insufficiency is discovered by chance in adulthood on auscultation with the presence of a systolic murmur that is usually mild, in fact covering all or part of the systole and radiating towards the tip of the heart.
Shortness of breath:
Shortness of breath (dyspnea) is the first and most common sign of mitral prolapse. Variable, it can be triggered by an effort so far achieved without problem. Depending on the course of the disease, it can nevertheless become less and less intense. It can occur while resting preventing later sleeping flat, the addition of pillows leading to sleep sitting up.
It can finally occur suddenly, with an awakening during the first hours of sleep and constitute a real emergency: it is paroxysmal dyspnea with acute edema of the lung , sudden and dramatic installation, which requires urgent intervention.
Tachycardia:
Tachycardia is an acceleration of the heartbeat and pulsations felt in the chest, often after physical exertion. A heart that beats too quickly is also a common sign of heart failure .
Palpitations:
Palpitations are an irregular heartbeat . They occur quite frequently and often at rest.
Chest pain:
Perceived as chest pains that can last a few seconds or several hours, these pains are more manifested at rest. Chest pain could in particular suggest a broken cord .
Anxiety:
There are often panic attacks and a sudden feeling of anxiety or imminent death, especially at night.
Tiredness :
Often mistakenly attributed to chronic fatigue syndrome ; fatigue, dizziness, and weakness are quite common.
Orthostatic hypotension:
Orthostatic hypotension is a sharp drop in blood pressure below normal when the person stands up, causing dizziness for a few seconds to a few minutes.
Course and complications of mitral prolapse
At the same time as the severity of the mitral prolapse develops an inevitable progressive mitral insufficiency resulting in heart failure, which can even be the cause of acute edema of the lung after rupture of the cord by overloading the support apparatus.
An increasing volume overload of the left ventricle also favors ventricular arrhythmias that can lead to sudden cardiac death, with a percentage of 1% in severe mitral insufficiency. But this percentage may be higher in cases of coronary heart disease or high blood pressure with left ventricular hypertrophy.
If severe mitral insufficiency sets in, the patient should undergo surgical correction . Early reconstruction of the valve, without life-long anticoagulation being necessary, makes it possible to prevent a mechanical prosthesis, with its morbidity and mortality, from becoming essential. But, if following the overload of the atrium in mitral insufficiency an atrial fibrillation has already set in, it is in any case necessary to start a life-long anticoagulation. The manifestation of heart failure with an ejection fraction of less than 50% clearly worsens the prognosis, and pump function can no longer normalize postoperatively.
Mitral prolapse is currently the most common indication for mitral reconstructive surgery .
What about control consultations?
Mitral prolapse without insufficiency should be monitored approximately every year from the time of diagnosis by the cardiologist, looking for mitral insufficiency . A color Doppler echocardiogram is normally necessary in the presence of mitral insufficiency on auscultation, to document the basic anatomy and severity. The intervals between clinical and cardiological checks are determined by the severity of the insufficiency and / or by the appearance of new clinical features (for example, valve enlargement).
Mitral insufficiency is at risk of bacterial endocarditis
Also called Osler’s disease, bacterial endocarditis is a serious infectious complication that must be prevented :
For this :
- Do not leave an unexplained fever without diagnosis and quickly seek medical advice to identify the germ (samples, search for infectious agents in the blood, blood cultures and prescription of antibiotic therapy without delay.
- Have a dentist watch for microbial deposits, and keep teeth in good condition. In the event of dental treatment, inform the dentist of the existence of a mitral insufficiency at risk of endocarditis.
- Have antibiotic coverage for certain surgical procedures or endoscopic explorations on the digestive system, the urinary system or the airways, certain skin procedures and therefore inform the doctor of the existence of mitral insufficiency.
Some naturopathic tips to help you prevent disorders associated with mitral prolapse
Understanding your illness is part of the treatment and care . If you have any questions or uncertainties, let your doctor or cardiologist know.
Is your diet suitable?
- Avoid salt, when cardiac decompensations have already occurred: The first recommendation is a low-salt diet of around 4 to 6 g of salt per day. Do not add salt at the table, reduce the salt when cooking and eliminate the main foods rich in salt such as cold meats, certain cheeses, pastries and pastries is a first step.
- A reduction in lipids and especially saturated lipids, ie animal fats (red meats, cold meats, cheeses, etc.) is essential!
- Low calorie diets (<1200 K calories / day) are not recommended. A moderate reduction in intake is better tolerated and gives better long-term results
- Alcohol consumption should be moderate and limited to wine. 2 to 3 glasses of wine a day with one or two days a week without consumption: alcohol has a direct effect on blood pressure.
Physical activity :
- Authorized physical activity can only be determined with the cardiologist. It depends on the extent of the mitral leak and its evolutionary stage. Competition is usually contraindicated, as in most heart conditions. As a general rule, avoid all so-called “cardio” sports.
- Avoid shortness of breath to live normally.
Your habits :
- Avoid cardiac stimulants (caffeine).
- Ban all chemical substances that accelerate the heart rate (drugs, medication, etc.).
- Avoid tobacco!
- Limit stress and anxiety.
- Watch out for the accumulation of fatigue.
Your sleep:
- Get at least 8 hours of sleep per night.
- If you experience shortness of breath when lying down, tell your doctor straight away!
Weather :
- Heat: Be careful! Make sure you stay hydrated!
- Cold: Beware of walking or any effort that requires more energy from your heart!
- Pay attention to the altitude, again depending on the severity of your heart failure
Are there any natural treatments for this pathology?
Unfortunately no, there is no treatment (natural or not) for this pathology before the complications. Surgical treatment is the only real treatment: Mitral valve surgery . The timing of the indication for this operation is therefore a real issue. Only the above advice and a suitable lifestyle are an integral part of the management of mitral prolapse.
Medical bibliographic sources and clinical trials :
- Combs MD, Yutzey KE. Heart valve development: regulatory networks in development and disease. Circ Res 2009
- Levine RA, Hagège AA, Judge DP, et al. Mitral valve disease: morphology and mechanisms. Nat Rev Cardiol 2015
- Delling FN, Vasan RS. Epidemiology and pathophysiology of mitral valve prolapse: new insights into disease progression, genetics, and molecular basis. Traffic 2014
- Grigioni F, Avierinos JF, Ling LH, Scott CG, Bailey KR, Tajik AJ, et al. Atrial fibrillation complicating the course of degenerative mitral regurgitation: determinants and long-term outcome. J Am Coll Cardiol 2002
