the heart with a different beat
Item# 68B
Table of Contents Introduction...................................3 Normal heart and valves..............4 Order this book from:
PRITCHETT & HULL ASSOCIATES INC 3440 OAKCLIFF RD NE, STE 110 ATLANTA GA 30340-3006 1-800-241-4925
Mitral valve prolapse....................6 The nervous system......................8 Symptoms.......................................9 Evaluation.................................... 12 Treatment (if any)....................... 14 Exercise........................................ 16
2014 Edition Copyright ©1986, 1992, 2005 by Pritchett & Hull Associates, Inc. All rights reserved.
This book is not meant to replace the advice and treatment you get from your doctor. It is only to help you understand mitral valve prolapse.
Conclusion................................... 16
the heart with a different beat by Nancy Tkaczuk, R.N.
Nancy Tkaczuk, R.N., is the Director of Cardiovascular Services at Northside Hospital, Atlanta, GA. Specializing in Cardiology since 1970, she has developed many educational programs and has written articles for local newspapers, hospital newsletters and for the Georgia Heart Association. She is a Public Education Speaker on heart disease and an Instructor Trainer in Cardiopulmonary Resuscitation. Based on in-depth research and personal experience with mitral valve prolapse, she has started an outreach program as well as developed patient education materials in this field.
I would like to express my appreciation to Barry D. Silverman, M.D., Alan Taranto, M.D., and D. Alan Lankford, Ph.D., for their support and assistance in reviewing this information.
–Nancy Tkaczuk, R.N.
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For most people, a different heartbeat is no problem.
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Introduction Mitral valve prolapse (MVP) is a minor heart condition. It affects about 5 to 7% or more of all people of all ages, and many people with MVP don’t even know that they have it. MVP is seen in people of all races and social levels. It is more common among women between the ages of 20 and 40, but men have it, too. MVP tends to be hereditary, and there is a body type that goes with it. Many people with MVP are tall and slender and have long arms and fingers, straight backs and loose joints. Very little treatment (if any) is needed for people with mitral valve prolapse, but there are precautions and symptoms you should know. Most of the time a prolapsed heart valve will not restrict what you can do, and, most important, MVP does not put you at a higher risk for a heart attack. This book will answer many of your questions about mitral valve prolapse and relieve some of the anxiety you may have. You will learn about normal heart valves and what happens when a mitral valve prolapses. If after reading this book you still have questions, be sure to talk with your doctor or nurse.
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Normal heart and valves The heart is a hollow, muscular organ with 4 chambers. It lies under the rib cage in the center of the chest and pumps blood to all parts of the body. The right and left sides of the heart are divided by a thick, muscular wall called the “septum.� The heart’s 2 upper chambers (atria) are divided from the lower chambers (ventricles) by 2 valves, the tricuspid and mitral valves. Two other valves, the pulmonary and aortic valves, divide the heart chambers (ventricles) from the lungs and body.
aorta
left atrium pulmonary valve right atrium
m
u pt
right ventricle
se
tricuspid valve
left ventricle
4
muscle
mitral valve aortic valve
The heart’s valves are like one-way doors. They open to let blood through and close to keep blood from flowing backward. The action of these 4 valves keeps blood flowing through the heart in one direction. The right side of the heart receives blood from the body and pumps it through the pulmonary artery to the lungs. In the lungs, carbon dioxide is removed from the blood, and fresh oxygen is added. The blood, fresh with oxygen, then flows back to the left side of the heart where it is pumped through the main artery (aorta) to all other parts of the body.
RIGHT
LEFT 5
Mitral valve prolapse (MVP) Sometimes heart valves open and close in different ways. Such is the case with a mitral valve prolapse. When the left lower chamber of the heart squeezes to send blood out through the heart’s main blood vessel (aorta), the mitral valve flops backward, or prolapses, into the upper heart chamber. This is why MVP is sometimes called “Floppy Mitral Valve Syndrome.”
Action of normal valve
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Action of prolapsed mitral valve
closed
closed
open
open
MVP is not new. It has been around for a long time but has been called by other names. While the name may change, the symptoms stay the same. Some terms used to describe MVP over the years are: • “prone to the vapors” • “soldier’s heart” (during WWI) • Barlow’s Syndrome (for the doctor who first reported MVP in 1963) • the Click Murmur Syndrome (for the sound the valve makes when it flops backward) • dysautonomia (an imbalance in the nervous system) Complications are very rare with MVP, but they may occur. One problem is a severe “leaky” valve. A “leak” occurs when the valve does not close tight, and blood seeps backward into the upper heart chamber (left atrium). Other rare problems may be severe chest pain, heart infections or a lot of irregular heartbeats (to have a few is normal). Again, these problems are rare, and most people have no problems with MVP.
blood “leaks” backward
closed valve
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The nervous system A slight imbalance in the autonomic system is sometimes seen with MVP. The autonomic system is the part of the nervous system over which you have no control. It controls breathing, heart rate and digestion. At times this involuntary part of the nervous system works too fast and at other times too slow. When this happens, you may feel anxious or panicky. You may also have rapid heartbeats, shortness of breath, chest pain or fatigue. If your MVP is related to the activity of your nervous system, it is called dysautonomia.
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Symptoms Most people with MVP have no symptoms, but some do. If you have any of these symptoms or if they change in any way, tell your doctor.
fatigue
Fatigue is the most common symptom of MVP, but the reason for this is not clear. Most often the fatigue is not related to exercise or stress. It is thought that people with dysautonomia don’t get enough blood flow to muscles in their arms and legs during activity. This causes a buildup of a chemical called lactic acid which leads to fatigue. The more tired you are, the less you do. Before you know it, even simple tasks wear you out. Regular exercise and a healthy diet are 2 ways to fight fatigue.
palpitations (arrythmias)
Palpitations are fast or irregular heartbeats. They can annoy you but are rarely serious. Each person has a wide range of heart rate during the day, but most are not aware of it. People with MVP can often feel their heart beat, even at rest. If you feel faint or dizzy with palpitations or notice that they increase with exercise, tell your doctor. He or she may want to do other tests on your heart.
chest pain
This pain is not the same as that caused by coronary artery disease (angina), but it may feel a lot like it. The pain with MVP may be a sharp, “sticky-stabbing” feeling over your left breast, or it may feel like a heavy pressure under your breastbone. At times the pain goes down the left arm and may last just a few minutes or for hours. Sometimes it goes away for a long time but returns when you are tired, sick, under a lot of stress or for no reason at all. It rarely happens during or after hard exercise. Angina pain, unlike MVP pain, most often gets worse with exercise and eases up with rest and nitroglycerin.
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panic attacks & anxiety At times MVP can make you feel a little “panicky,” even when there is no reason to feel that way. This feeling can make it hard for you to relax and cope with everyday stress. Panic can cause you to feel: short of breath, palpitations, dizzy, chest pain, faint or sweaty. You may have: a fear of dying; the impulse to flee or seek help; or a sense of unreality. Certain types of drugs may help control these symptoms, but drugs alone are not enough. Therapy, education, biofeedback and relaxation techniques can also help. Ask your doctor where to find this help.
shortness of breath Getting short of breath with even mild activity is a common symptom. It is thought that most often this is caused from being out of shape. If fatigue has caused you to slow down a great deal, even mild effort can cause you to be short of breath.
migraine headaches These headaches are due to either a widening or narrowing of blood vessels in the brain. Some people say they can feel the blood flow in the arteries on the side of their head. Migraine headaches can come less often and be less severe if you learn how to deal with stress.
other symptoms (often seen with MVP but may or may not be caused by it) 10
• • • • • • •
hot and cold flashes trouble sleeping waking up startled numbness shakiness vision problems depression
• • • • • •
aching & pain in arms or legs stomach or bowel trouble allergies trouble concentrating tense or twitching muscles poor health in general
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“Her prolapse personality is showing!”
Evaluation Mitral valve prolapse is most often found by your doctor during a physical exam while listening to your heart and hearing you describe your symptoms. People who have symptoms of palpitations and/or chest pain are often tested to see if any serious heart disease is present. You may have one or more of the following tests: An echocardiogram (ECHO) is the test most often used to see if you have MVP. It does not hurt and only takes about an hour. It uses sound waves to look at your heart’s size, chambers and valves to see how they are working. As you lie quietly, a technician moves a scanner (transducer) over your chest, taking pictures and recording them on paper.
ultrasound picture
transducer (scanner)
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MVP
EKG
An electrocardiogram (EKG or ECG) is often taken to record how well your heart’s electrical system is working. It shows how fast or slow your heart is beating, how regular it is and what size the heart chambers are. Holter monitoring may be used to record your heartbeat for 24 hours. The Holter is a small box about the size of a transistor radio that is worn on your belt or carried on a shoulder strap. Sticky patches (electrodes) are placed on your chest, and thin wires connect these patches to the recorder. You can go about your daily routines while wearing it. This test tells how your heart is beating when you are feeling symptoms and when you are feeling fine.
Holter monitor recorder hangs on belt
A treadmill test records your heartbeat and shows how well your heart responds to exercise. While hooked up to an EKG, you will walk or jog on a moving belt.
sticky patch
A tilt table test checks your heart rate and blood pressure when you are lying down and when you are standing. This test tells your doctor how your nervous system is working. In rare cases, your doctor may also suggest that you have a cardiac catheterization (taking pictures and measuring pressures inside the heart). 13
Treatment (if any) Most people with MVP just need to know the facts and have someone answer their questions. A few may be put on medications to treat their symptoms. If stress increases your symptoms or you can’t stop worrying about your prolapse, professional counseling or relaxation methods may be suggested. Here are some common suggestions for people with MVP: To reduce palpitations, cut down on caffeine and other things that make your heart beat faster. These include: coffee, tea, colas, chocolate, tobacco, alcohol or over-the-counter medicines such as cold remedies. Also cut down on sugar. It causes fatigue. Read all food and other labels for caffeine and sugar, and take your doctor’s advice about what you should not eat or drink. Drink plenty of fluids (without caffeine or sugar in them). People with MVP tend to have low blood pressure and to tire easily because of a lowered blood volume. Most doctors recommend 8 to 10 glasses of fluids each day. Also, too little fluid (dehydration) can make your symptoms worse, especially palpitations.
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To reduce chest pain, lie flat on your back and rest your legs on pillows so that your feet are above the level of your heart. When you do this, blood returns to the heart and puts less strain on the prolapsed valve. Putting your feet up also helps you relax. Medication is most often used if your symptoms are not controlled by reassurance or changes in diet and exercise. Two types of drugs often used are beta blockers and calcium channel blockers. These are given to control chest pain and headaches, slow down heart rate and reduce palpitations. Other drugs may be used for other symptoms of MVP. Many people with MVP have a greater chance of getting infective or bacterial endocarditis. This is an infection of the heart valves or inner heart lining that can cause scarring or damage to the valves. For this reason, your doctor may prescribe an antibiotic before you have any of these: • dental work: routine cleaning, filling or removing teeth, gum work, root canals, etc. • major surgery • minor surgeries, such as: tonsillectomy, appendectomy, drainage of an abscess, prostate surgery, childbirth (in some cases) • procedures that cause trauma to body tissues, such as: bladder exams, some rectal and colon exams
The symptoms of bacterial endocarditis are: fever that does not go away, flu-like feelings, shaking chills, sweating and loss of appetite. Call your doctor if you have any signs of infection.
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Exercise Some people with MVP have no trouble with exercise, but others do. The reason for this is not known. It could be caused by a fear that exercise will make MVP symptoms worse. Or, it could be due to a lot of fatigue. Whatever your condition, some exercise is good for you. How much will be up to you and your doctor. With exercise, you will feel better, look better and have more energy. Exercise can also help you control weight, lower heart rate, relieve stress and improve muscle tone. Talk with your doctor before starting any kind of regular workout. Here are some good aerobic exercises:
• • • •
walking aerobic dance stationary bike climbing stairs
• slow jogging • swimming • treadmill
Most people start with 10 to 15 minute workouts and build up to 30 minutes a session, 4 to 5 times a week. Drink lots of fluids when you exercise. Being dehydrated can produce palpitations or chest pain.
Conclusion You may now feel less anxious about your heart and MVP. With common sense, you can control many of your symptoms. When you get tired, rest. When life is stressful, practice relaxation. Exercise and eat well. And, whenever you have questions about MVP, talk with your doctor. Knowing what to expect from your health goes a long way towards helping you enjoy life. 16
Heart Valves aortic valve
pulmonary valve
prolapsed mitral valve
tricuspid valve
tendons (chordae tendineae)
muscle (papillary)
If you like this book, you may want to see what else we have. All of our books and programs are done in a similar fashion: informative, yet easy to read and understand. Topics include: by, Nancy Tkaczuk, R.N. Director of Cardiovascular Services Northside Hospital Atlanta, GA
• heart disease • stroke • open heart surgery • chronic lung disease • asthma • exercise • nutrition
• diabetes • kidney failure • hip, knee or back surgery • head injury • and more
Pritchett & Hull Associates, Inc. 3440 Oakcliff Road, NE, Suite 110 Atlanta, GA 30340-3006 Call 1-800-241-4925 or www.p-h.com Write or call toll free for our catalog of prices and product descriptions.
ISBN 0-939838-96-6