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Mitral Valve Prolapse
(MVP, Heart Murmur)
In this factsheet:

The Facts on Mitral Valve Prolapse

Causes of Mitral Valve Prolapse

Symptoms and Complications of Mitral Valve Prolapse

Diagnosing Mitral Valve Prolapse

Treating and Preventing Mitral Valve Prolapse

The Facts on Mitral Valve Prolapse

Mitral valve prolapse (MVP) is a common condition that affects one of the heart's valves. It
occurs in about 1 out of every 50 people and is seen twice as often in women than in men. This
condition can be undetected for years and doesn't usually cause serious heart problems. Most
people with MVP require no treatment.

Causes of Mitral Valve Prolapse

The mitral valve is the heart valve located between the upper and lower chambers of the left side
of the heart. The mitral valve is made up of two flaps and controls the blood flow from the top
chamber of the left side of the heart (the left atrium) to its bottom chamber (the left ventricle).
But in MVP, one or both of the flaps are too big. The valve can't close properly and will bulge
out or prolapse into the left atrium. With a stethoscope, doctors may hear the soft "clicking"

sound of the bulging. Sometimes, the bulging creates a little space between the flaps, which lets
the blood leak backwards into the left atrium from the ventricle. This leak can cause a
"whooshing" sound that can also be heard with the stethoscope.
MVP is sometimes inherited. Some people with MVP have minor deformities of the chest,
back, and spine. In rare cases, inherited diseases such as Marfan's syndrome have been
associated with MVP.

Symptoms and Complications of Mitral Valve Prolapse

MVP symptoms are usually minor. If you have MVP, you may feel perfectly fine or may not
even know about it. Most people with MVP have no symptoms. Some of the symptoms people
feel are often puzzling, since they aren't directly caused by the valve malfunction.
The symptoms of MVP include:

irregular heartbeat or palpitations

tachycardia, or increased heartbeats and pounding in the chest, often occurring after
exercise

chest pain that can last from seconds to hours, often when you are resting

panic attacks such as a sudden feeling of anxiety or doom

fatigue, dizziness, and weakness, sometimes misdiagnosed as chronic fatigue syndrome

blood pressure that falls below normal when you stand up, causing lightheadedness

Very few people with MVP experience complications. In rare cases, complications of MVP
include:

irregular heartbeat (arrhythmia) and chest pain (angina pectoris) - both of these
conditions may be treated with medications such as beta-blockers

blood clots that form directly on the mitral valve and increase the risk of stroke

endocarditis, the most serious MVP-related problem.

Endocarditis is a bacterial infection of the mitral valve, which can be treated with antibiotics.
People with MVP sometimes develop endocarditis after having certain dental or surgical
procedures that increase the risk of introducing bacteria into the blood.

Mitral Valve Prolapse

(MVP, Heart Murmur)
In this factsheet:

The Facts on Mitral Valve Prolapse

Causes of Mitral Valve Prolapse

Symptoms and Complications of Mitral Valve Prolapse

Diagnosing Mitral Valve Prolapse

Treating and Preventing Mitral Valve Prolapse

Diagnosing Mitral Valve Prolapse

Many people have MVP and never exhibit any symptoms. If you know about your condition,
it's quite likely that it was diagnosed as part of a routine checkup. With a stethoscope, doctors
can detect the clicking noise or murmur associated with MVP. The diagnosis should be
confirmed with an ultrasound of the heart (echocardiogram). Results from the echocardiogram
can tell doctors about the extent of the mitral valve bulge and leakage.

Treating and Preventing Mitral Valve Prolapse

Most people with MVP need no treatment, but should be checked at least every 3 to 5
years. Those who have a lot of blood leaking backwards (called mitral regurgitation) are usually
monitored more closely. The American Heart Association (AHA) used to but no longer
recommends giving antibiotics prior to surgery or dental work to prevent bacterial infections in
people with MVP, even in those who have substantial valve leakage or valve thickening.
Complications associated with MVP can be treated accordingly; for example, endocarditis with
antibiotics, and arrhythmias with medications such as beta-blockers or antiarrhythmics.

Sometimes people with severe MVP need heart surgery to either repair or replace the mitral
valve. This is necessary only if you have severe backwards leakage of blood, which can cause
your heart to enlarge over time and lead to heart failure or arrhythmias. If this is the case, heart
surgeons may be able to repair the valve instead of replacing it with an artificial one. When
repair is successful, the heart muscle is able to pump stronger than if an artificial valve was
implanted. A repaired valve also does not require the use of anticoagulants or blood thinners,
which are necessary with some kinds of artificial valves.
After severe MVP is detected, it is hard to know the best time for it to be fixed surgically. This is
a complex decision and your family doctor and cardiologist should continue to monitor your
condition regularly.

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Congestive Heart Failure
(CHF)
In this factsheet:

The Facts on Congestive Heart Failure

Causes of Congestive Heart Failure

Symptoms and Complications of Congestive Heart Failure

Diagnosing Congestive Heart Failure

Treating and Preventing Congestive Heart Failure

The Facts on Congestive Heart Failure

Congestive heart failure (CHF) occurs when the heart isn't able to pump blood normally.
As a result, there is not enough blood flow to provide the body's organs with oxygen and
nutrients. The term "heart failure" does not mean that the heart stops beating completely, but that
the heart is not working as efficiently.

CHF affects over 6 million people in North America and is the most common cause of
hospitalization for people over 65 years of age. Each year CHF is implicated in over 300,000
deaths.
Men are slightly more at risk than women. People of African descent are considerably more at
risk than those of European descent and also have a higher risk of death.
There are two basic problems in congestive heart failure:

systolic dysfunction occurs when the heart can't pump enough blood to supply all the
body's needs

diastolic dysfunction occurs when the heart cannot accept all the blood being sent to it

Many people have both systolic and diastolic heart failure.

Causes of Congestive Heart Failure

CHF is usually the result of other health problems:

coronary artery disease, a condition that causes narrowing of the arteries that supply the
heart with blood, can damage and weaken areas of the heart

persistent high blood pressure forces the heart to pump against higher pressure, which
causes it to weaken over time - people who have uncontrolled high blood pressure are
more likely to develop CHF than those who don't

heart attack damages the heart muscle - people who have had heart attacks are at 5 times
the average risk of developing CHF

diabetes also increases CHF risk

arrhythmias (abnormal heart rhythms) can cause the heart to pump inefficiently

heart valve disease may have been caused by abnormalities that have been present since
birth or have developed over time

heart valve damage may have been caused by rheumatic disease or infection

viral infection of the heart muscle can seriously weaken the heart

an enlarged wall between the heart chambers (a genetic condition) may be a cause

certain kidney conditions that increase blood pressure and fluid buildup can increase the
risk of CHF by placing more stress on the heart

In addition, all the risk factors that normally increase the chances of heart disease, such as
smoking and obesity, also increase your risk of congestive heart failure.

Symptoms and Complications of Congestive Heart Failure

The appearance of symptoms of CHF can be delayed for years. This is because the heart tries
to compensate when it is not pumping efficiently. The heart compensates in three ways:
1. dilating (enlarging) to form a bigger pump
2. adding new muscle tissue to pump harder
3. beating at a faster rate
As the heart compensates, several things happen that can result in symptoms. The heart cannot
pump well enough to pump the blood through the body and back to the heart again. Blood then
backs up into the legs and the lungs, causing fluid buildup. This causes visible swelling of the
ankles and legs and shortness of breath.
The most common symptoms of CHF include:

breathing difficulties during the night or when lying down

coughing and wheezing

fatigue and weakness

shortness of breath

swollen ankles

Other symptoms of CHF include:

abdominal pain, bloating, or loss of appetite

accumulation of fluid in the abdomen

bluish skin around the mouth

constipation

pale skin and cold hands or feet

urination at night

Diagnosing Congestive Heart Failure

If you have the symptoms mentioned in the previous section, along with one of the conditions
that puts you at risk, your doctor may suspect CHF. Your doctor will examine you to see if your
legs are swollen or if your lungs are filled with fluid.
Your doctor may also order tests to check your heart. They may send you for blood and urine
tests, an electrocardiogram (ECG), or a chest X-ray, which can show the excess fluid in the
lungs. An echocardiogram (an ultrasound of the heart) will help diagnose heart failure. An
echocardiogram can also tell the doctor how much of the blood in your heart is actually being
pumped out to the rest of the body. The proportion of blood that gets pumped out is called the
ejection fraction.

Treating and Preventing Congestive Heart Failure

All treatment for CHF should be carried out under the supervision of a doctor. CHF usually
is managed with lifestyle adjustments and medications. If you have CHF, you may have to make
some of the following lifestyle adjustments:

cut back on fluids - weighing yourself daily is often necessary to help adjust fluid intake
and medications

stay active, but avoid triggering CHF symptoms

lower sodium intake to 2.3 g daily or less. If possible, try for 1.5 g or less each day. Less
sodium reduces fluid retention

wear special elastic stockings to reduce swelling in the legs caused by fluid retention

follow an appropriate weight-loss program (for those who need it)

Congestive heart failure can be treated with the following medications:

ACE inhibitors (e.g., enalapril*, lisinopril) expand blood vessels, allowing blood to flow
more easily and making the heart's work easier or more efficient

aldosterone receptor blockers (e.g., eplerenone, spironolactone) work by blocking the

effects of aldosterone, which can make CHF worse, and by helping the body eliminate
excess salt and water. They may help to reduce the risk of death in certain people with
heart failure who have had a heart attack.

angiotensin receptor blockers (ARBs; e.g., candesartan, valsartan) may be useful in place
of ACE inhibitors when they cannot be used or sometimes in addition to ACE inhibitors.

certain beta-blockers (e.g., bisoprolol, carvedilol, metoprolol) have been proven to help
improve heart function

digoxin increases the force of the pumping action of the heart

diuretics (e.g., furosemide, hydrochlorothiazide) help the body eliminate excess salt and
water

hydralazine and nitrates (e.g., isosorbide dinitrate, nitorglycerin patch) may be useful in
place of ACE inhibitors or ARBs when they cannot be used, or sometimes in addition to
other therapies when symptoms are still present

Your doctor may prescribe these medications, usually in combination, to manage your CHF. In
some cases, surgery (e.g., surgery to insert a pacemaker) may be necessary to help improve heart
function. People with very severe CHF may also need special devices called mechanical
circulatory support (MCS) devices. These devices are implanted in the heart to help the heart
pump more blood to the body.
CHF can't always be prevented, but there are many things you can do to help. Try
preventing CHF by practising good heart health. This will also guard against heart attack, stroke,
and coronary artery disease. Tips to follow include:

control high blood pressure

eat a healthy diet

exercise

control blood sugar levels (especially if you have diabetes)

maintain good blood cholesterol levels

quit smoking

*All medications have both common (generic) and brand names. The brand name is what a
specific manufacturer calls the product (e.g., Tylenol). The common name is the medical name
for the medication (e.g., acetaminophen). A medication may have many brand names, but only
one common name. This article lists medications by their common names. For more information
on brand names, speak with your doctor or pharmacist.

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