Exercise Advice for Mitral Valve Prolapse

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Exercise Advice for Mitral Valve Prolapse

Question:

With the deaths of runners in the Chicago and New York marathons, will there be any changes in the advice given to people with mitral valve prolapse about running marathons?

Answer:

Since the death of a runner during the Chicago marathon in October 2007, there has been a flurry of concern about whether marathon running exposes people with mitral valve prolapse to risks. The runner who died had been previously diagnosed with mitral prolapse. This is a condition in which the flaps of the valve don't close normally. The flaps bulge backward into the left atrium and can allow blood to leak in the wrong direction.

The doctor who performed the autopsy on the runner said that the cause of death was not the extraordinary heat in which the marathon was run, but the runner's cardiac condition.

That conclusion might be correct, but it might not be. Mitral prolapse is very common, occurring in 2% to 5% of the population. That means of the 35,000 runners who started the race that day, somewhere between 700 and 1,750 people had the same heart valve condition. Mitral prolapse is associated with an increased risk for heart rhythm abnormalities, but so is running, especially when a person is dehydrated. This runner seems to have died from a heart rhythm abnormality. But did his mitral prolapse have anything to do with it? There is no way to know.

I don't think any doctor I know is giving advice to restrict exercise for people with mitral valve prolapse. Exercise is good, and the more the better. I would urge people with mitral prolapse to avoid dehydration, as that can shrink the size of the heart's chambers and make the bulging of the mitral valve worse. But avoiding dehydration is good advice for anyone.

Thomas Lee, M.D., is the chief executive officer for Partners Community HealthCare Inc. He is a professor of medicine at Harvard Medical School. He is an internist and cardiologist at Brigham and Women's Hospital. Dr. Lee is the chairman of the Cardiovascular Measurement Assessment Panel of the National Committee for Quality Assurance.

Last updated:	July 20, 2009