Magnesium. A deficiency of this mineral is linked to MVP. Magnesium is necessary for maintaining normal muscle and nerve function, as well as keeping bones strong and heart rhythm steady. One study found that, of 141 patients with heavily symptomatic MVP, 60 per cent showed lower-than-normal levels of blood magnesium. But after five weeks of supplementing their diets with magnesium, the patients experienced significant reductions in symptoms, including physical weakness, chest pain, dyspnoea (breathlessness), palpitations and anxiety (Am J Cardiol, 1997; 79: 768-72).

Magnesium is found in green vegetables such as spinach, and in nuts and seeds. Avoid refined foods such as white bread. Wheat germ and bran are rich in magnesium, but are removed during the processing of white flour. The recommended dosage of magnesium is 200-600 mg/day.

Coenzyme Q10 (ubiquinone). CoQ10 is fundamental to the body’s energy production and for the synthesis of nucleic acids and proteins. Among its various roles, it also enhances heart function. One study treated 424 patients who had various forms of cardiovascular disease, including MVP, by adding CoQ10 to their treatment regimes. Results showed that over 87 per cent of patients showed significant improvement in their everyday heart function and performance. Also, a considerable number were able to reduce the number of different medications they were having to take (Mol Aspects Med, 1994; 15 Suppl: s165-75).

The richest natural sources of CoQ10 are sardines and mackerel, pork, spinach, soya oil, peanuts, sesame seeds and walnuts. To aid its uptake, make sure you have plenty of B vitamins and iron. Avoid stimulants such as caffeine and nicotine, as well as sugar, as they destroy CoQ10. The recommended dosage of CoQ10 is 10-90 mg/day.

L-carnitine. A rich source of amino acid, it plays an important role in strengthening the heart. Italian researchers investigating the effect of L-carnitine in type 2 diabetic patients with essential hypertension found that 2 g twice daily for 45 weeks significantly reduced heart symptoms such as an irregular heartbeat as well as loss of strength (Minerva Med, 1989; 80: 227-31).

Good dietary sources of L-carnitine are dairy, red meat and avocado pears. The recommended dosage is 500 mg/day.

Vitamin E. There are mixed views as to whether this vitamin really can have benefit for potential heart-disease patients. Several observational studies support vitamin E’s role in lowering the risk of cardiovascular disease (Ann NY Acad Sci, 2004; 1031: 280-91). However, the Heart Outcomes Prevention Evaluation (HOPE) study, comparing the ACE-inhibitor ramipril with vitamin E, found that the vitamin did not protect patients against heart problems and chest pain (Cleve Clin J Med, 2000; 67: 287-93). Nevertheless, other studies are ongoing to determine whether a longer period of treatment with vitamin E supplements may be required for any benefit to become evident. The recommended dosage of vitamin E is 200-800 IU/day.

I am still awaiting the results from the diagnostic tests – an oesophageal echocardiogram and coronary angiography – but my doctors believe surgery is inevitable to have my mitral valve either repaired or replaced.

Are there any alternatives to surgery? If there are none, what are the risks and drawbacks of this operation? I am 55 years old, and both my parents also suffered from cardiac problems – my father had a slow heartbeat and needed two pacemakers, while my mother died from a heart condition. – Malcolm Linchis, London

A MVP is a common heart condition in which the two flaps of tissue (mitral valves) controlling the flow of blood from the upper to the lower left heart chambers stop working properly. As a result, blood is ‘regurgitated’ back into the upper chamber, causing a ‘heart murmur’.

While the symptoms of MVP are usually benign, with the majority of those affected continuing to lead normal lives, about a quarter of cases worsen with age. Progressive deterioration of the valves leads to more severe regurgitation, with the blood not only pushed back into the upper chamber, but also into the lungs. Symptoms such as breathlessness, fatigue and chest pain become more pronounced, as you’ve experienced and, in the worst-case scenario, congestive heart failure can ensue.

To prevent reaching such a dangerous stage, doctors recommend repairing your mitral valve or replacing it with a prosthesis, depending on the amount of damage. This essentially means open-heart surgery, and the risks are as high as you would expect for such an invasive procedure.

It is important that you consider very carefully if the benefits from surgery will outweigh the risks of the procedure. Once you have the results of your echo and angiographic tests, make sure the doctor explains to you as clearly as possible the severity of your condition and whether you really do need the surgery. Do not allow your doctor to wave away your questions and decide for you. Also, ask if there are any alternatives to surgery (see box on right).

If you do decide to opt for surgery, there seems to be a slight disparity between the success of mitral-valve repair vs replacement. Those who have undergone repair rather than replacement appear to have a slightly better chance of survival, and are less likely to need further surgery (J Cardiovasc Surg [Torino], 1999; 40: 93-9).