Mitral Valve Prolapse: Truth vs. Fiction
"There is nothing to fear except the persistent refusal to find the truth." – Dorothy Thompson
One of the chapters of my recent book, "Courageous Confrontations," describes my experience with a patient named Emma Jorgenson. Shortly after sitting in my consulting room, she said: "I hope you can help me, doctor. Other physicians continue to say that my symptoms are all in my head. "
"What seems to bother you, Emma?
"Annoy me? My problems are not only annoys me, they kill me. If you do not do something to help me, I'll die. I know. "
"What kind of symptoms are you having? "
Heaving a deep sigh, Emma shifted uncomfortable in his chair. "I do not know where start, "she said. "Every time I try to explain my symptoms to a doctor, he just rolls his eyes and told me that this is nothing to worry about. "Emma bowed, and began to flow.
I reached for the box of tissues on my desk and handed them Emma. "Let's understand how we can help. Why not start early? "I said." What was your first symptom?
"One night, nearly three years ago, I awoke with a feeling of beating in my chest. My heart was pounding so fast I thought it was out of my chest. Then I started to get nausea and dizziness. I called Mr. Cahill, my family doctor who is also my gynecologist, and when I went to see the next day, she found a tumor in my stomach. She said I had to have surgery to remove it. "
"What did she find?
"A cyst on my ovary. It was nothing serious, but after the operation, the shelling and dizziness became more frequent, so she sent me to a neurologist. "
"Why a neurologist?
"I read an article that said that the three most common symptoms of brain tumors were headache, nausea and dizziness, then I would asked to send me to a specialist. He has done lots of scans and electrical tests, and said everything was fine. He prescribed a tranquilizer, but I knew that this was not the intention of solving my problem. "
Did he tranquilizer Help?
"A little early, but then my symptoms have worsened. When the beating started, in addition to dizziness and nausea, my hands start to tingle and go numb. After while, the numbness spread to my face. The entire area around the mouth of losing all feeling, except for a tingling wired. I sure I'll have a stroke. It was then that Mr. Cahill referred me to an ENT doctor.
"An ear nose and throat doctor? "
"It's true. She thought my dizziness could be due to an inner ear problem. He reviewed and said he was not sure what was happening, but I needed an operation to get to the bottom of it. But I was too scared. Besides, I had not yet recovered from the surgery of the ovaries, and my wounds were not healing Right, so my gynecologist told me I could wait before having another operation. "
Emma's story me WinCE. She had unwittingly fallen into the maze of modern medicine. Each specialist consulted his symptoms through the prism of his own specialty, ordered the inevitable battery of tests, and treated her with a pill or a procedure without a diagnosis. The drugs are the fifth leading cause of preventable death in the United States.
"Why did she send it to me?"
"I told him I do not think I an inner ear problem, and it should be a kind of heart disease. After all, how a problem of inner ear pain causes chest and shortness of breath?
"Chest pain and shortness of breath? You said nothing about it. "
I told him explained that there are several causes for chest discomfort, and each has a set of characteristics revealing. For example, in patients pleurisy, an inflammation of the lining of the lungs, the pain occurs with deep breaths. With an inflammation of the sac surrounding the heart, called pericarditis, pain increases when the patient lies down and improves when they are sitting and leaning forward. In patients with blocked coronary arteries, the discomfort occurs during physical activity such as walking or climbing stairs. A bulge or tear in the aorta, the main artery in the body, also characteristics.
All these possibilities and more must be carefully explored by Delving into the nuances of pain in the chest Emma and his palpitations and shortness of breath. Emma's description of his chest pain was not consistent with a common cause of chest pain, but it was important not to neglect other serious possibilities. In patients with pleural friction sound may be heard with a stethoscope over the lungs during a deep inhalation. Pericarditis sounds like sandpaper rubbed in synchrony with the heartbeat. malformations congenital heart disease and heart muscle abnormalities valve murmurs provide witness and other characteristic signs on physical examination.
Despite a rapid pulse of Emma, his blood pressure was normal and his lungs sounded clear. On cardiac examination, his pulse normal heart, but when I placed the stethoscope under the left breast, the diagnosis becomes immediately obvious.
When the heart of Emma contract, a series to loud sounds were audible clicking. My patient had a mitral valve prolapse.
The heart is divided into two parts, each with four bedrooms. Both above are called atria, and the last two are the ventricles. The right atrium and ventricle receives oxygen-depleted blood from the body and sends it to the lungs where oxygen content is restored. The left atrium receives blood then rejuvenated by passing it along the left ventricle. The powerful left ventricular cavity, and then pumps its contents to the body.
The atria and ventricles are separated from each other by valves. The tricuspid valve is located on the right side of the heart, while the mitral valve is located on the left. When the mitral valve opens, resulting blood from the left atrium, through the valve, and enters the left ventricle. As the left ventricle begins to contract, the valve closes, preventing blood going back into the left atrium.
The mitral valve has two leaflets, or flaps, each in the form of a parachute. Normally, the two brochures about in unison, but in patients with mitral valve prolapse, or the valves are too large, the agreements that attach to the heart are too long, or connective tissue of the structure are more elastic than normal. In all cases, one or two of these balloons or prolapse-flops in the left atrium. The characteristic click heard when listening to the heart is caused by the noise of the valve leaflet prolapse in atrial chamber, just like a parachute in the wind.
Mitral valve prolapse is a relatively common, occurring in two and a half years five per cent of people in the United States. It is particularly common among pre-menopausal women between the ages of fourteen and forty. There was a considerable amount of speculation on how the valve abnormalities occur, but recent research has shown that there is a predisposition genetic syndrome. Between twenty and fifty percent of parents of patients mitral valve prolapse also have the syndrome.
Echocardiograms are valuable means of assessing patients with suspected mitral valve prolapse. The test confirms the diagnosis by showing the layers of the valve prolapse. In addition, the presence and severity of reflux of blood through the valve from the ventricle into the atrium can also be detected. In Emma's case, I have not heard the whispers suggesting the presence of a witness of a leak.
Patients with mitral valve prolapse often have symptoms that mimic illnesses such as heart attacks and heart rhythm abnormalities, but in the vast majority of women, the condition is not dangerous or life-threatening. Most of the relatives of patients with mitral valve prolapse who demonstrate a valve drive on echocardiography are totally free of symptoms.
The reason for chest pain, palpitations, or shortness of breath that occur in some patients with prolapse mitral valve has never been understood. In the absence of a more scientific explanation, he speculated that their nervous systems are programmed to respond to too much stress. For unknown reasons, they are triggered to react to circumstances not threatening, as if they were dangerous. This imbalance is called dysautonomia.
After putting my stethoscope in the pocket of my shirt, I gently patted Emma on the shoulder. "I have great news! Your symptoms are caused by a benign condition called a prolapsed mitral valve. "I guess that Emma would be relieved. Instead, the diagnosis has increased his anxiety to the point where it becomes idle.
Although the symptoms of mitral valve prolapse are divers and can be extremely serious, it is important to note that for the overwhelming majority of individuals with the condition, it is neither dangerous nor life threatening. Studies have shown that increased levels of adrenaline flows like substances explain the symptoms chest pain, palpitations, breathlessness, anxiety and Panic Attacks that plague people with the problem.
Prospects for the vast majority of people with mitral valve prolapse is excellent. My experience has been that people with debilitating symptoms will gradually feel better over time. They come to realize that their symptoms do not cause a heart attack or sudden death, and the symptoms themselves become while less disabling. As one of my patients said: "I just put the pain in my bag and went about my business."
For most patients, the only treatment needed is the use of prophylactic antibiotics before surgery and various types of dental care, but it is used than in those who have a leaky faucet. Medications, particularly a group of drugs called beta-blockers "can be useful for monitoring debilitating symptoms. Exercise, healthy diet and relaxation techniques have been useful in controlling symptoms.
And as Emma, she had a transformative experience that changed his life. No longer restrained by fear, she developed a remarkable new serenity and a new appreciation of life.
He also gave her a new life goal. Emma became a patient care adviser and an invaluable member of Our team of health care, using his experience as a resource to advise our patients in the grip of fear.
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