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partlycloudy 03-21-2009 11:39 AM

Risk of heart infection with mitral valve prolapse?
There isn't a whole lot of info on MVP out there, even though it's pretty common among women. I have it, and I worry about my risk of getting a heart infection because I have a really bad habit (when I'm stressed) of picking at an area of my upper mouth - sometimes it bleeds. Bacteria infected blood ( if my hands are dirty ) can travel to the heart, and with the valve not working as it should, can have a hard time getting rid of that bacteria. I know the Heart Association no longer requires dental patients with MVP to take antibiotics before cleanings (dirty instruments can cause heart infections). I guess this is because it was determined risk was low, though I have read of MVP patients almost dying from getting infected through dental cleanings.

What I want to know is what is the risk in my case? I try to keep my hands and nails clean because often I'm not even aware I'm picking until I've done it. My doctor thinks it's caused by my anxiety, and wanted to up my antidepressant, though I don't think that will help as I started to pick when I was on a high dose of Lexapro. So given that I do this, what is the risk from this behavior?

harka 03-21-2009 11:23 PM

Re: Risk of heart infection with mitral valve prolapse?
Hi partlycloudy,

You have some of your information right and some of it wrong. Allow me to explain: a heart infection or "endocarditis" is generally caused when there is bacteria in the bloodstream which then latches on to a heart valve and through a process where the bacteria grow, attract platelets and more bacteria and more gelatinous fibrin, a vegetation forms on the heart valve which continuously "seeds" the bloodstream so the process continues eventually destroying the valve if not treated. Though it has been related to dental procedures, it's not from dirty instruments--it's from the bacteria in the mouth. One of the most common causes of endocarditis in people with their own natural heart valves is from a group of bacteria known as Viridans group Streptococcus (bacteria which live on the crevices of the teeth). The thing is, what the American heart association (as well as other infectious disease associations) have known for years is that the risk of causing endocarditis from a single dental procedure is very small. There is much more risk of having bad teeth ALL the time than from a single dental visit.

Now in terms of mitral valve prolapse: there is a small increase in risk of endocarditis compared to the general population, but this risk (as small as it is) is still a lot less than other valvular abnormalities such as a bicuspid aortic valve or a prosthetic valve. The reason the AHA took away most of the previous indications for endocarditis prophylaxis (including mitral valve prolapse) is that it has been shown in studies over and over again that it is already unlikely to get endocarditis from a dental procedure. There was even a funny commentary going over these stats that you would have to use a ton (I mean that literally, 1000 pounds) of amoxicillin to prevent 1 case of endocarditis if you were to consider the baseline population as people in Brooklyn, New York!

Sure, when you are picking at your mouth, you may be causing transient bacteremias, but no more so than when you are brushing your teeth and having a bowel movement. or even eating! We have low grade bacteremias in our blood all the time, but our immune system deals with it. The reason bad teeth can result in endocarditis is because the burden of bacteria is much higher.

So in conclusion, I think your doctor is right--you're worrying excessively about something whose risk is very small.

partlycloudy 03-22-2009 11:51 AM

Re: Risk of heart infection with mitral valve prolapse?
Thanks for responding, cg. Would you know by chance if eye spasms are or could be related to heart issues? What has got me focused on the MVP more is eye spasms which came about a couple of weeks ago. My left eye twitches, visibly, for several seconds, and this occurs very often throughout the day. I've read that it's really no big deal, often brought on by stress, so I haven't worried about it, but it's quite frequent and in the past few days, I've had bouts of irregular heartbeats, often occurring at the same time as the spasms.

Arryhthmia is pretty common for me, but I have to watch it because having that plus MVP puts a person at higher risk for bigger problems. It can make me get really tired and like yesterday I felt really weak for a few minutes. I just wonder if there is a connection with the eye twitching. I have been under stress with getting my hours cut and doing substitute teaching more (which I don't really like) to make up for the lost hours with my main job. I can't get on a set schedule, so it's disrupted everything. I think I've been pretty calm considering, though.

harka 03-23-2009 01:57 PM

Re: Risk of heart infection with mitral valve prolapse?
Hi again!

Eye spasms are common, and they are not directly related to MVP. A lot of people who have benign palpitations (such as yourself) end up becoming very aware of their heart rates, while a significant proportion of people don't have any clue when their hearts are in arrhythmias because they don't notice it. Unfortunately, in the former case, it ends up being somewhat of a vicious cycle because once the person notices the heart rhythm it leads to anxiety, increased catecholamines (read: adrenaline) which can make the arrhythmia worse. In any case, MVP only puts you at a tiny increased risk of ANYTHING, and it seems like the way you talk about it that you think it's more serious than it actually is. MVP is largely a benign phenomenon which is not even close to as serious as other structural heart problems.

Hopefully that's good news for you! :)

k2626 05-10-2010 02:07 PM

Re: Risk of heart infection with mitral valve prolapse?
I have a question about this. Hoping I can get insight.

For 2 yrs I have had muscle twitching all over my body, nerve pains, pancreas inflammation.Drs have been at a loss. I have started to get blood lines under my nails, I have only gotten 4 in 2 months. My primary wants me to take some test to see if I have endocarditis.

I dont have fevers, I do have a fluttering heart on and off but have had this for yrs.

Does this sound like endo? The test is pretty invasive...

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