Mitral valve prolapse

The mitral valve is one of the four valves in the heart. A normal mitral valve has two small tendon “cords” or flaps, called mitral leaflets, that are pulled open by the papillary muscle and then close between heartbeats to prevent blood from leaking back through the valve.

Mitral valve prolapse occurs when one or both mitral valve leaflets stretch more than normal and bulge (prolapse) like a parachute during each heart contraction. When the mitral flaps don’t close properly, blood can leak backward into the left atrium.

Faulty mitral valves can lead to chronic symptoms

Faulty mitral valves can allow blood to leak backward into the left atrium, called mitral valve regurgitation. Mitral regurgitation may cause a heart murmur, an abnormal sound in the heart caused by turbulent blood flow. Mitral regurgitation is generally mild and may not cause problems. But it can get worse over time. More severe regurgitation can cause shortness of breath, lightheadedness, and fatigue.

What causes mitral valve prolapse?

Most causes of mitral valve prolapse (MVP) are unknown, and are generally thought to be inherited. It is theorized a possible cause of MVP is from abnormally stretchy valve leaflets (myxomatous valve disease). MVP is rarely a serious condition, and it doesn’t damage the heart. But regular checkups with a healthcare provider are advised.

Who is at risk for mitral valve prolapse?

Mitral valve prolapse occurs in about 2% of the population, and can affect anyone at any age. Serious symptoms of mitral valve disease tend to present in males over the age of 50.

MVP can run in families (be hereditary), and is often linked to the following conditions:

  • Certain connective tissue disorders, such as Marfan syndrome.
  • Ehlers-Danlos syndrome.
  • Ebstein anomaly.
  • Graves disease (a condition that affects the thyroid gland).
  • Scoliosis and other skeletal problems.
  • Some types of muscular dystrophy.

Man and lady sitting on a dock

Symptoms of mitral valve prolapse

Mitral valve prolapse may not cause any symptoms, or the symptoms may vary depending on the degree of prolapse present. The presence of symptoms doesn’t necessarily match the severity of MVP.

If you do have symptoms, it is typically because of regurgitation. They tend to be mild and develop gradually.

Some common symptoms of MVP may include:

  • A racing heartbeat (palpitation).
  • Irregular heartbeat (arrhythmia). These may be the result of irregular heartbeats or just the sensation of the valve closing when the heart rhythm is normal.
  • Chest pain. Chest pain linked to MVP is different from chest pain associated with heart disease, which is often a squeezing pain that comes on with physical activity. MVP chest pain tends to happen on a regular basis and cause a general feeling of discomfort
  • Anxiety.
  • Hyperventilation.
  • Exercise intolerance caused by difficulty breathing or shortness of breath.
  • Dizziness.
  • Lightheadedness.
  • Fatigue.

The symptoms of MVP may look like other medical conditions or problems. Always see a healthcare provider for a diagnosis.

Symptoms often depend on severity

Depending on the severity of the mitral regurgitation or leak, the left atrium or left ventricle may become enlarged, leading to symptoms of heart failure. These symptoms include weakness, tiredness, dizziness, and shortness of breath.

If you’re having these symptoms and chest pain, and unsure if it could be a heart attack, seek emergency care right away.

Provider with stethoscope examining older woman

How is mitral valve prolapse diagnosed?

With MVP, you may experience no noticeable symptoms. However, your healthcare provider may hear a click or murmur during a routine physical exam. The “click” is created by the snapping sound of the stretched flaps quickly tightening during contraction. The murmur is caused by the blood leaking back into the left atrium. This may be the only sign of MVP.

Diagnostic tests

Along with a complete medical history and physical exam, your provider may order these tests to diagnose MVP and evaluate your heart function:

  • Echocardiogram. This noninvasive test uses high-frequency sound waves (ultrasound) to create images of your heart. It can depict your heart’s chambers and valves to help your doctor see the flow of blood through the mitral valve and possible regurgitation. This test is usually performed to confirm your diagnosis and the severity of your MVP.
  • Electrocardiogram (ECG). This noninvasive test records the strength and timing of the electrical activity of the heart. Small sensors or probes are taped to your skin to record electrical activity and show abnormal heart rhythms and sometimes can detect damage to the muscle of the heart.
  • Chest X-ray. An X-ray may be done to check your heart, lungs, and blood vessels to see if your heart is enlarged to help make a diagnosis.
  • Coronary angiogram. This test uses X-ray imaging to evaluate your heart’s blood vessels to reveal another condition that may be causing your symptoms and gather more information.

Cardiac Testing Stress Test

  • Cardiac MRI (CMR). This imaging test takes detailed pictures of the heart. It may be used to get a more precise look at the heart valves and heart muscle, or to prepare for heart valve surgery.
  • Stress test (treadmill or exercise ECG). A stress test may be recommended to see if valve regurgitation is limiting your ability to exercise. During this test, you will be asked to walk on a treadmill while doctors monitor your heart, breathing, and blood pressure rate. A stress test can be used if another condition such as heart disease is causing your symptoms, or it can be paired with an echocardiogram to diagnose MVP.
  • Transesophageal echocardiogram. In this test, your doctor inserts a flexible tube with a small device called a transducer down your throat into your esophagus. From there, it can be positioned to take more detailed images of your heart and mitral valve.

Treatments for mitral valve prolapse

In many cases, people with MVP do not have symptoms and will not need treatment. Your doctor may suggest follow-up exams to monitor your condition depending on the severity.

However, if you have symptoms and experience significant regurgitation, your doctor may recommend either medications, surgery, or therapy.

Medications

Medications are usually prescribed to treat arrhythmia-related symptoms or other complications from MVP. The following medications may be prescribed by your doctor:

  • Aspirin. Aspirin may be prescribed to reduce your risk of developing blood clots, especially if you have MVP and a history of strokes.
  • Beta Blockers. Beta blockers are used to prevent irregular heartbeats and to improve the flow of blood. They usually make your heart beat slower and less forcefully, and can relax blood vessels.
  • Blood thinners. A blood thinner may be recommended to prevent your blood from clotting, especially if you have atrial fibrillation (AFib, the most common treated arrhythmia) or history of strokes. Blood thinners can pose dangerous side effects, and therefore must be taken exactly as prescribed.
  • Heart rhythm medications. To treat arrhythmia, your doctor may recommend medication such as propafenone (Rythmol SR) to treat it by controlling your heart rhythm and normalizing electrical signals in your heart tissue.
  • Water pills (diuretics). These may be recommended to help drain excess fluid from your lungs.

Pharmacist explaining medication to patient

Surgery

Though many people with heart valve disease don’t need mitral valve surgery, it may be recommended if you have severe or chronic mitral valve regurgitation. Mitral valve regurgitation can prevent your heart from properly pumping blood, resulting in heart failure. If left untreated, your heart may be too weak for surgery.

The following procedures may be recommended:

  • Mitral valve repair. During this procedure, your surgeon will modify your mitral valve to prevent the backward flow of blood. They may try to reconnect the valve tissue, or remove excess tissue (mitral stenosis). Your surgeon might also reinforce the ring around the heart to prevent regurgitation. This is typically done through minimally invasive surgery with small incisions, less blood loss, and quicker recovery time, but in some instances open-heart surgery may be necessary.
  • Mitral valve replacement. If mitral valve repair isn’t a possibility, your surgeon may replace your mitral valve with an artificial (mechanical) one, or one made from human, cow, or pig tissue. Mechanical valves will last a lifetime, but require the use of blood thinners to prevent blood clots, which could cause a stroke. Human or animal replacement valves don’t require blood thinners, but they only last about 10 years.

If you can’t have surgery

If you have severe mitral regurgitation and can’t have surgery, your doctor may recommend transcatheter valve therapy.

In this procedure, your doctor repairs a valve using a tube (catheter) inserted in a blood vessel in your groin that is guided to your heart.

Frequently asked questions (FAQs) about mitral valve prolapse

There are two forms of MVP: primary and secondary.

Primary MVP. Primary MVP means the mitral valve is abnormal because of 1one or more of these changes:

  • One or both of the flaps are too large and thick.
  • The flap surfaces are scarred.
  • The tendon cords are thinner or longer than they should be.

Primary MVP is most often an isolated disease. But it can be linked to other valve or skeletal problems. Some rare instances of MVP are hereditary.

Secondary MVP. In secondary MVP, another disease is linked to MVP. The prolapse may be from:

  • Damage caused by decreased blood flow to the muscles attached to the tendon cords because of coronary artery disease.
  • Functional changes in the heart muscle.
  • Damage to valve structures caused by heart attack, rheumatic fever, valve infection, or hypertrophic cardiomyopathy. Hypertrophic cardiomyopathy is when the left ventricle of the heart is larger than normal.
  • Damage caused by a connective tissue disorder such as Marfan syndrome.

Although most MVP patients rarely experience problems, complications can occur, including:

  • Heart rhythm problems (ventricular arrhythmias). Irregular heartbeats commonly happen in the upper heart chambers, and are bothersome but not typically life-threatening. Those with a severely deformed mitral valve or those with severe mitral valve regurgitation are most at risk of arrhythmia, which can affect the flow of blood through the heart.
  • Heart valve infection (infective endocarditis). The inside of the heart is lined with a thin membrane called the endocardium. Having an abnormal mitral valve increases your chance of developing infective endocarditis from bacteria, which can damage the mitral valve even more.
  • Severe mitral regurgitation. Regurgitation is the most common complication, when the blood leaks back into the left atrium. You are at increased risk of regurgitation if you are a male with high blood pressure. If regurgitation is too severe, you may need valve surgery to prevent heart disease and cardiac arrest.

Since most of the causes of MVP are unknown, it is not possible to prevent the syndrome.

However, complications of the disease such as infective endocarditis can be prevented by the following:

  • Practice good oral hygiene habits. Good oral health is effective in reducing your risk of bacterial endocarditis. Make sure to take care of your teeth and gums, and to inform your dentist if you have valve disease.
  • Prevent infections. Colds and flus do not cause endocarditis, but infections can. Be aware if you have symptoms of infection such as achiness, fever, and sore throat, and call your doctor early on if you experience symptoms.

The following are also recommended if you have MVP but show no symptoms:

  • Avoid caffeine and other stimulants.
  • Practice regular exercise.
  • Practice relaxation and stress-relieving techniques, such as yoga or meditation.
  • See your cardiologist every 2-3 years for follow-up.
  • Take any required prescriptions or pain relievers exactly as outline by your doctor.