Mitral Valve Prolapse

Topic Overview

What is mitral valve prolapse?

Your mitral valve controls blood flow on the left side of your heart. The valve opens and closes with each heartbeat. It works like a one-way gate, letting blood flow from your upper heart chamber to your lower chamber.

When you have mitral valve prolapse, the valve closes after blood flows through. But the valve bulges backward a little. It looks like a tiny parachute or balloon as it bulges. (See a picture of mitral valve prolapse .)

Is mitral valve prolapse a serious heart problem?

No. Mitral valve prolapse is not dangerous. It usually does not damage your heart. You can live a normal life without changing your activities or how you eat.

But a few people with this condition develop another problem. If the valve does not close tightly enough, blood can leak (regurgitate) into the upper chamber. This is called mitral valve regurgitation. The heart then has to work harder to pump this extra blood. Over time, this can damage the heart.

What are the symptoms?

You probably will not have any symptoms from mitral valve prolapse. You may not even know you have it until a doctor hears a 'clicking' sound or a murmur when listening to your heart.

But some people may feel that their heart is beating too fast or 'pounding.' This feeling is called palpitations. Others may have brief chest pain.

What causes mitral valve prolapse?

Mitral valve prolapse is caused by a physical change in the valve. Physical changes such as thickening and abnormal shapes cause most of the cases of MVP. What causes these physical changes is not known. A valve problem may be passed down through family members.

How is mitral valve prolapse diagnosed?

In most cases, mitral valve prolapse is found during a regular doctor visit. If your doctor hears a certain 'click' or murmur sound when listening to your heart, he or she may want you to have a test to check for mitral valve prolapse. This test is called an echocardiogram.

Will you need treatment?

You will probably not need treatment for mitral valve prolapse. Your doctor may want you to have a follow-up exam in 3 years.

Frequently Asked Questions

Cause

Mitral valve prolapse (MVP) is caused by a physical change in the valve. Physical changes such as thickening or abnormal shapes cause most of the cases of MVP. What causes these physical changes is not known. MVP may be passed down through family members.

Some people who have other inherited diseases (ones that run in families) may also have MVP. But this link is not common. Inherited diseases associated with MVP include:

• Marfan's syndrome.
• Ehlers-Danlos syndrome.

Conditions that affect the mitral valve, connective tissue, and heart muscle can cause mitral valve prolapse, but this is rare. Examples of these conditions include rheumatic fever, lupus, and coronary artery disease.

Other conditions, such as osteogenesis imperfecta and hyperthyroidism, are also associated with mitral valve prolapse.

Symptoms

For most people with mitral valve prolapse (MVP), the effect on the heart is minor, and they have no symptoms.

Some people with MVP have shortness of breath, chest pain, or heart palpitations. But it is not clear that these symptoms are caused by MVP. Doctors don't know exactly why some people have these symptoms.

In rare cases, people who develop severe mitral valve regurgitation may have symptoms of heart failure (such as shortness of breath, fluid buildup, and fatigue) or symptoms of arrhythmia (such as lightheadedness and weakness).

There are other conditions that have symptoms similar to MVP, including other heart valve conditions that cause similar abnormal heart sounds.

What Increases Your Risk

If someone in your family has mitral valve prolapse (MVP), you are more likely to develop it yourself.

Inherited conditions can increase your risk of MVP, but this is rare. These conditions include Marfan's syndrome or Ehlers-Danlos syndrome.

Any change in the shape of the valve can increase your risk of MVP. These changes can result from a birth (congenital) defect or a disease that affects the parts of the heart or how the heart works.

Diseases that increase your risk of developing MVP

Diseases that damage the mitral valve or affect the parts of the heart or how the heart works may increase your risk of getting MVP. But this cause is not common. Examples of these diseases include:

• Coronary artery disease.
• Connective tissue disorders, such as lupus (systemic lupus erythematosus).
• Rheumatic heart disease.
• Endocarditis, an infection of the heart.
• Hyperthyroidism, a disease of the thyroid gland.
• Osteogenesis imperfecta, a problem that causes fragile bones.

Factors that may increase the risk for MVP complications

• Being male. Men with MVP are more likely than women to have complications.
• Age. Older people who have MVP are more likely than younger people to have complications.
• Family history. Those who have a family member with MVP are more likely to have complications.
• Structural abnormalities. Those who have thickened valve flaps (leaflets) are more likely to have complications.

When to Call a Doctor

Call 911 or other emergency services immediately if you have:

• Symptoms of a stroke or transient ischemic attack (TIA), such as sudden numbness, tingling, or weakness in or an inability to move part or all of one side of the body; vision changes that come on suddenly; or sudden difficulty speaking or understanding speech.

Call a doctor immediately if you have mitral valve prolapse (MVP) and you have:

• Symptoms of heart failure, such as shortness of breath at rest, with mild exertion, while lying down, or that wakes you from sleep, and leg swelling.
• Symptoms of infection, such as a fever with no other obvious cause. Be alert for signs of infection if you have mitral valve regurgitation and you recently had any dental, diagnostic, or surgical procedure.
• Irregular heartbeats and have started having fainting episodes (syncope) or you notice an increase in fainting episodes.

Call your doctor for an appointment if you have noticed an increase in symptoms such as:

• Chest pain, palpitations, or shortness of breath. If you are having symptoms of a heart attack, call 911 or other emergency services immediately.
• A decreased ability to exercise at your usual level.
• Excessive fatigue (without another reason).

Watchful waiting

Episodes of chest pain or palpitations may come and go and may not be associated with other serious heart disease. But contact your doctor if:

• Symptoms get worse.
• Symptoms persist longer than usual.
• Palpitations occur with fainting, lightheadedness, or shortness of breath.

Who to see

The following health professionals can evaluate symptoms that may be related to mitral valve prolapse (MVP) and can order the tests you may need:

• Family medicine physician
• Internist
• Nurse practitioner
• Physician assistant
• Cardiologist

Exams and Tests

Since most people with mitral valve prolapse (MVP) do not have symptoms, MVP is usually discovered during a routine health exam.

In some women who are only mildly affected by MVP, the condition may become undetectable after middle age.

Medical history and physical exam

Your doctor may suspect MVP if he or she hears a click or murmur while listening to your heartbeat. MVP may be discovered if you have a test called an echocardiogram that is done for another reason.

If your doctor thinks you may have MVP, he or she will ask if you have a family history of MVP or heart disease and will conduct a physical exam to look for MVP. During the exam, he or she will listen closely to your heart.

To confirm the diagnosis, your doctor may request an echocardiogram if you haven't had one. Your doctor may also evaluate you for other heart conditions.

Echocardiogram

An echocardiogram is the most useful test for confirming that you have mitral valve prolapse. It is also useful to rule out MVP. But echocardiograms require careful review by an experienced doctor because MVP is difficult to detect with this test. Some people who have MVP will have a normal echocardiogram. An echocardiogram is not needed if you do not have symptoms or complications of MVP.

Having a yearly echocardiogram is important if you have severe mitral valve regurgitation or other complications.

In general, echocardiograms can show:

• The size and function of the left heart chambers (left atrium and ventricle).
• Bulging (prolapse) of the mitral valve flaps into the left upper chamber (left atrium) of the heart.
• Severe prolapse and thickened or misshapen flaps.
• Mitral regurgitation (backflow) of blood through the prolapsed valve.

Early detection and regular exams

Screening for MVP is not recommended or necessary. After MVP is diagnosed, the frequency of regular exams is based on whether you have mitral valve regurgitation or thickened valve flaps (leaflets).

If you don't have symptoms or significant mitral valve regurgitation, you will only need an exam every 3 to 5 years.¹

Treatment Overview

Initial treatment

Most people with mitral valve prolapse (MVP) do not have symptoms and do not need treatment. Regular checkups every 3 to 5 years are usually all that is required. A normal lifestyle and regular exercise are recommended for most people with MVP.¹

If you have symptoms, such as shortness of breath, chest pain, or palpitations, and your heart exam or echocardiogram suggests a higher risk of complications, you may need more frequent checkups, perhaps yearly.

Your doctor may want to do an echocardiogram to confirm that you have mitral valve prolapse, to see whether you have mitral valve regurgitation, or to rule out other heart problems.

Ongoing treatment

If you have severe mitral valve regurgitation as a complication, you may need surgery to repair the mitral valve. If your mitral valve cannot be repaired, you may need surgery to replace the mitral valve. Surgery may also be needed if other structures related to the mitral valve are severely damaged.

See a picture of mitral valve replacement .

If you have irregular heartbeats (atrial fibrillation), your doctor may prescribe medicines, such as:

• Beta-blockers or calcium channel blockers to control heart rate.
• Anticoagulants to prevent stroke.

Treatment if the condition gets worse

In rare cases, severe mitral valve regurgitation, which is a complication of MVP, can lead to heart failure. Treatment for heart failure includes taking medicines and making diet and lifestyle changes, such as limiting salt intake, balancing your rest and activity, and avoiding infection. For more information, see the topic Heart Failure.

Surgery to repair or replace your mitral valve may be required.

Ongoing Concerns

Monitoring your condition and seeing your doctor

Many people with mitral valve prolapse (MVP) are not aware that they have it until they have a routine physical or other checkup. Symptoms are rare. There is a slight chance of complications; if your doctor thinks you are at risk for complications, he or she will do more frequent exams. Tests, such as echocardiograms, are rarely needed.

Complications

Complications of MVP are rare. They are more likely in those who have serious structural problems with their valves. This generally occurs in people who have some form of connective tissue abnormality or in older people (mainly men). The most common complication of mitral valve prolapse is mitral valve regurgitation.

Symptoms that may appear with MVP may also be symptoms of other conditions or complications of MVP. Because of this, it is important to be aware of and rule out other conditions with similar symptoms.

Living With Mitral Valve Prolapse

Most people with mitral valve prolapse (MVP) have no symptoms and do not need treatment for their condition. Your doctor will advise you to exercise regularly, especially if you do not have symptoms. Controlling your weight and blood pressure as well as eating a healthy diet are important, especially if you have complications of mitral valve prolapse. People who have heart palpitations will need to limit alcohol and caffeine, stop smoking, and avoid secondhand smoke.

Medications

People with mitral valve prolapse (MVP) usually do not need medicines, especially if they do not have mitral valve regurgitation.

Medicines cannot correct bulging (prolapse) of the mitral valve or prevent many of the complications that can develop. But medicine is sometimes used to control symptoms.

Medication choices

Medicines may help relieve certain symptoms caused by mitral valve prolapse or complications that may develop.

The following medicines may be offered to treat MVP and its related problems:

• Beta-blockers. Beta-blockers are used to relieve palpitations, chest pain, or anxiety related to MVP or to control heart rate in people with atrial fibrillation. But these medicines may not be effective in all people who have symptoms.
• Anticoagulants. Anticoagulants are used to prevent stroke in those who have atrial fibrillation.
• Antibiotics. If you have an artificial valve, you may need to take antibiotics before you have certain dental or surgical procedures. The antibiotics help prevent an infection in your heart called endocarditis.

What to think about

People with significant mitral valve regurgitation who have symptoms of heart failure may need additional medicines. For more information, see the topic Heart Failure.

Surgery

Most people with mitral valve prolapse do not need surgery. Surgery is usually needed only for the small number of people who also have severe mitral valve regurgitation and a badly damaged mitral valve. This may cause the lower left heart chamber (ventricle) to malfunction, and symptoms of heart failure may develop. Although surgery is rarely required to treat MVP, it can be very effective.

Surgery choices

The main surgery options for people who have MVP and mitral valve regurgitation are mitral valve replacement or repair. These procedures are rarely performed on people who have MVP. But for some people who have MVP and mitral valve regurgitation, surgery can greatly improve the condition of the mitral valve. As with any surgery, risks are involved.

What to think about

Your doctor may recommend surgery for MVP based upon your risk for having complications.

Heart valve surgery alone will not correct any heart conditions, such as coronary artery disease. But it is possible to surgically treat some heart conditions during the same procedure for mitral valve repair or replacement, if necessary.

Other Treatment

There is no other treatment for mitral valve prolapse at this time.

Other Places To Get Help

Organizations

Related Information

• Heart Failure
• Mitral Valve Regurgitation
• Mitral Valve Stenosis

References

Citations

1. Bonow RO, et al. (2006) ACC/AHA 2006 guidelines for the management of patients with valvular heart disease. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients with Valvular Heart Disease). Circulation, 114(5): e84-e231.

Other Works Consulted

• Bonow RO, et al. (2008). 2008 Focused update incorporated into the ACC/AHA 2006 Guidelines for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing committee to revise the 1998 Guidelines for the management of patients with valvular heart disease). Circulation, 118(15): e523-e661.

• Lee TH, Bonow RO (2008). Management of valvular heart disease. In P Libby et al., eds., Braunwald's Heart Disease: A textbook of cardiovascular medicine, 8th ed., pp. 1693-1712. Philadelphia: Saunders Elsevier.

• O'Rourke RA, Dell'Italia LJ (2008). Mitral valve prolapse syndrome section of Mitral valve regurgitation including the mitral valve prolapse syndrome. In V Fuster et al., eds., Hurst's The Heart, 12th ed., pp. 1743-1756. New York: McGraw-Hill Medical.

• Otto CM, Bonow RO (2008). Mitral valve prolapse syndrome section of Valvular heart disease. In P Libby et al., eds., Braunwald's Heart Disease: A textbook of cardiovascular medicine, 8th ed., pp. 1669-1692. Philadelphia: Saunders Elsevier.

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