mitral valve prolapse

I was diagnosed 24 years ago with a mital valve prolapse after the birth of my daughter . This was after experiencing palpatations for several years prior to this. I was on 50mg atenalol three times per day to start & now down to 25mg per day  for the past several years. However of late I have been experiencing palpatations again & the nurse at the surgery says my blood pressure is a little low, so now I am going to be set up soon with a 24 hour cardiograph thing. Can Mitral valve prolapse  get worse over the years? I have not been under a consultant for about 20 years, As was told to be monitored by GP I am however suppose to take antibiotic for dental & minor surgery.

[Bromley]

I believe the way to check for heart valve issues is to do an echocardiogram.  This is the thing that checks the plumbing from the surface.  The electrical stuff is checked with an EKG or heart monitor (again from the surface).  Your 24 hour heart monitor is designed for the electrical stuff, and I am pretty sure it wont have diagnostic value for mitral valve prolapse.  It sounds like your doctor may want to check for an arrhythmia.

Incidentally, the guidelines for Antibiotic Prophylaxis have recently changed. Below I quote an article from Medscape.

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April 24, 2007 — Prophylactic antibiotic therapy for dental procedures is unlikely to prevent many cases of infective endocarditis and should be restricted to patients who would be at highest risk for the infection, such as those with prosthetic valves or certain congenital heart defects, according to updated guidelines by the American Heart Association (AHA) published online April 19 in the Publish Ahead of Print issue of Circulation.

"We've concluded that if giving prophylactic antibiotics prior to a dental procedure works at all — and there's no evidence that it does work — we should reserve that preventive treatment only for those people who would have the worst outcomes if they get infective endocarditis," noted Chair of the new guidelines writing group Walter R. Wilson, MD, from Mayo Clinic in Rochester, Minnesota, in a statement issued by the AHA. "This changes the whole philosophy of how we have constructed these recommendations for the last 50 years."

Based on an analysis of available literature, the document concludes that "random bacteremia" resulting from routine daily activities, such as chewing food or tooth brushing, is far more likely to cause IE [infective endocarditis] than bacteremia secondary to dental procedures.

"There should be a shift in emphasis away from a focus on a dental procedure and antibiotic prophylaxis toward a greater emphasis on improved access to dental care and oral health in patients with underlying cardiac conditions associated with the highest risk of adverse outcome from infective endocarditis and those conditions that predispose to the acquisition of infective endocarditis," write the authors of the updated guidelines.

Prophylactic antibiotics, the authors state, should not be given based on a lifetime risk for infective endocarditis but are recommended for high-risk patients undergoing "procedures that involve manipulation of gingival tissue or the periapical region of teeth or perforation of the oral mucosa." Such "high-risk" patients, according to the guidelines, include those with the following:

    * Prior infective endocarditis

    * Prosthetic cardiac valves

    * Unrepaired cyanotic congenital heart defects, including palliative shunts and conduits

    * Congenital heart defects completely repaired with prosthetic material or a device, whether placed by surgery or by catheter intervention, during the first 6 months after the procedure

    * Repaired congenital defects with residual defects at the site or adjacent to the site of a prosthetic patch or prosthetic device

    * Cardiac transplants and development of cardiac valvulopathy

Patient groups that may have received routine antibiotic prophylaxis in the past but are no longer candidates for it include those with mitral and aortic valve disease, rheumatic heart disease, or structural disorders like ventricular or atrial septal defects or hypertrophic cardiomyopathy, according to the AHA statement.

The revised guidelines were developed with the participation of and have been endorsed by the American Dental Association, the Infectious Diseases Society of America, and the American Academy of Pediatrics.

Disclosures of relevant financial relationships for the writing group and the document's reviewers are included in the guidelines.

Circulation. Published online April 19, 2007.

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