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Barlow's Syndrome

  • Barlow's syndrome is a condition caused by a prolapsed mitral valve of the heart.
  • Barlow's syndrome occurs more frequency in those patients who experience diseases such as Marfan's syndrome, Graves' disease or rheumatic heart disease.
  • Treatment is mainly symptomatic but new synthetic valves are now being put in to replace defective ones.

What is Barlow's Syndrome

The mitral valve is the valve of the heart which is present between the two left heart chambers ~the left atrium and left ventricle. The leaflets of the valve moves when closing and opening of valves take place. A mitral valve consists of thin tissue strips.

Barlow's syndrome is also called floppy-valve syndrome, mitral valve prolapse or billowing mitral valve syndrome. This syndrome is characterized by the bulging of the mitral valve into the left atrium and occurs when ventricular contraction takes place.  Therefore, closure of the valve cannot be achieved and leaking occurs. It can sometimes lead to the development of mitral regurgitation of a severe nature, causing leakage of the blood into the left atrium.

Complications depend upon the severity of Barlow's syndrome. In cases of severe or even moderate prolapse of mitral valve, sudden death can occur.  Untreated mitral syndrome can also lead to the development of atrial fibrillation, heart failure, rupture of the chordae or an infective endocarditis.


Prevalence & Course

The prevalence of this condition varies but is considered one of the most common diseases of the heart. The estimated prevalence of Barlow's syndrome is 2 to 3%. This condition can occur in teenagers too. The course is slow and of a chronic nature. In cases of severe disease, sudden death is reported among patients with a prolapsed mitral valve.

Causes

The mitral valve prolapse occurs due to degeneration of the tissue which makes the leaflets enlarged and stretched. This degenerative tissue protrudes into the atrium, preventing proper valve closure.

It can also occur when there is a dysfunctional papillary muscle and could be the result of ischemia of the heart or due to dilated cardiomyopathy.

Symptoms and Signs


Most of the time patients remain symptomless. Those who develop symptoms, complaint of:

  • Palpitations
  • Fatigue
  • Migraine
  • Shortness of breath
  • Dizziness
  • Orthostatic hypotension (low blood pressure when lying down)
  • Chest pain
  • Syncope
  • Anxiety

Low body mass index and murmurs are also found in these patients.


When to See the doctor


If you experience tiredness, dyspnea on exertion, chest pain and palpitation, you should seek the help of your health care provider.  If you have been diagnosed with this condition but experience a worsening of symptoms, a doctor visit should be made as soon as possible.


Diagnosis


Diagnosis is made by history, clinical presentation and physical examination. Further investigation requires:

  • Electrocardiogram by which a clinician can measure the electrical activity of the heart and any kind of characteristic alterations in heart function.
  • Echocardiogram: this is a heart ultrasound via which a clinician can see the heart. It allows one to access the measurement of thickness of the leaflet as well as its functions. It even determines the position of the leaflet.

Treatment


Symptoms such as chest pain, migraine, palpitations and dizziness should be treated medically after confirming no significant valve dysfunction. These are easily treated via the use of beta-blockers.

Patients who have had a previous stroke or who are suffering with additional atrial fibrillation, need anticoagulation therapy which is easily done with the use of warfarin or heparin.

In cases of mitral regurgitation, antibiotic prophylaxis is a must before going for any kind of medical procedure such as dental extractions etc.

All such patients can do moderate exercises but should avoid stress as well as CNS stimulants such as coffee or excess caffeine.

Those patients suffering with this severe disease and who have clicks and murmurs on auscultation should avoid sports requiring large amounts of stamina.

Some patients may require a valve replacement due to a decrease in cardiac functioning of around 50%.


Factors

Barlow’s syndrome occurs with an incidence of 1- 6% in otherwise healthy individuals. The risk factors are certain diseases such as hypertrophic cardiomyopathy, Graves’ disease, myotonic dystrophy, Marfan’s syndrome, sickle cell disease, Duchene muscular dystrophy and rheumatic heart disease.

Prevention

A degeneration of the valves is believed to be the result of genetic alteration, which signifies that not much can be done to prevent it.

It is recommended that patients with this disease go for regular monitoring of their valve functioning in order to prevent complications.


 

 
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