C. Mitral Valve Prolapsed

The valvular mitral cusps bulge into the left atrium when the left ventricle contracts, Allowing leakage of small amount of blood into the atrium. Peoples who with mitral valve prolapse may have mitral regurgitation ranging in severity from none to severe. Persistent billowing of the valve causes stress to the underlying chordae and papillary muscles. Progressive mitral valvular degeneration can result in increasingly severe mitral regurgitation. If chordal rupture happen, severe mitral regurgitation develops.



Causes of Valvular Mitral Prolapsed

1. Connective tissue disorders (systemic lupus erythematosus,Marfan’s syndrome): the chordae tendineae can become elongated, which allows the mitral valve leaflets to open backward into the atrium during systole.

2. Congenital heart disease: autosomal dominant inheritance seen in young women.

3. Acquired heart disease (coronary artery disease, rheumatic heart disease):causes valve bulge due to inflammation process.

4. The most common cause of mitral valve prolapse is myxomatous degeneration. Marfan's syndrome, Ehlers-Danlos syndrome, rheumatic heart disease, and ischemic papillary muscle dysfunction also cause mitral valve prolapse.





Sign and Symptoms of Mitral Valve Prolapsed

Fatigue and weakness, why? Because, during ventricular contraction the blood backs up into left atrium. The left side of heart, both the atrium and ventricles becoming hypertrophy and dilate. Cardiac output also will decreases. There is an imbalance between supply and demand, causing fatigue .


Angina, Palpitations, Migraine headaches, Dizziness, Orthostatic hypotension, Mid-to-late systolic
click; late systolic murmur.

Most patients with mitral valve prolapse are asymptomatic. Patients may complain of sharp, localized chest pain that is usually brief in duration.




Diagnostic Test for Valvular Mitral Regurgitation

1. Echocardiography plays a key role in the diagnosis of mitral valve prolapse. Abnormal systolic motion of one or both of the mitral valve leaflets superior to the annular plane can be seen. Doppler echocardiography gives additional evidence of valve regurgitation.

2. Electrocardiography is nondiagnostic. The ECG may be normal or have nonspecific ST-T–wave changes in the inferior leads (II, III, and aVF) and occasionally in the anterolateral leads (V4 through V6). The ST-T–wave changes may become more notable with exercise. Some have suggested that these changes occur secondary to ischemia from increased tension on the papillary muscles.41 Premature atrial and ventricular complexes may also be identified Exercise testing may be used to help rule out the etiology of the chest pain.

3. Auscultation: to reveal clicking sound.

4. Echocardiography: to show the prolapsed and to role out the severity of regurgitation if present.

5. Electrocardiography (EKG): may reveal atrial or ventricular arrhythmia.

6. Holter monitor for 24 hours: may will show arrhythmia.





Treatment

1. Decreased caffeine, alcohol, tobacco, stimulant intake: relieve palpitations
2. Fluid intake: to maintain hydration
3. Beta-blocker: to slow heart rate; reduces or relieve palpitations
4. Antibiotics should be given before medical procedures: prevention against bacterial infection of heart valve.
5. Anticoagulants: to prevent thrombus formation or blood clot
6. Antiarrhythmia drugs to prevent arrhythmias.