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Dear Dr. Stoll,
I've read the archives and your article on MVP, but I am still a little confused...not your fault, it's just me. I was diagnosed with a prolapsed mitral valve by an internist about ten years ago. I was seeing him for something completely unrelated, and he said he heard something irregular in my heartbeat, and told me from now on I needed to be premedicated for dental work, then he sent me for an echocardiogram. The echocardiogram confirmed his diagnosis. I think there was some slight regurgitation. I didn't want to take antibiotics for dental work, so I consulted a cardiologist. The only symptom that I had involving my heart was occassional, mild palpitations...very occassional. The cardiologist said I was in a gray region, and that my MVP was mild, and that it had nothing to do with the palpitations I sometimes got. I kept pressing him about premedication for dental work, and he finally agreed that I only needed premedication for dental cleanings and for extractions, oral surgery, or root canals, but not for other dental work. My dentist, nevertheless, insisted that I be premedicated for everything.
Is the MVP that I've been told that I have of the "fad diagnosis" type that you've described in your article, and in the archives, or is it the real thing?
I'm sorry, but I honestly am confused. I understand that you're saying that the symptoms that many people see a doctor about and who are then given the dx of MVP as an explanation for, is generally totally stupid. The symptoms do not come from the MVP which is just coincodentally dx'd. The symptoms come from stress, CR-S, LGS, etc. But in some cases, you say that the MVP is a real physical entity, and I guess in those cases the person would need to be premedicated for dental work and surgery?
The American Heart Association changed its guidelines back in 1997, and reduced the amount of premedication. In 1998 a study was published by Strom, et.al. ("Dental and CArdiac Rish Factors for INfective Endocarditis: A Population Based Case-Control Study". Ann Intern Med 1998; 129:761-769), that concludes that antibiotic prophylaxis for dental treatment in patients with endocarditis might be overkill...that it would only be necessary in high risk patients and then only for extractions, surgery, and implants.
Anyway, I haven't been able to find a dentist yet, including the wholistic, non-mercury, hal huggins trained variety who will agree to no premedication if they think you have MVP.
Given the info I've described, do you think I need premedicaiton for my MVP? I realize now that I will have to make an informed decision about this, and take responsibility for it when I go to the dentist. I can't expect any dentist to do anything other than hold the the line the AHA has put forth.
I appreciate you help.
Hope you enjoy your vacation!
In Reply to: Mitral Valve Prolapse or Not posted by Cindy on June 22, 2001 at 14:06:23:
dont tell the dentist. i wouldnt take the antibiotic.
In Reply to: Mitral Valve Prolapse or Not posted by Cindy on June 22, 2001 at 14:06:23:
Hi, Cindy.
It really IS too bad when the patient has to protect herself from the dentist or physician because she knows more than the doc. Remember, YOU are still the boss of your body. Have the dentist's secretary type out that you have been recommended to take preoperative,prophylactic antibiotics, in spite of the current research results, and that you have refused them. Then, both you and the dentist sign it.
He will likely be angry but you have to stand up for your rights. Remember, his anger will be more a function of his ego than about your risk. Actually this is a good test as to whether you are going to the right dentist or not.
From what you are describing, there is no way that you need prophylactic antibiotics which cannot possibly be beneficial to you and so ALL you get is any bad effects.
The only real mitral valvular deformity is rheumatic and that changes the rules completely. However, the research you are listing are even skeptical that the very worst of THOSE problems STILL very questionably need prophylactic antibiotics for dental work of any kind.
Hope this helps.
Walt
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