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Forum Name: Valvular Heart Diseases

Question: MVP, MVR and Tricuspid Regurgitation


 Azalea - Wed Jan 28, 2009 3:19 am

Hi there,

I'm 30 years old female and I have been diagnosed with Mitral Valve Prolapse (MVP) in 2006. It may sound strange since I might have had it since I was born. I have always wondered if some of the symptoms that I have experienced are due to MVP such as:

- Anxiety, nervousness
- Very sharp chest pain which happens very rarely ( maybe once a year or less) and it lasts less than a minute. When this happens I have to hold my breath because of the unbearable pain.
- Having difficulty breathing especially when I'm stressed out.
- Having fast heart rate during exercise - up to 187 beats per minute. During rest period my heart rate is 70 to 90 per minute.

My other questions are:

- Can mild MVP progress into moderate and eventually severe without any infection problem?
- What can cause it?
- Could that possibly be caused by doing heavy physical activities or stress?
- What is the range for a normal heart rate during exercise?

Here is the summary of my Eco reports:

My echocardiography report in 2006 showed that I had a mildly redundant mitral leaflet with trace mitral regurgitation, trace tricuspid regurgitation and normal heart size. The 2007 report showed mild prolapse of anterior mitral leaflet with moderate mitral regurgitation (eccentrically directed posterio-laterally and may be underestimated), moderate tricuspid regurgitation and mild left atrial enlargement.


2006 report: 2007 report:

Aorta: Normal Normal
Root Diameter: 33 mm 35mm
Left Atrium: Int. Diameter 37 mm 41mm
Left Ventricle: Normal Normal
Posterior Wall Thickness
Diastole: 10mm 10mm
Septal Thickness:
Diastole: 10mm
Diastolic dimension: 49mm 45mm
Systolic dimension: 27 22mm
Ejection friction: 65% 67%
No pericardial effusion. No pericardial effusion.


Does this mean that my prolapse has really worsened? If it has what could have caused it?

Has my tricuspid valve also been effected since my mitral valve has worsened? The evidence is that the trace regurgitation had progressed into moderate regurgitation.

Can this condition progress into cardiomyopathy?


Why my diastolic and systolic dimensions decreased on 2007 report considering the report also shows that my heart has enlarged?

I am very worried about my condition since I am planning to get pregnant. I cannot ask my physician about this because I moved to another state. I would appreciate if anyone can answer my questions and give me advice for my heart condition.

Thank you very much.
 John Kenyon, CNA - Tue Feb 03, 2009 2:01 am

User avatar Hi there -

MVP is one of the most common "abnormal" findings, with estimates of up to 15 per cent of the population having some degree of it. While there are two kinds, the far more common type is often considered a "variant of normal;" the other more rare sort is a degenerative myxotomous disease that can be progressive and sometimes requires surgical intervention. This latter type is usually easily visualized on echocardiogram as it generally looks much different from the "normal" type.

As for the variations in your two echo reports: both are within normal limits. It's important to understand that it would be unusual for two different exams on two different days to yield exactly the same results. MVP is especially variable from day to day, and in some patients it cannot be seen at all on some days, while is fairly clear on others. While the echocardiogram is an invaluable tool, it only "sees" what is there on a given day, and to some degree is influenced also by the technician's style. Given these vagaries, your two reports are very consistent and very normal with the exception of "moderate" mitral regurge, which is greater than "trace", which almost everyone has at some times. For this reason it should be followed, even though the likelihood of it progressing to a problematic degree is very slight.

As for the symptoms you describe, they are all commonly associated with MVP syndrome, a syndrome which only occurs in a minority of the very many people who are known to have MVP. This, of course, is still a relatively rather large number of people. The sharp, stabbing pains, anxiety, perceived difficulty breathing (yet exercise is generally well-tolerated), and sometimes frequent premature heartbeats ('flutter" sensations or sense of a "skipped" beat), unwarranted fatigue (again, with exercise generally well-tolerated), panic attacks, and even a faster-than-average resting heart rate, are all classic for both anxious patients and patients with MVP syndrome. It is unclear what the connection is between the "redundant" leaflet tissue and the symptoms, but it's common enough to be considered classic.

The echo reports, side by side, do not indicate that your heart has enlarged, only that there are differences between the two exams, but that both are within normal limits. Again, this is the rule, and to have an exam exactly replicate a previous one would only happen in an android with a mechanical heart or if someone had accidentally pulled up the previous report by accident.

The best number in the bunch is yuor ejection fraction, which is preferred to be higher rather than lower, although the normal range is between 50 and 70+. Yours was already very good and the second time was even a little better. In both cases it was excellent. It is the most crucial number of them all. Your resting heart rate is also normal.

Your prolapse may have increased slightly, or it may have simply been more prominent on the day of the second exam than the first one. Because of this you will likely have the test done again, and if there is an increase in any of the prolapse or regurge numbers and you also have symptoms which might relate to that, then you'd be evaluated further. However, this is very unlikely, since there is no mention of myxotomous disease. The next exam could as easily show an "improvement." This is the nature of these things generally.

The situation, as described in your two reports, would not cause cardiomyopathy, and there is no reason to assume that might happen in the future. Generally a seriously failing mitral valve with myxotomous disease is most likely to cause a weakening and dilated cardiomyopathy of the left ventricle, but so far you have nothing to suggest this is taking place or that it will. Your exams, again, are very normal with that one exception of "moderate" regurge, which could stay that way or could be less (or missing) during the next exam.

Oh! Also, no, MVP cannot be caused by heavy lifting or exertion. The MVP syndrome symptoms, however, are sometimes triggered initially by stress, at which time the patient discovers he or she has MVP. MVP is almost always genetic in origin, and is rarely acquired. One way it can be acquired is by use/abuse of amphetemines, although this is difficult to prove because it is such a common condition anyway.

You're in very good company. There are millions of people out there with similar MVP findings. Some have more or less severe symptoms associated with it, and the majority are completely unaware of it.

I hope this helps ease your your concerns about this very common, sometimes annoying, very rarely serious problem. Good luck to you, and please do follow up with us as needed.
 Azalea - Tue Feb 03, 2009 7:00 pm

Hi John,


Thank you very much for answering my questions. It was very helpful and know I feel more relax. I will follow up with you if I have more news or other concern.


Regards,
Azalea

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