Prevalence of Mitral Canal Disease - Term Paper Example

Running head: MITRAL VALVE PROLAPSE Mitral Valve Prolapse (school) Mitral Valve Prolapse and Treatment Introduction Various health issues involve the heart. These conditions impact significantly on heart functions and interfere with the normal functions of the heart, including the delivery of oxygen. These health conditions may include mild issues which can easily be corrected by medicines or other forms of therapy or the grave conditions which can compromise normal functions and lead to eventual death. One of these health conditions which impacts significantly on normal functions is mitral valve prolapse. This is basically a heart problem where the mitral valve does not close properly. This paper shall discuss mitral valve prolapse, its causes, incidence, and risk factors, as well as interventions and treatment measures. This paper is being carried out in order to establish a clear and comprehensive understanding of the condition, its impact on the health, as well as related nursing interventions. Discussion Overview of the disease The mitral valve is the valve which ensures that blood on the left side of the heart flows in one direction (University of Maryland Medical Center, 2011). In effect, it prevents backflow of blood during heart contraction. Causes Mitral valve prolapse manifests when the mitral valve fails to close properly, thereby causing the back flow of blood during contraction. Mitral valve prolapse can be caused by a variety of things, mostly by physical changes in the valve (WebMD, 2011). Physical changes, including the thickening of the valve can cause the prolapse. The causes of these physical changes are not entirely known. It may also be genetically inherited by family members. Health issues which affect the mitral valve, connective tissue and heart muscles can also cause mitral valve prolapse, however, these are very rare. Related conditions, including osteogenesis imperfecta and hyperthyroidism are also considerations in this condition (WebMD, 2011). Prevalence For the most part, this condition is harmless and sometimes patients are unaware that they have this heart condition. In fact, about 10% of the population is known to have minor mitral valve prolapse, however, most of the time it does not affect their lives. In some instances, this prolapse can cause blood back flow. This is known as mitral regurgitation, and may sometimes require surgery and medical treatment (University of Maryland Medical Center, 2011). Mitral valves which have structural issues have an increased risk for bacterial infection. It is a condition which often impacts on thin women with minor chest deformities, scoliosis, or related disorders (University of Maryland Medical Center, 2011). Symptoms For most individuals with this disease, the effect is relatively minor; in effect, they can be asymptomatic. Nevertheless, some individuals have been known to manifest with shortness of breath, chest pains, and heart palpitations (WebMD, 2011). It is not however clear if these symptoms are attributed to mitral valve prolapse. Some patients may also experience symptoms related to heart failure, including shortness of breath, fluid build-up, and fatigue; and other patients may also manifest with arrhythmic symptoms, which includes lightheadedness and body weakness (WebMd, 2011). It is a considered a common valvular problem, impacting on about 2-6% of the population in the US. It usually leads to various complications, like infective endocarditis, sudden cardiac death, and cerebrovascular ischemic events (Thakkar, 2011). There is a need therefore to ensure the effective management of this disease. The following discussion sets forth current interventions in the diagnosis and treatment of mitral valve prolapse. Diagnosis According to the National Heart Lung and Blood Institute (n.d), mitral valve prolapse is usually established by routine medical check-ups. In these routine tests, the physician may auscultate the heart for heart sounds. The stretched valve flaps may sometimes make a clicking sound when they close. When there is leaking into the left atrium, heart murmurs may also be heard by the physician (NHLBI, n.d). Other tests and procedures may be undertaken in order to establish definitively the condition of the heart. Echocardiography is one of the most important tests which can be used to establish MVP. It is relatively painless as it uses sound waves in order to create an image of the heart. Through this test, the size and shape of the heart can be seen, as well as the functioning of the heart chambers (NHLBI, n.d). The Doppler ultrasound can also be used, and it is also a part of the Echocardiogram test already. It exhibits speed and direction of the blood flowing through the heart (NHLBI, n.d). Other tests to diagnose this disease include a chest X-ray which can show fluid in the lungs and heart enlargement; or an EKG or an electrocardiogram which can establish the heart’s electrical functions. The EKG can indicate the speed and the rhythm of the heart which can either be irregular or steady (NHLBI, n.d). Treatment Various interventions are available for mitral valve prolapse patients. These interventions largely depend on the impact of the disease and the extent of the prolapse. Asymptomatic patients with minimal affectation have to be reassured of the benign nature of their disorder (Thakkar, 2011). It is also important for these patients to maintain a healthy lifestyle with a healthy diet and lifestyle. In order to prevent infective endocarditis, prophylaxis with antibiotics can be administered (Bouknight and O’Rourke, 2000). An initial electrocardiography may also be carried out on them in order to establish their risk and the progression of their disease. Without any mitral regurgitation, follow-up checks can be carried out every 3-5 years. Patients who are symptomatic need a trial of beta-blockers in order to manage symptoms. Those who manifest with palpitations and mild tachyarrhythmias, as well as those with chest pains, anxiety, and fatigue can be treated with beta blockers (Bouknight and O’Rourke, 2000). Postural hypotension can be managed with increased fluid and salt intake in order to promote volume expansion. In severe cases, mineralocorticoids can also be administered (Bouknight and O’Rourke, 2000). Regular aspirin therapy is also advisable for these patients, mostly those who have focal neurologic events; and those who are at sinus rhythm with no atrial thrombus. These patients must also not smoke cigarettes or take any oral contraceptives (Bouknight and O’Rourke, 2000). Anti-coagulation therapy with warfarin can also recommended for patients with MVP who have had a stroke or persistent transient ischemic attacks even while on aspirin therapy (Bouknight and O’Rourke, 2000). Among patients with atrial fibrillation, warfarin is advised for patients 65 years or older and patients with regurgitation, high blood pressure or those with heart failure. Among those with atrial fibrillation, 65 years or older or those without any history of high blood pressure or heart failure, Aspirin therapy is recommended (Bouknight and O’Rourke, 2000). Among patients with increased left atrium or left ventricle (LV) size, they are recommended for daily aspirin use. Among patients with LV enlargement, uncontrolled tachyarrhythmias, a prolonged QT interval, as well as an aortic root enlargement, they are prevented from participating in competitive sports (Bouknight and O’Rourke, 2000). Abstention from stimulants like caffeine, alcohol and cigarettes is also recommended for symptomatic MVP patients. A 24-hour monitor to assess supraventricular and ventricular arrhythmias must be also used on these patients (Thakkar, 2011). Patients manifesting with severe mitral regurgitation require close monitoring and referral for surgical evaluation before left ventricular dilatation develop (Thakkar, 2011). Those who are asymptomatic with severe regurgitation must have surgery before their left ventricular function shuts down. Finally, those with neurologic issues where atrial fibrillation and left atrial thrombus are excluded, daily blood thinners must be administered (Thakkar, 2011). Smoking is also negated as well as the use of oral contraception in order to avoid hypercoagulability. Warfarin must be utilized for patients older than 65 with atrial fibrillation, most especially when various risk factors like strokes, diabetes, valvular heart disease, high blood pressure, and a history of heart failure are present (Thakkar, 2011). Among patients with mid-systolic click and late-systolic mitral regurgitation murmur, antibiotic prophylaxis is recommended. Antibiotics are however not recommended for those with isolated mid-to-late systolic clicks with murmur, unless echochardiogram confirms leaflet redundancy and/or thickness (Thakkar, 2011). Surgery may also be recommended for some patients with MVP, especially among those with severe mitral regurgitation. This severe condition can sometimes cause heart failure if uncorrected, as it prevents the heart from pumping blood (Mayo Clinic, 2011). If regurgitation goes on for too long, the heart may be too weak for surgery, therefore, the earliest time that the surgery can be carried out, the better. Surgery may either be for repair of for the replacement of the mitral valve. These are both open heart surgeries and both take up a significant length of recovery time (Mayo Clinic, 2011). Mitral valve repair involves surgery where the patient’s own valve is preserved. This is the preferred surgery for most MVP patients. The mitral valve has two flaps or leaflets; these leaflets connect to the heart muscle through the annulus which modify original valve and prevents blood backflow (Mayo Clinic, 2011). Surgery can help repair the original valve through the reconnection of the leaflets or through the elimination of excess valve tissues, allowing the valve to close properly. This repair may sometimes include the tightening or even the replacement of the annulus (annuloplasty). Valve replacement is carried out when valve repair is not possible. In this type of surgery, the damaged mitral valve is replaced by a prosthetic valve (either mechanical or tissue). Mechanical valves last longer. It requires continued anticoagulant therapy for the rest for the rest of the patient’s life in order to prevent blood clots from manifesting on the valve. Blood clots in the valve may cause strokes. Tissue valves come from animal tissue, most particularly, pig’s heart valves. These are known as bioprostheses. They do not last as long and may require replacement; no anticoagulant therapy is however needed with the use of tissue valves. The repair of the mitral valve is preferred over its replacement, especially among patients with moderate or severe mitral regurgitation; moreover, patients must also be referred to the appropriate surgical centers (Hanson, 2011). A variety of percutaneous strategies are also being considered for the treatment of mitral regurgitation. Double-orifice mitral valve repair using an implanted device has also been recommended for mitral regurgitation. So far, it has been considered much safer than surgery, mostly because of the decreased risk of transfusion (Hanson, 2011). Where surgery causes a more favorable reduction of MR, better quality of life within a year has been seen in both approaches. While, surgical mitral valve repair still remains the standard intervention for severe MR; percutaneous double-orifice repair has also become a recommended option for patients who are at high risk for surgery (Hanson, 2011). Conclusion The above discussion exemplifies the pertinent details involving mitral valve prolapse. The above details indicate that this disease is basically about the failure of the mitral valve to adequately close during heart contractions, thereby causing the back flow of blood. The cause of this disease is not exactly known, but it is sometimes associated with inherited genes. It can be asymptomatic or symptomatic and can cause heart failure, shortness of breath and a host of other symptoms. The milder cases can be managed with moderate aspirin therapy and regular monitoring. The more severe cases however need treatment via mitral valve replacement or mitral valve repair. Repair and replacement are the recommended surgeries for this condition, and these surgeries help provide adequate treatment options for this disease. Works Cited Bouknight, D., O’Rourke, R. (2000). Current Management of Mitral Valve Prolapse. American Family Physician. Retrieved 21 August 2011 from http://www.aafp.org/afp/20000601/3343.html Hanson, I. (2011). Mitral Regurgitation Treatment & Management. Medscape. Retrieved 21 August 2011 from http://emedicine.medscape.com/article/155618-treatment#a1128 Mayo Clinic. (2011). Mitral valve prolapse. Retrieved 21 August 2011 from http://www.mayoclinic.com/health/mitral-valve-prolapse/DS00504/DSECTION=treatments-and-drugs National Heart Lung Blood Institute (n.d). How Is Mitral Valve Prolapse Diagnosed?. Retrieved 21 August 2011 from http://www.nhlbi.nih.gov/health/dci/Diseases/mvp/mvp_diagnosis.html Thakkar, B. (2011). Mitral Valve Prolapse Clinical Presentation. Medscape. Retrieved 21 August 2011 from http://emedicine.medscape.com/article/155494-clinical#a0218 University of Maryland Medical Center (2011). Mitral valve prolapse – Overview. Retrieved 21 August 2011 from http://www.umm.edu/ency/article/000180.htm WebMd. (2011). Mitral Valve Prolapse – Symptoms. Retrieved 21 August 2011 from http://www.webmd.com/heart-disease/tc/mitral-valve-prolapse-symptoms Read More