Peter Hibberd, M.D., is a doctor whose advice is based on more than 28 years of hospital outpatient and inpatient experience. He is an experienced emergency medicine physician, surgeon, and consultant. Dr. Hibberd is certified by the American Board of Emergency Medicine. He is also a fellow and active member of the American Academy of Family Physicians, an active member of the American College of Emergency Physicians, and a member and fellow of the American Academy of Emergency Medicine. Dr. Hibberd has earned numerous national and international professional certifications, memberships, and awards.
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Mitral Valve Prolapse and Clots

Tuesday, 06 Sep 2011 08:07 AM


Question: Can a mitral valve prolapse with mild regurgitation cause clots to form and then be pumped through the body? What can this type of condition turn into if not medically treated?

I'm a 39-year-old woman, and had a deep vein thrombosis last year and small pulmonary embolisms this year. One in the brain caused an ischemic stroke and another one was found in my lower right lung. I have a blockage of 30 percent in my left carotid artery that the doctor said wasn't a concern.

Dr. Hibberd's Answer:

Mitral valve prolapse refers to a condition where the mitral valve leaflets flutter backward into the left atrium when the large left ventricle — the main pumping chamber of the heart — contracts to pump blood though your body.

This small degree of flutter is usually insignificant. It is not a major source for blood clots and will not normally place you at risk for stroke. Blood thinners are not usually needed unless you develop additional problems such as atrial fibrillation or severe valvular regurgitation/insufficiency (rare).

Your history of DVT (peripheral leg thrombosis) and PE (lung embolus) indicate you have an increased risk for clot formation. You should be checked for rare hypercoagulable conditions such as protein C deficiency that may mandate you be on full life-long anticoagulant (blood thinner) therapy such as Coumadin, not just aspirin daily, as opposed to the usual six to12 months of Coumadin recommended for victims of pulmonary embolisms.

There is a newer blood thinning agent called Pradaxa that is used to protect atrial fibrillation patients from stroke that may become a suitable option for you. It may put you at less risk for bleeding without the need for weekly/monthly tests needed on Coumadin, depending upon your test results for hypercoagulable state.

In addition, you probably need to be evaluated for a correctable underlying cause to this newly discovered hypercoagulable state. Underlying causes include chronic infection, malignancy, rheumatic, and hematologic disorder as well as a genetic component.

Your carotid artery narrowing of 30 percent isn't significant unless it has ulcerated or the plaque becomes unstable. Surgical intervention is usually reserved for those with narrowing of 70 percent or more.

You are correct to be proactive with your health, and you should pursue aggressive preventive measures to reverse and stabilize intravascular plaque. These include regular exercise, aggressive glucose management if you have Type 2 diabetes risks, aggressive lipid management with LDL goals of 80, optimized HDL improvement (the higher the better), triglyceride management to less than 150, and weight management.

Consult with your doctor to review your various preventive options. If you are unsure of what you need to do, you should always request a consultation with a cardiovascular and hematology consultant.





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