Q: My mother is 47 years old and has mitral valve prolapse (MVP) for more than 27 years. Last month she got acute pain in her hands and legs. We took her to the cardiologist who said that there is some heart enlargement and she was given Nitrocontin 2.6. She also had some breathing problems. Is this is very serious situation, as she is very dull. Is surgery a solution for it? How much will it cost? Where can we get this treated?

A:Mitral valve prolapse is an innocuous problem, but one needs to get echo tests every year if there is a leak due to the prolapse. If the heart is enlarged she needs other medicines apart from nitrates. Surgery is indicated only if there is a severe leak and/or symptoms of significant leak like breathlessness on mild exertion. If there are palpitations (sense of missed or fast heart beating at rest) or a family history of sudden death, other tests like a 24 hours ECG recording may be indicated. Breathlessness, chest pain and palpitations but not dullness are symptoms of prolapse. Of course people of her age could be having other problems unrelated to prolapse that need to be looked into. For example if she is having chest pain that sounds like anginal pain from a detailed history elicited by a doctor, she will need tests to exclude blocks in heart tubes supplying blood to the heart (the simplest test is usually an exercise treadmill test). Other risk factors for blocks like high BP / cholesterol / blood sugars need to be treated if present.