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How to manage mitral valve prolapse?

Q: I am aged 41 years and diagnosed having Mitral Valve Prolapse in 1991. Having Hypertension since 2 years and on Betaloc 50 mg twice (morning-evening)plus Ramipril 2.5. In October 2003 due to chest discomfort, underwent TMT which was positive and to rule out CAG was done which was absolutely normal. Three days back, while walking, I felt breathlessness and heaviness and immediately ECG was taken which was within normal limits and NSR. BP was also 140/94 mmhg. Doctor advised for Pulmonary Function Test which was also normal. Cardiologist advised for 2D echo on doppler and findings were: MVP ++ No I/C clot LVEF 71%. BP recorded was 144/92. He mentioned in his clinical examination as Exe SOBD. Cardiologist suggested a change in BP medicine and prescribed LosacaeH 1/2 in place of Ramipril 2.5. I want to know whether breathlessness or choking sensation at relevant point of time is due to which reason and is it serious? Kindly provide guidance so as to derive reassurance and the suggestions if any? Lipid profile within normal limits. Height: 148 cms Weight 59.3 Haemoglobin 11, No thyroid problem. Family history + for IHD and HBP. X ray chest was normal. No Diabetes.

A:In the absence of any blockages in the coronary arteries, pain in a setting of mitral valve prolapse is usually due to pull or stretching on the mitral valve apparatus itself. It is a very safe condition and without leak in the mitral valve calls for either no treatment or just beta blockers, which you are already taking in form of Betaloc 50 mg twice a day. You should rest assured that this is unlikely to give you any problem and you should only watch out for any leak developing in the mitral valve which will be picked up on 2D Echocardiography much before you start getting symptoms from it. When ever a leak is significant and it starts producing symptoms, then the mitral valve may require an open heart surgical repair of the valve but till that time no treatment is warranted and I repeat, please be rest assured that you shall stay fine as far as mitral valve prolapse is concerned.

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