Mitral valve prolapse

General

Mitral valve prolapse (MVP) occurs when the leaflets of the mitral valve bulge (prolapse) into the heart’s left upper chamber (left atrium) like a parachute during the heart’s contraction.

Mitral (MY-trul) valve prolapse sometimes leads to blood leaking backward into the left atrium, a condition called mitral valve regurgitation.

In most people, mitral valve prolapse isn’t life-threatening and doesn’t require treatment or changes in lifestyle. Some people with mitral valve prolapse, however, require treatment.

Symptoms

Although mitral valve prolapse is usually a lifelong disorder, many people with this condition never have symptoms. When diagnosed, people may be surprised to learn that they have a heart condition.

When signs and symptoms do occur, it may be because blood is leaking backward through the valve (regurgitation). Mitral valve prolapse symptoms can vary widely from one person to another. They tend to be mild and develop gradually. Symptoms may include:

  • A racing or irregular heartbeat (arrhythmia)
  • Dizziness or lightheadedness
  • Difficulty breathing or shortness of breath, often when lying flat or during physical activity
  • Fatigue
  • Chest pain that’s not caused by a heart attack or coronary artery disease

When to see a doctor

If you think you have any of the above symptoms, make an appointment with your doctor.

Many other conditions cause the same symptoms as mitral valve prolapse, so only a visit to your doctor can determine the cause of your symptoms. If you’re having chest pain and you’re unsure if it could be a heart attack, seek emergency medical care immediately.

If you’ve already been diagnosed with mitral valve prolapse, see your doctor if your symptoms worsen.

Causes

When your heart is working properly, the mitral valve closes completely during contraction of the left ventricle and prevents blood from flowing back into your heart’s upper left chamber (left atrium).

But in some people with mitral valve prolapse, one or both of the mitral valve’s flaps (leaflets) have extra tissue bulging (prolapsing) like a parachute into the left atrium each time the heart contracts.

The bulging may keep the valve from closing tightly. When blood leaks backward through the valve, it’s called mitral valve regurgitation.

This may not cause problems if only a small amount of blood leaks back into the atrium. More-severe mitral valve regurgitation can cause symptoms such as shortness of breath, fatigue or lightheadedness.

Another name for mitral valve prolapse is click-murmur syndrome. When a doctor listens to your heart using a stethoscope, he or she may hear a clicking sound as the valve’s leaflets billow out, followed by a murmur resulting from blood flowing back into the atrium. Other names to describe mitral valve prolapse include:

  • Barlow’s syndrome
  • Floppy valve syndrome
  • Billowing mitral valve syndrome
  • Myxomatous mitral valve disease

Risk factors

Mitral valve prolapse can develop in any person at any age.

Serious symptoms of mitral valve prolapse tend to occur most often in men older than 50.

Mitral valve prolapse can run in families and may be linked to several other conditions, such as:

  • Marfan syndrome
  • Ehlers-Danlos syndrome
  • Ebstein’s anomaly
  • Muscular dystrophy
  • Graves’ disease
  • Scoliosis

Complications

Although most people with mitral valve prolapse never have problems, complications can occur. They may include:

  • Mitral valve regurgitation. The most common complication is a condition in which the valve leaks blood back into the left atrium (mitral valve regurgitation).

    Being male or having high blood pressure increases your risk of mitral valve regurgitation.

    If regurgitation is severe, you may need surgery to repair or replace the valve in order to prevent heart failure.

  • Heart rhythm problems (arrhythmias). Irregular heart rhythms most commonly occur in the upper chambers of the heart. They may be bothersome, but aren’t usually life-threatening.

    People with severe mitral valve regurgitation or severe deformity of their mitral valve are most at risk of having rhythm problems, which can affect blood flow through the heart.

  • Heart valve infection (endocarditis). The inside of your heart is lined by a thin membrane called the endocardium. Endocarditis is an infection of this inner lining.

    An abnormal mitral valve increases your chance of getting endocarditis from bacteria, which can further damage the mitral valve.

    People at high risk of endocarditis may be prescribed antibiotics before certain dental and medical procedures, to reduce the risk of infection.

Prevention

You can’t prevent mitral valve prolapse. However, you can lower your chances of developing the complications associated with it by making sure you take your medications, if any, as directed.

Diagnosis

Doctors may diagnose mitral valve prolapse at any age. Your doctor is most likely to diagnose mitral valve prolapse while listening to your heart with a stethoscope during a physical examination.

If you have mitral valve prolapse, your doctor may hear a clicking sound, which is common with this condition. Your doctor may detect a heart murmur, which would be due to mitral regurgitation if it is present.

Other tests that may be used to evaluate your heart may include:

  • Echocardiogram. An echocardiogram is usually done to confirm the diagnosis and determine the severity of your condition. An echocardiogram is a noninvasive ultrasound evaluation of your heart.

    This test uses high-frequency sound waves to create images of your heart. It helps doctors see the flow of blood through your mitral valve and measure the amount of blood leakage (regurgitation).

    You may have a transesophageal echocardiogram. In this test, your doctor inserts a flexible tube with a small device (transducer) attached into your throat and down into your esophagus — the tube that connects the back of your mouth to your stomach. From there, the transducer can be positioned to obtain more-detailed images of your heart.

  • Chest X-ray. A chest X-ray shows a picture of your heart, lungs and blood vessels and can help your doctor make a diagnosis. It can help show if your heart is enlarged.
  • Electrocardiogram (ECG). In this noninvasive test, a technician will place probes on your chest that record the electrical impulses that make your heart beat.

    An ECG records these electrical signals and can help your doctor detect irregularities in your heart’s rhythm and structure, including mitral valve prolapse.

  • Stress test. Your doctor may order a stress test to see if mitral valve regurgitation limits your ability to exercise. In a stress test, you exercise or take certain medications to increase your heart rate and make your heart work harder.

    You may also have a stress test if your doctor is trying to determine if you have another condition such as coronary artery disease.

  • Coronary angiogram. This type of cardiac catheterization uses X-ray imaging to see your heart’s blood vessels. It isn’t generally used to diagnose mitral valve prolapse, but may reveal the condition when you’re being testing for another suspected diagnosis.

    In some cases, your doctor may recommend a coronary angiogram and cardiac catheterization to gather more information about the severity of your condition.

    In a cardiac catheterization procedure, doctors insert a catheter in an artery in your groin (femoral artery) or in your wrist (radial artery). The catheter is then threaded through your blood vessels to your heart.

Treatment

Most people with mitral valve prolapse, particularly people without symptoms, don’t require treatment.

If you have mitral valve regurgitation but don’t have symptoms, your doctor may suggest you return regularly for follow-up examinations to monitor your condition, depending on the severity of your condition.

However, if you have symptoms and if a significant amount of blood is leaking through the mitral valve, your doctor may recommend medications or surgery, depending on the severity of your condition.

Medications

If you develop symptoms, your doctor might prescribe certain medications to treat mitral valve prolapse-related chest pain, heart rhythm abnormalities or other complications. Some medications you might be prescribed include:

  • Beta blockers. These drugs help prevent irregular heartbeats by making your heart beat more slowly and with less force, which reduces your blood pressure. Beta blockers also help blood vessels relax and open up to improve blood flow.
  • Diuretics. Your doctor may prescribe water pills (diuretics) to drain fluid from your lungs.
  • Heart rhythm medications. Your doctor may prescribe an antiarrhythmic medication, such as flecainide (Tambocor), amiodarone (Cordarone, Pacerone), and propafenone (Rythmol, Rythmol SR). Antiarrhythmics help control your heart rhythm by normalizing electrical signals in heart tissue.
  • Aspirin. If you have mitral valve prolapse and a history of strokes, your doctor might prescribe aspirin to reduce the risk of blood clots.
  • Prescription anticoagulants (blood thinners). These medications — such as warfarin (Coumadin), heparin, dabigatran (Pradaxa), rivaroxaban (Xarelto), apixaban (Eliquis) and edoxaban (Savaysa) — prevent your blood from clotting if you have had irregular heart rhythms, such as atrial fibrillation.

    If you have atrial fibrillation, a history of heart failure or a history of strokes, your doctor may suggest these drugs. They can have dangerous side effects, however, and must be taken exactly as prescribed.

Surgery

Though most people with mitral valve prolapse don’t need surgery, your doctor may suggest surgical treatment if you have severe mitral valve regurgitation with or without symptoms.

Severe mitral valve regurgitation can eventually cause heart failure, preventing your heart from effectively pumping blood. If regurgitation goes on too long, your heart may be too weak for surgery.

If your doctor suggests surgery, he or she may suggest repairing or replacing the mitral valve. Valve repair and replacement may be performed using open-heart surgery or minimally invasive surgery. Minimally invasive surgery involves smaller incisions and may have less blood loss and a quicker recovery time than open surgery.

  • Valve repair. Mitral valve repair is a surgery that preserves your own valve. For most people with mitral valve prolapse, this is the preferred surgical treatment to correct the condition.

    Your mitral valve consists of two triangular-shaped flaps of tissue called leaflets. The leaflets of the mitral valve connect to the heart muscle through a ring called the annulus.

    The surgeon can modify the original valve (valvuloplasty) to eliminate backward blood flow. Surgeons can also repair the valve by reconnecting valve leaflets or by removing excess valve tissue so that the leaflets can close tightly.

    Sometimes repairing the valve includes tightening or replacing the annulus. This is called an annuloplasty. It is important to ensure that your surgeon is experienced in performing mitral valve repair.

  • Valve replacement. Your surgeon may perform a valve replacement if valve repair isn’t possible. In valve replacement surgery, the damaged mitral valve is replaced by an artificial (prosthetic) valve. Artificial valves are mechanical or tissue valves.

    Mechanical valves may last a long time. However, if you have a mechanical valve, you must use an anticoagulant medication, such as warfarin (Coumadin), for the rest of your life to prevent blood clots from forming on the valve. If a blood clot forms on the valve and breaks free, it could travel to your brain and cause a stroke.

    Tissue valves are made from animal tissue such as a pig or cow valve. These kinds of valves are called bioprostheses. They may wear out over time and need replacement. However, an advantage of the tissue valve is that you don’t have to use long-term anticoagulant medication.

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