mitral

What is the mitral valve?

The mitral valve is one of the four valves in your heart. Heart valves have flaps that open and close. The flaps make sure that blood flows in the right direction through your heart and to the rest of your body. When your heart beats, the flaps open to let blood through. Between heartbeats they close to stop the blood from flowing backwards.

The mitral valve opens to let blood flow from your heart's upper left chamber to the lower left chamber. When the lower left chamber contracts (squeezes) to pump blood to your body, the mitral valve closes tightly to keep any blood from flowing backwards.

What is mitral valve prolapse (MVP)?

Mitral valve prolapse (MVP) happens when the flaps of the mitral valve become floppy and don't close tightly. In some cases, blood may leak backwards through the valve to the chamber it came from. This is called backflow, or regurgitation. When there is a lot of mitral valve backflow, the heart can't push enough blood out to the body.

But most people who have MVP don't have any backflow. In fact, MVP doesn't cause any health problems for most people who have it.

Who is more likely to develop mitral valve prolapse (MVP)?

Anyone can have MVP. Most people who have it were born with it. MVP tends to run in families, but researchers don't know the exact cause.

You may be more likely to develop MVP if you:

• Are older. The risk of MVP increases as aging affects the valve.
• Had rheumatic fever, a disease that can develop after a strep throat infection and cause damage to the heart valves.
• Were born with a connective tissue disorder, such as Marfan syndrome or Ehlers-Danlos syndrome.
• Have Graves' disease, a type of thyroid condition.
• Have scoliosis (a side-to-side curve of the spine) or other problems with the bones of your body.
• Have some types of muscular dystrophy.

Mitral valve prolapse with backflow is most common in men and people who have high blood pressure.

What are the symptoms of mitral valve prolapse (MVP)?

Most people who have MVP don't have any symptoms. But if it does cause symptoms, they may include:

• Heart palpitations (feeling that your heart is fluttering, skipping beats, or beating too hard or too fast)
• Shortness of breath (feeling like you can't get enough air)
• A cough
• Fatigue, dizziness, or anxiety
• A migraine
• Chest pain

What other problems can mitral valve prolapse (MVP) cause?

In rare cases, MVP can cause other problems. They're most often caused by backflow. They can include:

• Arrhythmia, a problem with the rate or rhythm of your heartbeat
• Endocarditis, an infection in the lining of the heart and heart valves
• Heart failure

How is mitral valve prolapse (MVP) diagnosed?

Health care providers often find MVP during routine health check-ups. If you have MVP, your provider may hear a clicking sound when listening to your heart with a stethoscope. If blood flows backwards through the valve, your heart may also make a whooshing sound called a heart murmur.

You may also need certain heart tests. The most useful test is an echocardiogram, or echo. This is a type of ultrasound that uses sound waves to make a moving picture of your heart.

What are the treatments for mitral valve prolapse (MVP)?

Most people don't need any treatment for MVP. If you have symptoms with little or no backflow, you may only need medicine to relieve your discomfort.

If the amount of backflow is significant, you may need treatment to prevent other heart problems from developing. Treatments may include:

• Medicines to help your heart work better.
• Heart surgery to repair or replace a very abnormal mitral valve with backflow. The goal of surgery is to improve your symptoms and reduce your risk of developing heart failure.

When possible, valve repair is generally preferred over replacement. That's because repairs are less likely to weaken the heart muscle, and they're less likely to cause heart infection.

Can mitral valve prolapse be prevented?

You can't prevent mitral valve prolapse. But if you have mitral valve prolapse, you can help prevent the rare but serious problems it can cause by:

• Brushing and flossing your teeth regularly. That helps keep bacteria out of your bloodstream, which further reduces the rare risk of a heart infection.
• Asking your provider if you need to take antibiotics before dental work or surgery to lower your risk of heart infection. This mostly applies to people who have had valve repair or replacement surgery.
• Getting regular check-ups and taking any medicines that your provider may have prescribed.
• Making heart-healthy habits part of your life to prevent heart disease.

NIH: National Heart, Lung, and Blood Institute

What are heart valve diseases?

Heart valve disease happens when one or more of your heart valves don't work well.

Your heart has four valves: the tricuspid, pulmonary, mitral, and aortic valves. The valves have flaps that open and close. The flaps make sure that blood flows in the right direction through your heart and to the rest of your body. When your heart beats, the flaps open to let blood through. Between heartbeats they close to stop the blood from flowing backwards.

If one or more of your heart valves doesn't open or close correctly, it can affect your blood flow and strain your heart. Fortunately, treatment helps most valve diseases.

What are the types of heart valve diseases?

Heart valves can have three basic kinds of problems:

• Regurgitation, or backflow, happens when the flaps of a valve don't close tightly. This allows the blood to leak backwards. A common cause of regurgitation is prolapse, where the flaps of the valve flop or bulge back. Prolapse most often affects the mitral valve.
• Stenosis happens when the flaps of a valve become thick, stiff, or stuck together. This prevents the heart valve from opening all the way. Not enough blood can pass through the valve. Aortic valve stenosis is a common type of stenosis. It affects the valve that controls blood flow into the large artery that carries blood out of the heart to the body.
• Atresia happens when a heart valve did not form properly and does not have an opening for blood to pass through.

Sometimes a valve can have both regurgitation and stenosis.

What causes heart valve diseases?

Some people are born with heart valve disease. This is called congenital heart valve disease. It can happen alone or along with other congenital heart defects. Heart valve disease can also develop over time as you get older or have certain conditions that affect the heart.

Who is more likely to develop heart valve diseases?

Your chance of having heart valve disease is higher if:

• You are older. With age, the heart valves can become thick and stiff.
• You have or have had other conditions that affect your heart and blood vessels. These include:
  • Rheumatic fever. An untreated strep throat can become rheumatic fever, which can harm the heart valves. The damage may not show up for years. Today, most people take antibiotics to cure strep throat before it can cause heart valve damage.
  • Endocarditis. This is a rare infection in the lining of the heart and heart valves. It is usually caused by bacteria in the bloodstream.
  • A heart attack.
  • Heart failure.
  • Coronary artery disease, especially when it affects the aorta (the large artery that carries blood from the heart to the body).
  • High blood pressure.
  • High blood cholesterol.
  • Diabetes.
  • Obesity and overweight.
  • Lack of physical activity.
• A family history of early heart disease:
  • A father or brother who had heart disease younger than 55.
  • A mother or sister who had heart disease younger than 65.
• You were born with an aortic valve that wasn't formed right. Sometimes this will cause problems right away. Other times, the valve may work well enough for years before causing problems.

What are the symptoms of heart valve diseases?

Many people live their whole lives with a heart valve that doesn't work perfectly and never have any problems. But heart valve disease may get worse slowly over time. You may develop signs and symptoms, such as:

• Shortness of breath (feeling like you can't get enough air)
• Fatigue
• Swelling in your feet, ankles, abdomen (belly), or the veins in your neck
• Chest pain when you're physically active
• Arrhythmia, a problem with the rate or rhythm of your heartbeat
• Dizziness or fainting

If you don't get treatment for heart valve disease, the symptoms and strain on your heart may keep getting worse.

What other problems can heart valve diseases cause?

When the valves don't work well, your heart has to pump harder to get enough blood out to the body. Without treatment, this extra workload on your heart can lead to:

• Heart failure
• Stroke
• Blood clots
• Sudden cardiac arrest or death

How is heart valve disease diagnosed?

Your health care provider may listen to your heart with a stethoscope and hear that your heart makes abnormal sounds, such as a click or a heart murmur. These sounds may mean a valve isn't working normally. The provider will usually refer you to a cardiologist, a doctor who specializes in heart diseases.

The doctor will also listen to your heart and will do a physical exam. You will also likely need to have one or more heart tests.

What are the treatments for heart valve diseases?

Most heart valve problems can be treated successfully. Treatment may include:

• Medicines to control your symptoms and keep your heart pumping well
• Heart-healthy lifestyle changes to treat other related heart conditions
• Surgery to repair or replace a valve

It's possible that you may need surgery, even if you don't have symptoms. Fixing the valve can help can prevent future heart problems.

There are many ways to do heart valve surgery. You and your doctor can decide what's best for you, based on your valve problem and general health. Heart valve repair surgery has fewer risks than heart valve replacement. So, when repair is possible, it's preferred over valve replacement.

In some cases, valve replacement is necessary. There are 2 types of replacement valves:

• Biologic valves made from pig, cow, or human tissue. These valves tend to wear out after 10 to 15 years, but some may last longer.
• Mechanical (human-made) valves usually don't wear out. But with a mechanical valve, you usually have to take blood thinners for the rest of your life to prevent blood clots. And your risk of endocarditis (a heart infection) is higher than with a biologic valve.

NIH: National Heart, Lung, and Blood Institute

What is heart surgery?

Heart surgery can correct certain heart problems when other treatments haven't worked or can't be used.

In some cases, heart surgery may be a medical emergency. For example, surgery for a severe heart attack may need to be done right away. In other cases, you can plan heart surgery ahead of time. Some heart surgeries are major operations, such as heart bypass surgery for blocked arteries in the heart. Other surgeries are more minor heart procedures, such as putting in a pacemaker.

What conditions does heart surgery treat?

There are different types of heart surgery that can help treat many heart conditions:

What conditions does heart surgery treat?What does the heart surgery do?Coronary artery disease (CAD) - when a sticky substance called plaque narrows or blocks the arteries that supply blood to your heart muscle.Makes a new path for blood to flow around the blocked part of an artery in the heart. This is called a coronary artery bypass graft (CABG), or heart bypass. It's the most common heart surgery in adults.Heart valve diseases - problems with the valves that control the flow of blood through your heart.Repairs heart valves.Replaces heart valves with a mechanical valve or a biologic valve made from pig, cow, or human heart tissue.Arrhythmia - problems with the rate or rhythm of your heartbeat. They are caused by changes in the electrical signals that control your heartbeat.Places a pacemaker or an implantable cardioverter defibrillator (ICD) in the chest to correct your heartbeat.Treats atrial fibrillation with small cuts in the heart muscle. The cuts form scars that make a path for the heart's electrical signals (Maze surgery).Heart failure - when your heart is too weak or stiff to pump enough oxygen-rich blood to meet your body's needs.Places a device in the chest which may include:

• An implantable cardioverter defibrillator (ICD) to help prevent sudden cardiac arrest.
• A biventricular pacemaker to coordinate the heart's pumping action so it's more powerful.
• A ventricular assist device to help the heart pump blood.
• A total artificial heart to pump blood for the heart.

Replaces a seriously diseased heart with a heathy heart (heart transplantation).Heart aneurysm - a balloon-like bulge in the wall of an artery. It can be life-threatening if the aneurysm tears or bursts.Repairs or replaces the weak part of a heart artery using a patch or a tube made of fabric.Angina - chest pain from coronary artery disease.Uses a laser to make small channels through part of the heart muscle (transmyocardial laser revascularization).Damaged and abnormal heart structures, including congenital heart defects - heart structure problems that you're born with.Repairs heart damage or problems with how the heart and blood vessels are formed. Repairs depend on the type of defect or damage.What approaches do surgeons use to do heart surgery?

The approach a surgeon uses to do heart surgery depends on your heart problem, your general health, and other factors. Approaches to heart surgery include:

• Open-heart surgery (also called traditional heart surgery) is when the surgeon cuts the chest open to reach the heart. Because it's difficult to operate on a beating heart, medicines are used to stop the heart. A heart-lung bypass machine keeps oxygen-rich blood pumping through the body during the surgery.
• Off-pump heart surgery is open-heart surgery on a beating heart without using a heart-lung bypass machine. The surgeon holds the heart steady with a device. Surgeons may use off-pump heart surgery to do coronary artery bypass grafts (CABG), but only in certain cases.
• Minimally invasive heart surgery uses small cuts between the ribs. The cuts may be as small as 2 to 3 inches. The surgeon inserts tools into the chest through the cuts. This type of heart surgery may or may not use a heart-lung bypass machine.
• Robotic-assisted surgery is a type of minimally invasive surgery. The surgeon uses a computer to control tools on the arms of a robot. This allows the surgeon to be very accurate when doing difficult operations.

What are the risks of heart surgery?

Like all surgery, heart surgery has risks even though the results are often excellent. The risks include:

• Bleeding
• Infection, fever, and swelling
• A problem from anesthesia (medicine that makes you sleep during surgery)
• Arrhythmia
• Damage to the heart, kidneys, liver, and lungs
• Stroke

The risks of heart surgery tend to be higher if:

• The surgery is an emergency.
• You have other medical conditions, including:
  • Diabetes
  • Kidney diseases
  • Lung diseases
  • Peripheral artery disease (PAD)

NIH: National Heart, Lung, and Blood Institute

What is endocarditis?

Endocarditis is sometimes called infective endocarditis. It's a rare, but life-threatening inflammation of the lining inside your heart's chambers and valves (the endocardium).

Endocarditis is usually caused by germs that get into your bloodstream and travel to your heart. Once they get inside your heart, the germs can attach to the lining or get trapped in the valves. They start to grow, causing an infection. If not treated quickly, the infection can cause damage to the heart and lead to serious health problems.

What causes endocarditis?

Bacterial infections cause most endocarditis. Normally, many bacteria live in your mouth, on your skin, or in other parts of the body. Sometimes the bacteria can get into your bloodstream from injuries such cuts or scrapes. Dental work and certain surgeries can also allow small amounts of bacteria to enter your bloodstream.

In some cases, fungal infections cause endocarditis. The fungi, such as yeast, can live in parts of your body. Fungal infections generally happen in people who have weakened immune systems that can't stop the fungus from growing. This includes people who have HIV.

Who is more likely to develop endocarditis?

In general, endocarditis is rare. If you're healthy, your immune system usually destroys the germs in your bloodstream before they can cause harm.

But your chance of developing endocarditis may be higher than most people if you:

• Have certain heart conditions. Damaged or abnormal heart tissue and devices in your heart can trap germs more easily than healthy heart tissue. That means your risk of endocarditis is higher if you have:
  • Heart valve disease.
  • Certain congenital heart defects.
  • A pacemaker or an implantable defibrillator.
  • A heart valve replacement.
• Are older. Age-related changes to the heart valves, such as mitral valve prolapse or calcium deposits in the aortic valve, create places for germs to attach to the heart.
• Inject illegal drugs. Unclean needles may carry bacteria into the bloodstream.
• Have a condition that weakens your immune system.
• Don't take care of your teeth and gums. Poor dental health makes it easier for germs to get into your bloodstream through your gums and mouth.
• Have a long-term central venous line, a tube that stays in a large vein for weeks or months for medical treatment.
• Have already had endocarditis. Endocarditis can damage heart tissue, which increases your risk of getting it again.

What are the symptoms of endocarditis?

Endocarditis symptoms may be severe or very mild. They may start suddenly or slowly. And they can vary from person to person. The possible symptoms of endocarditis include:

• Fever and chills
• New or worsening heart murmur (an unusual sound heard between heartbeats)
• Chest pain
• Cough
• Muscle, joint, and back pain
• Night sweats (heavy sweating during sleep)
• Shortness of breath (feeling like you can't get enough air)
• Skin changes, including:
  • Broken blood vessels
  • Painful red or purple bumps
  • Painless flat red spots on the palms of your hands or soles of your feet

What other problems can endocarditis cause?

When the germs are in your heart, they can clump together with blood cells. These clumps can break off and travel through your bloodstream. They may block blood flow, spread infection, or damage your organs, including your brain, lungs, kidneys, and spleen.

Endocarditis may sometimes lead to sepsis, a medical emergency that happens when your body has an extreme response to the infection.

Endocarditis can also cause serious heart problems including:

• Heart valve damage
• Heart failure
• Arrhythmia (a problem with the rate or rhythm of your heartbeat)

How is endocarditis diagnosed?

To find out if you have endocarditis, your doctor will:

• Ask about your medical history, including your symptoms, recent illnesses, and other health conditions that affect your chance of developing endocarditis.
• Do a physical exam.
• Likely order tests, such as:
  • Blood tests to check for signs of infection, bacteria, or fungi in your blood.
  • Chest x-rays.
  • Heart tests.

What are the treatments for endocarditis?

If you have endocarditis, it's important to get treatment quickly. Treatments may include:

• Medicines
  • Antibiotics to treat bacterial infections. Antibiotics are usually started through an intravenous (IV) line in the hospital.
  • Antifungal medicine to treat fungal infections. Your doctor may suggest taking antifungal medicine for the rest of your life to prevent the infection from coming back.
• Heart surgery may be needed to repair or replace damaged valves and heart tissue. Surgery may also be done to remove infected tissue.
• Dental care, especially cleanings, can help reduce the amount of bacteria that grows in your mouth.

Treatment may last weeks, and you may need tests to make sure it's working. Your doctor will also check you for problems that could develop from endocarditis, such as heart failure or an irregular heartbeat.

Can endocarditis be prevented?

If you have a higher chance of developing endocarditis than most people, you can reduce your risk if you:

• Take good care of your teeth and gums every day
• Have dental exams and cleaning at your dentist's office every 6 months
• Make heart-healthy habits part of your daily life to help prevent heart disease
• Call your health care provider right away if you have symptoms that could be endocarditis

People with the highest risk for bacterial endocarditis need antibiotics before dental visits or certain medical or surgical procedures. Ask your provider if you're part of the highest risk group. If so, let all your providers know about your risk.

NIH: National Heart, Lung, and Blood Institute