The overdiagnosis of MVP
It now appears that MVP has been systematically overdiagnosed for many years. Indeed, in some studies, up to 35% of the general population was found to have MVP by echocardiography.In a landmark article in the New England Journal of Medicine in 1999, researchers documented that, when using strict diagnostic criteria, MVP is seen in only 2% of the population. This figure still means that millions of Americans have MVP, but underscores the gross overdiagnosis that has been seen habitually with this condition during the past decades.
This overdiagnosis is a problem for several reasons. Patients are labeled as having a “cardiac condition” when in fact they have none. Such a label has possible insurability implications. Patients are placed on prophylactic antibiotics inappropriately. But more importantly, difficult but treatable conditions (like the dysautonomia syndromes) are “written off” as being caused by MVP, and potentially effective therapies ignored.
General recommendations
If you have been told you have MVP, you ought to consider doing the following:1) Make sure the diagnosis is correct. Ask your doctor if she made the diagnosis of MVP using the Freed criteria (the criteria used by the authors of the New England Journal study mentioned above). If she did not, or if she doesn’t know what you’re talking about, you should consider getting a second opinion.
2) If you do have true MVP, make sure you have been fully instructed about antibiotic prophylaxis for endocarditis.
3) If you do have true MVP, make sure you understand from your physician the degree of mitral regurgitation you have (i.e., minimal vs. moderate or severe), and that your doctor has outlined a schedule for following the degree of regurgitation over time.
4) If you have chest pain or palpitations, these symptoms ought to be evaluated as separate entities. If your doctor merely writes these symptoms off as being due to MVP, without ever performing an evaluation, remember the First Rule in being an effective patient: You hired him; you can fire him.
5) If you think you may have one of the dysautonomia syndromes, make sure your doctor is well-versed in managing these conditions, works with you to develop a treatment plan, and is committed to working with you long-term to alleviate your symptoms. Again, don’t waste time with a doctor who seems too willing to write off your symptoms as "just one of those things" that goes along with MVP. The dysautonomias are real, honest-to-goodness physiologic disorders. While their treatment is often difficult, they can be treated. And while they’re enough to make anyone crazy, they are not to be dismissed as being caused by either MVP or craziness.
