Mitral Valve Prolapse

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Mitral Valve Prolapse

Topic Overview

Picture of the heart

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.)

Mitral valve prolapse is the most common heart valve problem. It is more common in people who have a family history of this problem.

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 regular examinations every 3 to 5 years.

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:

Conditions that affect the mitral valve, connective tissue, and heart muscle can cause mitral valve prolapse, but this is rare.

Other conditions, such as osteogenesis imperfecta and hyperthyroidism, are linked 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 light-headedness and weakness).

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:

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.
  • Symptoms of a heart attack, such as chest pain or pressure, sweating, shortness of breath, or pain, pressure, or a strange feeling in the back, neck, jaw, upper belly, or in one or both shoulders or arms.

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 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 new symptoms or an increase in symptoms such as:

  • Chest pain, palpitations, or shortness of breath.
  • A decreased ability to exercise at your usual level.
  • Excessive fatigue (without another reason).

Watchful waiting

Some people who have mitral valve prolapse have chest pain or palpitations that 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, light-headedness, or shortness of breath.

Who to see

Your family doctor or general practitioner can check symptoms that may be related to mitral valve prolapse (MVP) and can order any tests you may need. You may be referred to a heart specialist (cardiologist).

Examinations and Tests

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

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

Medical history and physical examination

Your doctor may suspect MVP if he or she hears a click or murmur while listening to your heartbeat. This click or murmur happens because the mitral valve is not shaped normally. 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 examination to check for MVP. During the examination, 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. 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 examinations

Screening for MVP is not recommended or necessary.

If you have MVP, you will have regular follow-up examinations. How often you need these examinations is based on whether you have complications like mitral valve regurgitation or thickened valve flaps (leaflets). If you do not have symptoms or complications, your doctor may suggest an examination 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 who have MVP.1

If you have symptoms, such as shortness of breath, chest pain, or palpitations, and your heart examination 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.

Treatment if the condition gets worse

If you have severe mitral valve regurgitation as a complication of MVP, 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.

In rare cases, severe mitral valve regurgitation, which is a complication of MVP, can lead to heart failure. For more information, see the topics Mitral Valve Regurgitation and Heart Failure.

If you have a rhythm problem called atrial fibrillation, you will be treated for that problem. For more information, see the topic Atrial Fibrillation.

Ongoing Concerns

Monitoring your condition and seeing your doctor

Many people who have mitral valve prolapse (MVP) are not aware that they have it until they have a routine physical or other checkup. Symptoms are rare.

After MVP is diagnosed, you will have regular examinations. How often you need these examinations is based on whether you have complications like mitral valve regurgitation or thickened valve flaps (leaflets). If you do not have symptoms or complications, your doctor may suggest an examination every 3 to 5 years.1

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, your doctor may do tests to 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.

A healthy lifestyle is also important if you have complications of mitral valve prolapse. People who have heart palpitations can try lifestyle changes to help, such as limiting alcohol and caffeine, not smoking, and avoiding second-hand smoke.

Take care of your teeth to help prevent an infection in the heart called endocarditis. If you do not take care of your teeth, bacteria in your mouth might move into your bloodstream to your heart. These bacteria can cause an infection around your mitral valve. Brush and floss regularly, and visit the dentist twice a year. If you wear dentures, check your gums often for sores or signs of irritation. Before you have dental or medical procedures, tell your doctor or dentist that you have mitral valve prolapse. If you do not have other heart problems or an artificial heart valve, you will not need to take antibiotics before dental or medical procedures.

More information

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.

Beta-blockers are used to relieve symptoms of palpitations or chest pain that might happen with mitral valve prolapse. Beta-blockers do not improve how the mitral valve works.

Surgery

Most people who have 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. The main surgery options for people who have MVP and mitral valve regurgitation are mitral valve replacement or repair. These procedures are rarely done on people who only have MVP.

For more information, see the topic Mitral Valve Regurgitation.

Other Places To Get Help

Organizations

Canadian Cardiovascular Society
222 Queen Street
Suite 1403
Ottawa, ON  K1P 5V9
Phone: 1-877-569-3407 toll-free
(613) 569-3407
Fax: (613) 569-6574
Web Address: www.ccs.ca
 

The Canadian Cardiovascular Society works to advance the cardiovascular health and care of Canadians through leadership, research, and advocacy.


American Heart Association (AHA)
7272 Greenville Avenue
Dallas, TX  75231
Phone: 1-800-AHA-USA1 (1-800-242-8721)
Web Address: www.heart.org
 

Visit the American Heart Association (AHA) website for information on physical activity, diet, and various heart-related conditions. You can search for information on heart disease and stroke, share information with friends and family, and use tools to help you make heart-healthy goals and plans. Contact the AHA to find your nearest local or state AHA group. The AHA provides brochures and information about support groups and community programs, including Mended Hearts, a nationwide organization whose members visit people with heart problems and provide information and support.


Heart and Stroke Foundation of Canada
222 Queen Street
Suite 1402
Ottawa, ON  K1P 5V9
Phone: (613) 569-4361
Fax: (613) 569-3278
Web Address: www.heartandstroke.ca
 

The Heart and Stroke Foundation of Canada works to improve the health of Canadians by preventing and reducing disability and death from heart disease and stroke through research, health promotion, and advocacy.


U.S. National Heart, Lung, and Blood Institute (NHLBI)
P.O. Box 30105
Bethesda, MD  20824-0105
Phone: (301) 592-8573
Fax: (240) 629-3246
TDD: (240) 629-3255
Email: nhlbiinfo@nhlbi.nih.gov
Web Address: www.nhlbi.nih.gov
 

The U.S. National Heart, Lung, and Blood Institute (NHLBI) information center offers information and publications about preventing and treating:

  • Diseases affecting the heart and circulation, such as heart attacks, high cholesterol, high blood pressure, peripheral artery disease, and heart problems present at birth (congenital heart diseases).
  • Diseases that affect the lungs, such as asthma, chronic obstructive pulmonary disease (COPD), emphysema, sleep apnea, and pneumonia.
  • Diseases that affect the blood, such as anemia, hemochromatosis, hemophilia, thalassemia, and von Willebrand disease.

References

Citations

  1. 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.

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.

Credits

By Healthwise Staff
Primary Medical Reviewer E. Gregory Thompson, MD - Internal Medicine
Primary Medical Reviewer Andrew Swan, MD, CCFP, FCFP - Family Medicine
Specialist Medical Reviewer John A. McPherson, MD, FACC, FSCAI - Cardiology
Last Revised March 24, 2011

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