Mitral Valve Prolapse - Exercise Recommendations

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Mitral valve prolapse (MVP) is a very commonly diagnosed condition in which the mitral valve (the

Mitral valve prolapse (MVP) is a condition that is diagnosed very frequently. In MVP, the mitral valve (the valve that lies between the left atrium and left ventricle) partially prolapses (or "flops") back into the left atrium while the left ventricle is contracting.

    Modern, high-definition echocardiography has become so sensitive that some degree of prolapse is typically seen in people whose mitral valves are actually quite normal. It is not uncommon for these normal individuals to be told they have MVP. This is unfortunate, since these people are inappropriately labeled with a cardiac diagnosis, and may come to think of themselves as having a significant heart problem.

    For this reason, the diagnosis of MVP is probably being made too often. Patients with this "mild" (or, some would say, nonexistent) kind of MVP do not appear to be at risk for sudden death, or any other cardiac problems due to MVP.

    With true MVP, however, it can be a different story. Real MVP can vary in severity between being quite mild to quite severe. Patients with the more severe forms of MVP need to be followed carefully by a cardiologist.

    With significant MVP, an appreciable volume of blood can leak backwards across the mitral valve as the left ventricle is contracting, This condition is called mitral regurgitation.

    If mitral regurgitation is significant enough it can eventually produce heart failure. Patients with significant MVP can also develop a thrombus (blood clot) on their mitral valves. These blood clots can themselves further disrupt the function of the valve. The clots can also break loose and embolize to distant organs.

    For instance, they may travel to the the brain, producing a stroke. People with severe MVP often eventually require cardiac surgery to repair or replace their damaged mitral valves.

    Patients with severe MVP may also have an increased risk for sudden death from ventricular fibrillation. If so, the risk is often higher during periods of exertion.

    What Are the General Exercise Recommendations For Young Athletes With MVP?

    The large majority of people diagnosed with MVP are not at increased risk for sudden death. In fact, the 2005 36th Bethesda Conference on Eligibility Recommendations for Competitive Athletes with Cardiovascular Abnormalities recommends that the large majority of people with MVP can compete in all types of sports without restriction. Restrictions on exercise are necessary only in patients with MVP who have additional evidence of an increased risk.

    Such evidence of higher risk includes a family history of sudden death due to MVP, a history of loss if consciousness (syncope) associated with a cardiac arrhythmia, a prior history of having documented, significant cardiac arrhythmias, moderate or severe mitral regurgitation, or a history of embolic disease that is suspected to be due to the abnormal heart valve.

    If any of these high-risk indicators are present, the athlete with MVP should be limited to low-intensity sports like golf or bowling.

    Sources:

    Maron, BJ, Ackerman, MJ, Nishimura, RA, et al. Task Force 4: HCM and other cardiomyopathies, mitral valve prolapse, myocarditis, and Marfan syndrome. J Am Coll Cardiol 2005; 45:1340

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