Mitral Valve Prolapse

What is the mitral valve?

The mitral valve is one of the four valves in your heart. Heart valves have flaps that open and close. The flaps make sure that blood flows in the right direction through your heart and to the rest of your body. When your heart beats, the flaps open to let blood through. Between heartbeats, they close to stop the blood from flowing backwards.

The mitral valve opens to let blood flow from your heart's upper left chamber to the lower left chamber. When the lower left chamber contracts (squeezes) to pump blood to your body, the mitral valve closes tightly to keep any blood from flowing backwards.

What is mitral valve prolapse (MVP)?

Mitral valve prolapse (MVP) happens when the flaps of the mitral valve become floppy and don't close tightly. In some cases, blood may leak backwards through the valve to the chamber it came from. This is called backflow, or regurgitation. When there is a lot of mitral valve backflow, the heart can't push enough blood out to the body.

But most people who have MVP don't have any backflow. In fact, MVP doesn't cause any health problems for most people who have it.

Who is more likely to develop mitral valve prolapse (MVP)?

Anyone can have MVP. Most people who have it were born with it. MVP tends to run in families, but researchers don't know the exact cause.

You may be more likely to develop MVP if you:

• Are older. The risk of MVP increases as aging affects the valve.
• Had rheumatic fever, a disease that can develop after a strep throat infection and cause damage to the heart valves.
• Were born with a connective tissue disorder, such as Marfan syndrome or Ehlers-Danlos syndrome.
• Have Graves' disease, a type of thyroid condition.
• Have scoliosis (a side-to-side curve of the spine) or other problems with the bones of your body.
• Have some types of muscular dystrophy.

Mitral valve prolapse with backflow is most common in men and people who have high blood pressure.

What are the symptoms of mitral valve prolapse (MVP)?

Most people who have MVP don't have any symptoms. But if it does cause symptoms, they may include:

• Heart palpitations (feeling that your heart is fluttering, skipping beats, or beating too hard or too fast)
• Shortness of breath (feeling like you can't get enough air)
• A cough
• Fatigue, dizziness, or anxiety
• Migraines
• Chest pain

What other problems can mitral valve prolapse (MVP) cause?

In rare cases, MVP can cause other problems. They're most often caused by backflow. They can include:

• Arrhythmia, a problem with the rate or rhythm of your heartbeat
• Endocarditis, an infection in the lining of the heart and heart valves
• Heart failure

How is mitral valve prolapse (MVP) diagnosed?

Health care providers often find MVP during routine health check-ups. If you have MVP, your provider may hear a clicking sound when listening to your heart with a stethoscope. If blood flows backwards through the valve, your heart may also make a whooshing sound called a heart murmur.

You may also need certain heart tests. The most useful test is an echocardiogram, or echo. This is a type of ultrasound that uses sound waves to make a moving picture of your heart.

What are the treatments for mitral valve prolapse (MVP)?

Most people don't need any treatment for MVP. If you have symptoms with little or no backflow, you may only need medicine to relieve your discomfort.

If the amount of backflow is significant, you may need treatment to prevent other heart problems from developing. Treatments may include:

• Medicines to help your heart work better.
• Heart surgery to repair or replace a very abnormal mitral valve with backflow. The goal of surgery is to improve your symptoms and reduce your risk of developing heart failure.

When possible, valve repair is generally preferred over replacement. That's because repairs are less likely to weaken the heart muscle, and they're less likely to cause heart infection.

Can mitral valve prolapse be prevented?

You can't prevent mitral valve prolapse. But if you have mitral valve prolapse, you can help prevent the rare but serious problems it can cause by:

• Brushing and flossing your teeth regularly. That helps keep bacteria out of your bloodstream, which further reduces the rare risk of a heart infection.
• Asking your provider if you need to take antibiotics before dental work or surgery to lower your risk of heart infection. This mostly applies to people who have had valve repair or replacement surgery.
• Getting regular check-ups and taking any medicines that your provider may have prescribed.
• Making heart-healthy habits part of your life to prevent heart disease.

NIH: National Heart, Lung, and Blood Institute

Nutrition for Older Adults

What is nutrition and why is it important for older adults?

Nutrition is about eating a healthy and balanced diet so your body gets the nutrients that it needs. Nutrients are substances in foods that our bodies need so they can function and grow. They include carbohydrates, fats, proteins, vitamins, minerals, and water.

Good nutrition is important, no matter what your age. It gives you energy and can help you control your weight. It may also help prevent some diseases, such as osteoporosis, high blood pressure, heart disease, type 2 diabetes, and certain cancers.

But as you age, your body and life change, and so does what you need to stay healthy. For example, you may need fewer calories, but you still need to get enough nutrients. Some older adults need more protein.

What can make it harder for me to eat healthy as I age?

Some changes that can happen as you age can make it harder for you to eat healthy. These include changes in your:

• Home life, such as suddenly living alone or having trouble getting around
• Health, which can make it harder for you to cook or feed yourself
• Medicines, which can change how food tastes, make your mouth dry, or take away your appetite
• Income, which means that you may not have as much money for food
• Sense of smell and taste
• Problems chewing or swallowing your food

How can I eat healthy as I age?

To stay healthy as you age, you should:

• Eat foods that give you lots of nutrients without a lot of extra calories, such as
  • Fruits and vegetables (choose different types with bright colors)
  • Whole grains, like oatmeal, whole-wheat bread, and brown rice
  • Fat-free or low-fat milk and cheese, or soy or rice milk that has added vitamin D and calcium
  • Seafood, lean meats, poultry, and eggs
  • Beans, nuts, and seeds
• Avoid empty calories. These are foods with lots of calories but few nutrients, such as chips, candy, baked goods, soda, and alcohol.
• Pick foods that are low in cholesterol and fat. You especially want to try to avoid saturated and trans fats. Saturated fats are usually fats that come from animals. Trans fats are processed fats in stick margarine and vegetable shortening. You may find them in some store-bought baked goods and fried foods at some fast-food restaurants.
• Drink enough liquids, so you don't get dehydrated. Some people lose their sense of thirst as they age. And certain medicines might make it even more important to have plenty of fluids.
• Be physically active. If you have started losing your appetite, exercising may help you to feel hungrier.

What can I do if I am having trouble eating healthy?

Sometimes health issues or other problems can make it hard to eat healthy. Here are some tips that might help:

• If you are tired of eating alone, try organizing some potluck meals or cooking with a friend. You can also look into having some meals at a nearby senior center, community center, or religious facility.
• If you are having trouble chewing, see your dentist to check for problems
• If you are having trouble swallowing, try drinking plenty of liquids with your meal. If that does not help, check with your health care provider. A health condition or medicine could be causing the problem.
• If you're having trouble smelling and tasting your food, try adding color and texture to make your food more interesting
• If you aren't eating enough, add some healthy snacks throughout the day to help you get more nutrients and calories
• If an illness is making it harder for you to cook or feed yourself, check with your health care provider. He or she may recommend an occupational therapist, who can help you find ways to make it easier.

NIH: National Institute on Aging

Over-the-Counter Medicines

Over-the-counter (OTC) medicines are drugs you can buy without a prescription. Some OTC medicines relieve aches, pains, and itches. Some prevent or cure diseases, like tooth decay and athlete's foot. Others help manage recurring problems, like migraines and allergies.

In the United States, the Food and Drug Administration decides whether a medicine is safe and effective enough to sell over-the-counter. This allows you to take a more active role in your health care. But you also need to be careful to avoid mistakes. Make sure to follow the instructions on the drug label. If you don't understand the instructions, ask your pharmacist or health care provider.

Also keep in mind that that there are still risks to taking OTC medicines:

• The medicine you are taking could interact with other medicines, supplements, foods, or drinks
• Some medicines are not right for people with certain medical conditions. For example, people with high blood pressure should not take certain decongestants.
• Some people are allergic to certain medicines
• Many medicines are not safe during pregnancy. If you are pregnant, check with your health care provider before taking any medicine.
• Be careful when giving medicines to children. Make sure that you give your child the correct dose. If you are giving your child a liquid medicine, don't use a kitchen spoon. Instead use a measuring spoon or a dosing cup marked in teaspoons.

If you have been taking an OTC medicine but your symptoms don't go away, contact your health care provider. You should not take OTC medicines longer or in higher doses than the label recommends.

Food and Drug Administration

Pheochromocytoma

Pheochromocytoma is a rare tumor that usually starts in the cells of one of your adrenal glands. Although they are usually benign, pheochromocytomas often cause the adrenal gland to make too many hormones. This can lead to high blood pressure and cause symptoms such as :

• Headaches
• Sweating
• Pounding of the heart
• Being shaky
• Being extremely pale

Sometimes pheochromocytoma is part of another condition called multiple endocrine neoplasia syndrome (MEN). People with MEN often have other cancers and other problems involving hormones.

Doctors use lab tests and imaging tests to diagnose it. Surgery is the most common treatment. Other options include radiation therapy, chemotherapy, and targeted therapy. Targeted therapy uses drugs or other substances that attack specific cancer cells with less harm to normal cells.

NIH: National Cancer Institute

Polycystic Ovary Syndrome

What is polycystic ovary syndrome (PCOS)?

Polycystic ovary syndrome (PCOS) is the name for set of symptoms that are related to an imbalance of hormones. PCOS affects the ovaries, as well as many other parts of the body.

People with PCOS usually have at least two of these problems:

• Not ovulating. Normally, your ovaries make the egg that is released each month as part of a healthy menstrual cycle. This is called ovulation. But with PCOS, the egg may not develop as it should, or it may not be released during ovulation. Your periods may be irregular, or you may not have them at all.
• High levels of androgens. Androgens are hormones that are important for normal male sexual development. Women normally make smaller amounts of androgens. Having higher levels of androgens can cause you to have extra body or facial hair (called hirsutism).
• Cysts in one or both ovaries. Cysts are growths that are small, fluid-filled sacs.

What causes polycystic ovary syndrome (PCOS)?

The exact cause of PCOS in unknown. Research has shown that different factors may play a role, including:

• Genetics. PCOS tends to run in families.
• Imbalances in androgen levels.
• Insulin resistance. This is a condition in which your body can't use insulin properly. Insulin is a hormone that helps move blood glucose (sugar) into your cells to give them energy. Insulin resistance can lead to high blood glucose levels.

What are the symptoms of polycystic ovary syndrome (PCOS)?

PCOS often develops as young as age 11 or 12, around the time of your first period. But you can develop it later.

The symptoms can vary from person to person. Some people have few or even no symptoms. They may not realize they have PCOS until they have trouble getting pregnant. Other people may have more severe symptoms.

The symptoms of PCOS may include:

• Irregular or missed menstrual periods.
• Too much hair on the face, chest, stomach, or thighs.
• Obesity, weight gain, or trouble losing weight.
• Severe acne which may be hard to treat.
• Oily skin.
• Patches of thickened dark skin (called acanthosis nigricans).
• Infertility. PCOS is one of the most common causes of infertility. But many people with PCOS can still get pregnant.

What other health problems are linked to polycystic ovary syndrome (PCOS)?

PCOS is linked to many other health problems, including:

• Insulin resistance, which can lead to prediabetes and type 2 diabetes.
• Heart disease. Having PCOS increases your risk, and this risk goes up as you age.
• High blood pressure.
• High LDL ("bad") cholesterol and low HDL ("good") cholesterol. This increases your risk of heart disease.
• Sleep apnea, a disorder that causes you to repeatedly stop breathing during sleep.
• Depression and anxiety.

Although there are links between PCOS and these conditions, researchers do not know whether:

• PCOS causes some of these problems
• Some of these problems cause PCOS, or
• There are other conditions that cause both PCOS and these other health problems

Not everyone who has PCOS will have all these problems. However, you and your health care provider may want to monitor your health for signs of them, so they can be treated early.

How is polycystic ovary syndrome (PCOS) diagnosed?

There is no specific test for PCOS. To find out if you have PCOS, your provider:

• Will do a physical exam, which will include looking for the physical signs of PCOS.
• Will ask about your medical history and family health history.
• May do a pelvic exam to check for signs of extra male hormones and to see if your ovaries are enlarged or swollen.
• May order a pelvic ultrasound to look for cysts on your ovaries and check the thickness of your endometrium (the lining of your uterus, or womb).
• May order blood tests, including tests to check your hormone levels.

What are the treatments for polycystic ovary syndrome (PCOS)?

There is no cure for PCOS, but treatments can help you manage your symptoms. The treatments may include:

• Lifestyle changes, which can help reduce many symptoms. They can also lower your risk for or help manage related health problems. These changes include:
  • Maintaining a healthy weight
  • Getting regular physical activity
  • Eating healthy foods
• Medicines:
  • Hormonal birth control, such as pills, shots, and IUDs, can make your period more regular. They may also help remove acne and extra facial and body hair. But you would only use them if you don't want to get pregnant.
  • Anti-androgen medicines, which block the effect of androgens. This can help reduce hair loss on your head, the growth of facial and body hair, and acne. Providers do use them to help with these symptoms, but anti-androgen medicines are not approved by the U.S. Food and Drug Administration (FDA) to treat PCOS. These medicines can cause problems during pregnancy. Your provider may have you take them with birth control (to prevent pregnancy).
  • Insulin-sensitizing medicines, which are medicines that are used to treat type 2 diabetes. They improve insulin resistance and keep your blood glucose levels steady. They may also lower your androgen levels. They are not approved by the FDA to treat PCOS. But they may help with your symptoms.
  • Medicines for acne. These medicines come in pills, creams, or gels.
• Treatments for hair removal, such as facial hair removal creams, laser hair removal, and electrolysis.
• Fertility treatments if you are having trouble getting pregnant. They include medicines and procedures such as in vitro fertilization (IVF).