mitral regurg vs mitral prolapse

My daughter is 25 years old female who was told that she has mitral regurgitation since 3 years old (there is a question of rheumatic fever but it was never formally diagnosed, she was never on prophelactic antibiotics). Later in life when she was about 15 she was told that she has mitral prolapse, no echo was done at the time and she was told to take antibiotics when going for dental procedures. When echo was done when she was 20 it showed that she just has mild mitral regurg without a prolapse, however, on auscultation you hear a murmur consistent with prolapse. Because echo showed no prolapse whe was told that she does not need to take antibiotics when going to dentist. My daughter never saw cardiologist, only PMD(internist). My question #1: How come there is such inconsitency with past and current diagnosis, how come echo showed a different finding from what they find on auscultation? Does my daughter needs to take antibiotics when going to dentist? Should echo be repeated?
Q2: My daughter has different exercise tolerance at different days, some times she can clime 6 flights of stairs without a problem, some times she gets SOB going up one flight. Can this be explained by diagnosis of mitral regurg? Futhermore, her resting heart rate never goes below 90 bits per minute, should she be concerned? (Holter was done by PMD and showed sinus rhythm with some PVC/PAC and very shirt episode of atrial flutter). My daughter is not taking any medication, her PMD told her that it was not necessary.
Thank you for answering my questions.

[CCF-M.D.-RCJ]

Cathy12,

Thanks for the questions.

(1) The diagnositic criteria for mitral valve prolapse have changed considerably over the past 20 years, largely becasue it was being over-diagnosed and mis-diagnosed.

The ACC has issued a statement about MVP, some of which I've re-printed below (ref www.acc.org):
2-D and Doppler echocardiography is the most useful noninvasive test for defining MVP. The M-mode echocardiographic definition of MVP includes >2 mm posterior displacement of one or both leaflets or holosystolic posterior "hammocking" >3 mm. On 2-D echocardiography, systolic displacement of one or both mitral leaflets in the parasternal long-axis view, particularly when they coapt on the atrial side of the annular plane, indicates a high likelihood of MVP ... At present, there is no consensus on the 2-D echocardiographic criteria for MVP ... All available echocardiographic views should be used with the provision that billowing of the anterior leaflet alone in the 4-chamber apical view is not evidence of prolapse; however, a displacement of the posterior leaflet or the coaptation point in any view, including the apical view, suggests the diagnosis of prolapse. The echocardiographic criteria for MVP should include structural changes such as leaflet thickening, redundancy, annular dilatation, and chordal elongation.

I put in the above paragraph to demonstrate the need for diagnosis of MVP by an expert.  Many internists (and for that matter, some cardiologists) are too quick to use the term MVP.  The bottom line is that the matter can be quickly resolved by your daughter seeing a cardiologist.

(2) SOB can indeed can be caused by MR, but also by many other things.  If your daughter chooses to see a cardiologist, this matter too can be sorted out.  One way to tell if the MR is causing the SOB would be for your daughter to undergo an exercise echo test, where the effects of exercise on the heart can be directly visualized.

Hope that helps.

[Jean27]

I am 31 and have exactly the same situation as your daughter. My echo shows no MVP but mitral trace regurgitation. Before doing the echo I was told I had MVP but the echo says no just the reg. The cardiologists have told me it is nothing to worry about and does not cause symptoms. I however am very confused because like your daughter some days I feel ok and others I feel like walking up one flight of stairs is very hard. Also I find I can not walk long distances without needing to sit on those days,if I am at the mall it feels like major exercise. I also do not like to exercise because it causes my heart rate to go faster than it already is. Does your daughter get that also?

[Cathy12]

I am answering previous comment...
My daughter does have some problems exercising... some days she has no problems, other times she gets short of breath very easily. So it sounds like your problem also.
One thing that your doctor should rule out is asthma because it can cause intermittent shortness of breath, especially with exercise, it was ruled out in my daughter's case.

[karie]

I have offered a support group on-line with much information on Mitral Valve prolapse/ Syndrome at http://clubs.yahoo.com/clubs/mitralvalveprolapse2
I am 34 and see a cardiologist yearly for re-checks with my mitral valve prolapse, heart murmurs and symptoms.
The symptoms range from patient to patient.
Some of the tests I had:
cardio-beeper, echocardiogram, ekg, tilt table test, ct, blood work, holter monitor, treadmill.
I exercise daily , But don't do hills, or lifting.

[joe_q]

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