Ronnie Jay Miguel

Ronnie Jay Miguel MT2 What is mitral valve prolapse? Mitral valve prolapse (also known as "click murmur syndrome" and "Barlow's syndrome") is the most common heart valve abnormality, affecting five to ten percent of the world population. A normal mitral valve consists of two thin leaflets, located between the left atrium and the left ventricle of the heart. Mitral valve leaflets, shaped like parachutes, are attached to the inner wall of the left ventricle by a series of strings called "chordae." When the ventricles contract, the mitral valve leaflets close snugly and prevent the backflow of blood from the left ventricle into the left atrium. When the ventricles relax, the valves open to allow oxygenated blood from the lungs to fill the left ventricle.

Causes In patients with mitral valve prolapse, the mitral apparatus (valve leaflets and chordae) becomes affected by a process called myxomatous degeneration. In myxomatous degeneration, the structural protein collagen forms abnormally and causes thickening, enlargement, and redundancy of the leaflets and chordae. When the ventricles contract, the redundant leaflets prolapse (flop backwards) into the left atrium, sometimes allowing leakage of blood through the valve opening (mitral regurgitation). When severe, mitral regurgitation can lead to heart failure and abnormal heart rhythms. Most patients are totally unaware of the prolapsing of the mitral valve. Others may experience a number of symptoms discussed below. The mitral valve prolapse (MVP) syndrome has a strong hereditary tendency, although the exact cause is unknown. Affected family members are often tall, thin, with long arms and fingers, and straight backs. It is seen most commonly in women from 20 to 40 years old, but also occurs in men.

Effects Most people with mitral valve prolapse have no symptoms, however, those who do commonly complain of symptoms such as fatigue, palpitations, chest pain, anxiety, and migraine headaches. Stroke is a very rare complication of mitral valve prolapse. Fatigue is the most common complaint, although the reason for fatigue is not understood. Patients with mitral valve prolapse may have imbalances in their autonomic nervous system, which regulates heart rate and breathing. Such imbalances may cause inadequate blood oxygen delivery to the working muscles during exercise, thereby causing fatigue. Palpitations are sensations of fast or irregular heart beats. In most patients with mitral valve prolapse, palpitations are harmless. In very rare cases, potentially serious heart rhythm abnormalities may underlie palpitations which require further evaluation and treatment. Sharp chest pains are reported in some patients with mitral valve prolapse, which can be prolonged. Unlike angina, chest pain with mitral valve prolapse rarely occurs during or after exercise, and may not respond to nitroglycerin. Anxiety, panic attacks, and depression may be associated with mitral valve prolapse. Like fatigue, these symptoms are believed to be related to imbalances of the autonomic nervous system. Migraine headaches have been occasionally linked to mitral valve prolapse. They are probably related to abnormal nervous system control of the tension in the blood vessels in the brain. Mitral valve prolapse may be rarely associated with strokes occurring in young patients. These patients appear to have increased blood clotting tendencies due to abnormally sticky blood clotting elements, called platelets.

Cure The vast majority of patients with mitral valve prolapse have an excellent prognosis and need no treatment. For these individuals, routine examinations including echocardiograms every few years may suffice. Mitral regurgitation in patients with mitral valve prolapse can lead to heart failure, heart enlargement, and abnormal rhythms. Therefore, mitral valve prolapse patients with mitral regurgitation are often evaluated annually. Since valve infection, endocarditis, is a rare, but potentially serious complication of mitral valve prolapse, patients with mitral valve prolapse are usually given antibiotics prior to any procedure which can introduce bacteria into the bloodstream. These procedures include routine dental work, minor surgery, and procedures that can traumatize body tissues such as colonoscopy, gynecologic, or urologic examinations. Examples of antibiotics used include oral amoxicillin and erythromycin as well as intramuscular or intravenous ampicillin, gentamycin, and vancomycin. Patients with severe prolapse, abnormal heart rhythms, fainting spells, significant palpitations, chest pain, and anxiety attacks may need treatment. Beta-blockers, such as atenolol (Tenormin), metoprolol (Lopressor), and propranolol (Inderal), are the drugs of choice. These act by increasing the size of the left ventricle, thereby reducing the degree of prolapse. The calcium blockers verapamil (Calan) and diltiazem (Cardizem) are useful in patients who cannot tolerate beta-blockers. Although most patients with mitral valve prolapse require no treatment or treatment with oral medications, in very rare cases, surgery (mitral valve replacement or repair) may be required. Patients who require surgery usually have severe mitral regurgitation causing worsening heart failure and progressive heart enlargement. Rarely, rupture of one or more chordae can cause sudden, severe mitral regurgitation and heart failure requiring surgical repair. Mitral valve repair is preferable if possible, to mitral valve replacement as the surgical treatment for mitral valve regurgitation. After mitral valve replacement, lifelong blood thinning medications are necessary to prevent blood from clotting on the artificial valves. After mitral valve repair, these blood thinning medications are unnecessary. Because of the success of valve repair, it is being performed earlier in patients with mitral regurgitation, thus reducing the risk of abnormal heart rhythms and heart failure. Rare patients with mitral valve prolapse may suffer strokes because of increased blood clotting. These patients can be treated with a combination of a blood thinner (anticoagulant) and a beta-blocker. Again, although patients with mitral valve prolapse may experience a variety of complications, most have no symptoms and can lead healthy, active, and normal lives.

Part of the spine is open at birth

Effects Spina bifida occurs when the fetus is growing in the womb and its spine doesn't form correctly (a neural tube defect). Some of the vertebrae (bones in the spine) don't close to make their normal ring shapes around the spinal cord. The opening that results causes one of three types of spina bifida: Spina bifida occulta: a tiny opening, usually causes mild or no symptoms Spina bifida cystica - meningocele: a big enough opening so that some of the membrane surrounding the spinal cord sticks out through the opening Spina bifida cystica - myelomeningocele: the most serious kind, in which some of the spinal cord itself sticks out through the opening in the spine. What type of symptoms the person has depends on where along the spine the opening occurred, since that is where the spinal cord was injured. How severe the symptoms will be depends on which type of spina bifida has occurred. Children born with spina bifida may have other nervous system disorders such as hydrocephalus or Chiari malformation. Who gets it? In the U.S., spina bifida occurs more frequently among Hispanics and whites of European extraction, and less commonly among Asians and African-Americans. 95% of babies born with spina bifida have no family history of it. However, if a mother has a child with spina bifida, the risk of it happening again in a subsequent pregnancy is greatly increased. Causes Folic acid deficiency Folic acid deficiency in the mother has been linked to the development of spina bifida in the baby. To help reduce the chance of spina bifida happening, the FDA mandated that all enriched cereal grain products be fortified with folic acid beginning in 1998. A study published in 2002 found that in the United States, there were 24% fewer cases of spina bifida between 1996-2001 compared to the years before. However, there are issues about adding folic acid to food. Diagnosis A screening blood test, called an alphafetoprotein test (AFP), is done using the pregnant mother's blood when she is about 15-17 weeks into the pregnancy. If the results are abnormal, a detailed (Level II) ultrasound is done which can show the presence of spina bifida. An amniocentesis (sampling of the amniotic fluid in the womb) may be done to recheck the AFP level or do other tests. Treatment There is no complete cure for spina bifida. The opening in the spine can be closed surgically either before or after birth, and this will reduce its effects on the body. Since spina bifida causes injury to the spinal cord, treatment consists of managing the symptoms that the person has, such as difficulty standing, walking, or urinating. Some people will be able to walk with crutches or leg braces; others may need a wheelchair to get around. Children and adults with myelomeningocele will have the most medical complications and need the most medical care. Life expectancy The outlook for children with spina bifida has changed dramatically over the years. A study published in 2001 found that with appropriate medical care, at least 75% of children born with the most severe form of spina bifida (myelomeningocele) will most likely live until their early adult years. The study's authors point out that providing supportive care for these adults is challenging.