Clinical and echocardiographic patterns of mirtal valve prolapse among medical students at muhas Dar es Salaam Tanzania

Abstract

MVP is a valvular heart disease characterized by the displacement of an abnormally thickened mitral valve leaflet into the Left Atrium (LA) during systole. Its aetiology is yet to be elucidated. Clinically, MVP has been associated with a wide variety of non-specific clinical features. Its complications include; infective endocarditis, cerebral vascular accidents (CV A), frail leaflets, mitral regurgitation, heart failure, etc. The prevalence of MVP and it's characteristics in Sub-Saharan Africa and particularly in black Africans, including Tanzania has not been well studied. There is lack of awareness on the magnitude of MVP in Tanzania based on clinical and echocardiographic criteria specific for diagnosing MVP, thus, the rationale for conducting the study. Objective: To determine the prevalence, clinical and echo cardiographic patterns of MVP among medical students at MUHAS, Dar es Salaam. Tanzania. Study design and site; A cross- sectional descriptive study was done, involving MD4 and MD5 students at MUHAS, Dar es Salaam. Tanzania. Method: Classic MVP was defined as an upward displacement of the leaflet(s) exceeding 2mm and maximal thickness of _ 5mm on a 2-dimensional Echocardiography. Non classic mitral valve prolapse diagnosis was accepted when the displacement exceeded 2mm but maximal thickness was less than 5mm. Study procedure: A designed structured questionnaire for the purpose of the study was administered to all consenting MD4 and MD5 medical students. Social demographic data, history, clinical cardiac findings and echocardiographic results were recorded.

vu Results: A total of 202 students were recruited, 101 from each class. Among them, 136 (67.3%) were males and 66 (32.7%) were females, with a male to female ratio of 3:1. Majority of the study group were in the age group 24-26 years, with a mean age of 25.71 ± 1.58 (Range 22-29 yrs). The prevalence of classic MVP was 0.99% with equal gender distribution. None of those with MVP had a past history of heart diseases e.g. heart failure, atria fibrillation, cerebral vascular accident, or syncope attack. Chest pain and heart palpitations were the only two common presenting symptoms, while systolic click was the only significant clinical sign detected in students with classical MVP. Five (2.5%) students had mitral valve prolapse. Three (1.5%) had non-classic MVP, while two (0.99%) had classic MVP. The two (0.99%) who had classic MVP, all had symmetric type of prolapse with no cardiac abnormalities or co-morbidities. Conclusion and recommendations From a sample size of 202 presumably healthy medical students, the prevalence of classic MVP was 0.99% supporting some previous studies. A bigger sample sized community based study is recommended so as to determine the actual prevalence of MVP, the associated symptoms and signs, and echocardiographic patterns in our community.