Mitral Valve Prolapse and the Benefits of Exercise

Aerobic exercise remains key to managing the disease

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The mitral valve is located in the heart's left ventricle between the upper and lower chambers. This valve has a right and left section that open to allow blood to move from the upper atrium and the lower ventricle on the left side of the heart, and then close to prevent the backflow of blood.

A normal valve is fairly rigid and opens and closes completely with regularity. The term prolapse means that the valve is loose and a little floppy so that it doesn't shut as firmly as it should. It may close with a faint click or may permit a tiny amount of blood to leak through, producing a heart murmur.

A large prolapse can allow blood to seep back into the heart’s top chamber. This is called mitral regurgitation or a "leaky valve."

Mitral valve prolapse is generally not considered to be life-threatening or progressive. It is regarded by most as one of the more benign forms of a heart murmur.

Symptoms

It is estimated that two to four percent of the population has a mitral valve prolapse of some degree. It is also likely that there is a genetic component to MVP since it seems to run in families.

Many people live their whole lives without symptoms. Those who do have symptoms may experience heart palpitations, chest pain, fainting, shortness of breath, reduced stamina, or fatigue with periods of weakness.

The two main concerns for those living with MVP are the long-term complications that can arise if the condition is not properly treated.

Endocarditis

The risk of developing a heart infection called endocarditis is a rare but potential occurrence anytime there is a leaky heart valve.

To decrease the risk of this infection, doctors will prescribe antibiotics before any procedure that is likely to introduce bacteria into the bloodstream. Most people with diagnosed MVP will even take antibiotics before dental work.

Mitral Regurgitation

Mitral regurgitation is the backflow of blood from the ventricle to the atrium. Mitral regurgitation can lead to enlargement of the cardiac chamber, the weakening of the heart muscle, and, in some cases, heart failure.

Mitral regurgitation is relatively rare, affecting only around 5% of those with MVP. People who have had a previous heart attack or prolonged exposure to the drug Ergomar (ergotamine) are at greatest risk.

Treatment

The heart is a muscle and, like any muscle, it gets stronger with exercise. Aerobic exercise strengthens the heart and makes it more efficient and is generally recommended for those with MVP.

Aerobic exercise including walking, jogging, swimming, or cycling, at a moderate pace for 30 minutes at a time is the safest way to begin exercise. A person with MVP should monitor their heart rate and other symptoms and slow down if they feel their heart racing or lightheaded or faint.

Those who experience chest pains, heart palpitations or other significant symptoms of MVP are sometimes given beta-blockers to slow the heart rate during exercise. Rarely is someone discouraged from exercise because of a mitral valve prolapse.

Treatment for MVP varies depending upon the extent of the prolapse, so it's important to discuss your individual symptoms with your physician before starting an exercise plan.

Severe cases may require the input of a cardiologist to ensure that exercise doesn't inadvertently promote mitral regurgitation. In some cases, exercise can place undue stress on the mitral valve, causing more harm than good.

To avoid this, the cardiologist will likely ask you to undergo an exercise tolerance test during which you would be connected to an electrocardiogram (ECG) while on a treadmill or stationary bike. The results of this test can determine how much exercise you can safely perform without compromising the mitral valve.

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  1. Bertrand PB, Sdhwammentthal E, Levine RA, et al. Exercise Dynamics in Secondary Mitral Regurgitation: Pathophysiology and Therapeutic Implications. Circulation. 2017 Jan 17;135(3):297-314. doi:10.1161/CIRCULATIONAHA.116.025260


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