To your health - heart disease

Nation's Business, Dec, 1987 by Phyllis M. Barrier

To Your Health

Murmurs Of The Heart

Several years ago, during a hectic day at work, I noticed discomfort in my chest and a shortness of breath. The chest discomfort went away after a short time, but over the weekend at home, in a more relaxed atmosphere, the same symptoms kept recurring with some frequency. Since I have a strong family history of heart disease, I made an appointment with my doctor.

He diagnosed the problem as a mitral-valve prolapse. To confirm his diagnosis, he sent me for an echocardiogram, an examination that uses ultrasound to produce an image of the heart as it beats.

As it turns out, mitral-valve prolapse (also known as the click-murmur syndrome, Barlow's syndrome, balloon mitral valve and floppy-valve syndrome) is the most common form of heart disease. It occurs in 4 to 6 percent of the population, more frequently in women.

Dr. Bernard Slosberg, chief of internal medicine at Group Health Association in Washington, says MVP "can be diagnosed by a kind of click heard through the stethoscope, and sometimes a brief murmur, as blood slips back through the valve." Slosberg screens patients carefully before sending them for echocardiograms because the test is so sensitive that it produces many false negatives (indications of a problem when there isn't one).

I was fascinated by the echocardiogram. I could watch the valves of my heart on a small screen as the diagnosis was being made.

The mitral valve lies between the two chambers that make up the left side of the heart. Blood flows from a filling chamber, the left atrium, into a pumping chamber, the left ventricle. When the heart pumps blood out into the body, the two triangular flaps of the valve close tightly to prevent the blood from flowing backward from the ventricle into the atrium.

(As the mitral valve's flaps pull apart, the flaps look a little like a bishop's mitre--hence the name.)

In some people, the mitral valve's flaps are so flexible that they billow a little--or prolapse--as they close, causing the "click."

My hectic day at work may have made me more aware of MVP's symptoms, but so far no study has found that MVP is related to stress. Similarly, many studies have tried to find a relationship between MVP and panic attacks, but so far none has. There seems to be little likelihood that MVP, in itself, can bring on a heart attack.

MVP can have other, less serious consequences, however. Some people with MVP may have abnormal heart rhythms; these usually require no treatment, although in some cases they may call for medication.

In addition, according to the American Heart Association, a few patients with MVP may tire easily, have chest pains or suffer shortness of breath. These symptoms rarely require medication.

Most people with MVP need no treatment of any kind, but those people who have leaky--"regurgitant"--valves may need antibiotics to prevent infection of the valve during surgery or dental treatment. Such procedures--because they involve violating body surfaces like skin and gums--can allow bacteria into the blood stream. The valves may then become infected.

(Bacteria can also enter the blood stream through accidental cuts and abrasions, of course, but no medical authorities recommend special precautions against them.)

Heart-valve infections, known as endocarditis, are serious and often life-threatening. Treatment requires getting intravenous antibiotics for up to 12 weeks and sometimes open-heart surgery. Most dentists now ask routinely if you have a heart murmur. If you do, the dentist or hygienist will ask if you have taken your oral penicillin. On one occasion, I had forgotten to take it-- and had to reschedule my appointment.

I still take notice when I feel those strange sensations in my chest. But I continue with what I'm doing. And I always remember to take oral penicillin before I have my teeth cleaned.

Photo: An echocardiogram, which produces an image of the heart as it beats, can be used to diagnose mitral-valve prolapse, the most common form of heart disease.