What is mitral valve prolapse. How is it caused. What are the symptoms of mitral valve prolapse. How is mitral valve prolapse diagnosed. What are the treatment options for mitral valve prolapse.

The Anatomy and Function of the Mitral Valve

The mitral valve plays a crucial role in the heart’s function. Located between the left atrium and left ventricle, it consists of two flaps that regulate blood flow. During left ventricular contraction (systole), these flaps are normally held tightly closed by chordae tendineae, small tendon-like cords connecting the flaps to the heart muscles.

In cases of mitral valve prolapse (MVP), the flaps enlarge and stretch inward toward the left atrium. This can sometimes result in a “snapping” sound during systole and may allow blood to flow back into the left atrium, a condition known as regurgitation.

The Importance of Proper Mitral Valve Function

A properly functioning mitral valve ensures that blood flows in the correct direction through the heart. When the valve doesn’t close properly, it can lead to various complications and symptoms that affect overall heart health.

Causes and Types of Mitral Valve Prolapse

The exact cause of mitral valve prolapse remains unknown, but researchers believe it may have a genetic component. MVP is typically categorized into two main types: primary and secondary.

Primary Mitral Valve Prolapse

Primary MVP is characterized by thickening of one or both valve flaps. Additional features may include:

• Fibrosis (scarring) of the flap surface
• Thinning or lengthening of the chordae tendineae
• Fibrin deposits on the flaps

This form of MVP is frequently observed in individuals with Marfan’s Syndrome or other inherited connective tissue diseases. However, it’s most commonly seen in people without any other form of heart disease.

Secondary Mitral Valve Prolapse

In secondary MVP, the valve flaps are not thickened. The prolapse may be caused by:

• Ischemic damage to the papillary muscles (due to decreased blood flow from coronary artery disease)
• Functional changes in the myocardium

Secondary MVP can result from various conditions, including:

• Damage to valvular structures during acute myocardial infarction
• Rheumatic heart disease
• Hypertrophic cardiomyopathy (enlarged left ventricular muscle mass)

Recognizing the Symptoms of Mitral Valve Prolapse

Mitral valve prolapse may not always cause noticeable symptoms. When symptoms do occur, they can vary depending on the degree of prolapse. Common symptoms include:

Palpitations

Palpitations, or the sensation of a fast or irregular heartbeat, are the most frequently reported symptom among MVP patients. These are often associated with premature ventricular contractions, where the ventricles beat sooner than they should. In some cases, supraventricular rhythms (abnormal rhythms originating above the ventricles) may also be detected.

Interestingly, some patients may experience palpitations without any observable dysrhythmias (irregular heart rhythms).

Chest Pain

Chest pain associated with MVP differs from that of coronary artery disease. It can be recurrent and incapacitating, but it typically doesn’t present as classic angina.

Heart Failure Symptoms

Depending on the severity of mitral regurgitation (leakage into the left atrium during systole), the left atrium and/or left ventricle may become enlarged. This can lead to symptoms of heart failure, including:

• Weakness
• Fatigue
• Shortness of breath

Is chest pain always present in mitral valve prolapse? No, chest pain is not always present in cases of mitral valve prolapse. Some individuals may have MVP without experiencing any chest pain, while others may have recurrent and significant chest discomfort.

Diagnostic Approaches for Mitral Valve Prolapse

Diagnosing mitral valve prolapse often begins with a routine examination, as many people with MVP have no symptoms. The initial detection may involve hearing a characteristic “click” or murmur during auscultation with a stethoscope.

Physical Examination

During a physical exam, a healthcare provider may detect:

• A “click” sound created by the stretched flaps snapping against each other during contraction
• A murmur caused by blood leaking back into the left atrium

In some cases, these audible signs may be the only clinical indications of MVP.

Diagnostic Procedures

To confirm a diagnosis of mitral valve prolapse and assess its severity, doctors may employ various diagnostic procedures, including:

1. Electrocardiogram (ECG or EKG): This test records the heart’s electrical activity, revealing abnormal rhythms and potentially detecting heart muscle damage.
2. Echocardiogram: Considered the most useful diagnostic test for MVP, this non-invasive procedure uses sound waves to evaluate the heart’s chambers and valves, creating real-time images of the heart’s structure and function.

Can mitral valve prolapse be diagnosed with a stethoscope alone? While a stethoscope can detect the characteristic “click” or murmur associated with MVP, a definitive diagnosis typically requires additional tests, particularly an echocardiogram, to confirm the condition and assess its severity.

Advanced Diagnostic Procedures for Severe Cases

In situations where symptoms are more severe or when initial tests are inconclusive, additional diagnostic procedures may be necessary. These can include:

Stress Test

Also known as a treadmill or exercise ECG, this test monitors the heart during physical activity. The patient walks on a treadmill while their heart rate, breathing, and blood pressure are closely observed. This can help evaluate how the heart responds to exertion and whether symptoms worsen during exercise.

Cardiac Catheterization

In some cases, cardiac catheterization may be recommended. This invasive procedure involves inserting a thin tube (catheter) into a blood vessel and guiding it to the heart. It allows for direct measurement of pressures within the heart chambers and can provide detailed information about the severity of mitral regurgitation.

Treatment Options for Mitral Valve Prolapse

The treatment approach for mitral valve prolapse depends on the severity of the condition and the presence of symptoms. Options may include:

Monitoring and Lifestyle Changes

For many individuals with mild MVP and no significant symptoms, regular monitoring and lifestyle modifications may be sufficient. This can include:

• Regular check-ups with a cardiologist
• Maintaining a heart-healthy diet
• Engaging in appropriate exercise as recommended by a healthcare provider
• Stress management techniques

Medications

In cases where symptoms are more pronounced, medications may be prescribed to manage specific issues:

• Beta-blockers to control heart rate and reduce palpitations
• Anticoagulants to reduce the risk of blood clots in patients with atrial fibrillation
• Diuretics to manage fluid retention in cases of heart failure

Surgical Intervention

For severe cases of mitral valve prolapse, particularly those with significant regurgitation, surgical intervention may be necessary. The two main surgical approaches are:

1. Mitral valve repair: This procedure aims to restore proper function to the existing valve, often by reinforcing or reshaping the valve leaflets.
2. Mitral valve replacement: In cases where repair is not feasible, the damaged valve may be replaced with an artificial valve (mechanical or biological).

How is the decision made between mitral valve repair and replacement? The choice between repair and replacement depends on several factors, including the extent of valve damage, the patient’s age and overall health, and the surgeon’s expertise. Generally, valve repair is preferred when possible, as it preserves the patient’s native valve tissue and may have better long-term outcomes.

Living with Mitral Valve Prolapse: Long-Term Management and Prognosis

For most individuals diagnosed with mitral valve prolapse, the long-term outlook is positive. Many people with MVP lead normal, active lives without significant complications. However, proper management and regular follow-up are essential for maintaining heart health and preventing potential complications.

Regular Monitoring

Individuals with MVP should undergo regular cardiac evaluations to monitor the progression of their condition. This typically involves:

• Periodic echocardiograms to assess valve function and any changes in regurgitation
• Regular check-ups with a cardiologist to evaluate symptoms and overall heart health
• Monitoring for potential complications, such as endocarditis or arrhythmias

Lifestyle Considerations

While MVP doesn’t usually require significant lifestyle changes, some considerations can help manage the condition:

• Maintaining a heart-healthy diet low in saturated fats and sodium
• Engaging in regular physical activity as approved by a healthcare provider
• Avoiding caffeine and other stimulants that may exacerbate palpitations
• Practicing stress-reduction techniques, such as meditation or yoga

Can individuals with mitral valve prolapse participate in competitive sports? In most cases, people with mild to moderate MVP can participate in competitive sports. However, those with severe regurgitation or other complications may need to limit their activities. It’s crucial to consult with a cardiologist for personalized recommendations based on the individual’s specific condition.

Potential Complications and When to Seek Medical Attention

While mitral valve prolapse is often a benign condition, it can lead to complications in some cases. Being aware of potential issues and knowing when to seek medical attention is crucial for individuals living with MVP.

Possible Complications

Some potential complications associated with mitral valve prolapse include:

• Severe mitral regurgitation: If left untreated, this can lead to heart failure over time
• Atrial fibrillation: An irregular heart rhythm that can increase the risk of blood clots and stroke
• Endocarditis: A rare but serious infection of the heart valve
• Mitral valve surgery: In severe cases, surgical intervention may become necessary

When to Seek Medical Attention

Individuals with MVP should contact their healthcare provider if they experience:

• Chest pain or discomfort that is severe or persistent
• Shortness of breath that is new or worsening
• Fainting or near-fainting episodes
• Palpitations that are frequent or prolonged
• Swelling in the legs or feet
• Unexplained fatigue or weakness

What is the risk of developing endocarditis in patients with mitral valve prolapse? The risk of endocarditis in MVP patients is generally low. However, individuals with MVP and significant mitral regurgitation may have a slightly increased risk. Practicing good oral hygiene and following guidelines for antibiotic prophylaxis (if recommended by a healthcare provider) can help reduce this risk.

Advances in Mitral Valve Prolapse Research and Treatment

The field of cardiology continues to advance, bringing new insights and treatment options for mitral valve prolapse. Recent developments and ongoing research are shaping the future of MVP management.

Genetic Research

Scientists are making progress in understanding the genetic factors that contribute to mitral valve prolapse. This research may lead to:

• Earlier identification of individuals at risk for MVP
• Development of targeted therapies based on genetic profiles
• Improved understanding of the mechanisms underlying valve degeneration

Minimally Invasive Surgical Techniques

Advancements in surgical techniques are making mitral valve repair and replacement procedures less invasive. Some innovative approaches include:

• Robotic-assisted surgery, allowing for smaller incisions and faster recovery times
• Transcatheter mitral valve repair, using catheter-based techniques to repair the valve without open-heart surgery
• 3D-printed valve models to assist in surgical planning and improve outcomes

Tissue Engineering

Researchers are exploring the potential of tissue engineering to create living valve replacements. This could lead to:

• Personalized valve replacements grown from a patient’s own cells
• Improved long-term outcomes compared to current mechanical or biological valve options
• Reduced need for anticoagulation therapy in valve replacement patients

How might personalized medicine impact the treatment of mitral valve prolapse in the future? As our understanding of the genetic and molecular basis of MVP improves, treatment approaches may become more tailored to individual patients. This could involve targeted therapies based on specific genetic markers, personalized risk assessments, and customized surgical or interventional approaches designed to address each patient’s unique valve anatomy and underlying causes of prolapse.

The ongoing research and technological advancements in the field of mitral valve prolapse offer hope for improved diagnosis, treatment, and long-term management of this common cardiac condition. As our understanding of MVP continues to evolve, patients can look forward to more effective, less invasive treatment options and potentially even preventative strategies in the future.

Mitral Valve Prolapse | Johns Hopkins Medicine

What is the mitral valve?

The mitral valve is located between the left atrium and the left ventricle and is composed of two flaps. Normally the flaps are held tightly closed during left ventricular contraction (systole) by the chordae tendineae (small tendon “cords” that connect the flaps to the muscles of the heart). In Mitral Valve Prolapse, the flaps enlarge and stretch inward toward the left atrium, sometimes “snapping” during systole, and may allow some backflow of blood into the left atrium (regurgitation).

What causes Mitral Valve Prolapse?

The cause of Mitral Valve Prolapse is unknown, but is thought to be linked to heredity. Primary and secondary forms of Mitral Valve Prolapse are described below.

• Primary Mitral Valve Prolapse. Primary Mitral Valve Prolapse is distinguished by thickening of one or both valve flaps. Other effects are fibrosis (scarring) of the flap surface, thinning or lengthening of the chordae tendineae, and fibrin deposits on the flaps. The primary form of Mitral Valve Prolapse is seen frequently in people with Marfan’s Syndrome or other inherited connective tissue diseases, but is most often seen in people with no other form of heart disease.

• Secondary Mitral Valve Prolapse. In secondary Mitral Valve Prolapse, the flaps are not thickened. The prolapse may be due to ischemic damage (caused by decreased blood flow as a result of coronary artery disease) to the papillary muscles attached to the chordae tendineae or to functional changes in the myocardium. Secondary Mitral Valve Prolapse may result from damage to valvular structures during acute myocardial infarction, rheumatic heart disease, or hypertrophic cardiomyopathy (occurs when the muscle mass of the left ventricle of the heart is larger than normal).

What are the symptoms of Mitral Valve Prolapse?

Mitral valve prolapse may not cause any symptoms. The following are the most common symptoms of Mitral Valve Prolapse. However, each individual may experience symptoms differently. Symptoms may vary depending on the degree of prolapse present and may include:

• Palpitations. Palpitations (sensation of fast or irregular heart beat) are the most common complaint among patients with Mitral Valve Prolapse. The palpitations are usually associated with premature ventricular contractions (the ventricles beat sooner than they should), but supraventricular rhythms (abnormal rhythms that begin above the ventricles) have also been detected. In some cases, patients may experience palpitations without observed dysrhythmias (irregular heart rhythm).

• Chest pain. Chest pain associated with Mitral Valve Prolapse is different from chest pain associated with coronary artery disease and is a frequent complaint. Usually the chest pain is not like classic angina, but can be recurrent and incapacitating.

Depending on the severity of the leak into the left atrium during systole (mitral regurgitation), the left atrium and/or left ventricle may become enlarged, leading to symptoms of heart failure. These symptoms include weakness, fatigue, and shortness of breath.

The symptoms of mitral valve prolapse may resemble other medical conditions or problems. Always consult your doctor for a diagnosis.

How is Mitral Valve Prolapse diagnosed?

People with Mitral Valve Prolapse often have no symptoms and detection of a click or murmur may be discovered during a routine examination.

Mitral Valve Prolapse may be detected by listening with a stethoscope, revealing a “click” (created by the stretched flaps snapping against each other during contraction) and/or a murmur. The murmur is caused by some of the blood leaking back into the left atrium. The click or murmur may be the only clinical sign.

In addition to a complete medical history and physical examination, diagnostic procedures for Mitral Valve Prolapse may include any, or a combination, of the following:

• Electrocardiogram (ECG or EKG). A test that records the electrical activity of the heart, shows abnormal rhythms (arrhythmias or dysrhythmias), and can sometimes detect heart muscle damage.

• Echocardiogram (also called echo). A noninvasive test that uses sound waves to evaluate the heart’s chambers and valves. The echo sound waves create an image on the monitor as an ultrasound transducer is passed over the heart. Echocardiography is the most useful diagnostic test for Mitral Valve Prolapse.

In some situations where symptoms are more severe, additional diagnostic procedures may be performed. Additional procedures may include:

• Stress test (also called treadmill or exercise ECG). A test that is performed while a patient walks on a treadmill to monitor the heart during exercise. Breathing and blood pressure rates are also monitored.

• Cardiac catheterization. With this procedure, X-rays are taken after a contrast agent is injected into an artery to locate any narrowing, occlusions, or other abnormalities of specific arteries. In addition, the function of the heart and the valves may be assessed.

• Cardiac MRI. This is a noninvasive test that produces comprehensive images of the heart. It may be used as a complement to echo for a more precise look at the heart valves and heart muscle, or in preparation for heart valve surgery.

How is Mitral Valve Prolapse treated?

Specific treatment for mitral valve prolapse will be determined by your doctor based on:

• Your overall health and medical history

• Extent of the disease

• Your signs and symptoms

• Your tolerance for specific medications, procedures, or therapies

• Expectations for the course of the disease

• Your opinion or preference

Treatment is not usually necessary as Mitral Valve Prolapse is rarely a serious condition. Regular checkups with a doctor are advised.

People with rhythm disturbances may need to be treated with beta blockers or other medications to control tachycardias (fast heart rhythms). In most cases, limiting stimulants, such as caffeine and cigarettes, is all that is needed to control symptoms.

If atrial fibrillation or severe left atrial enlargement is present, treatment with an anticoagulant may be recommended. This can be in the form of aspirin or warfarin (Coumadin) therapy.

For the person with symptoms of dizziness or fainting, maintaining adequate hydration (fluid volume in the blood vessels) with liberal salt and fluid intake is important. Support stockings may be beneficial.

If severe mitral regurgitation resulting from a floppy mitral leaflet, rupture of the chordae tendineae, or extreme lengthening of the valve should occur, surgical repair may be indicated.

What is the prognosis for Mitral Valve Prolapse?

This condition is usually harmless and does not shorten life expectancy. Healthy lifestyle behaviors and regular exercise are encouraged.

Problem: Mitral Valve Prolapse | American Heart Association

What’s mitral valve prolapse?

Mitral valve prolapse, also called MVP, is a condition in which the two valve flaps of the mitral valve don’t close smoothly or evenly, but bulge (prolapse) upward into the left atrium. Mitral valve prolapse is also known as click-murmur syndrome, Barlow’s syndrome or floppy valve syndrome.

What happens during MVP?

When the heart pumps (contracts) part of one or both flaps collapse backward into the left atrium. In some cases, the prolapsed valve lets a small amount of blood leak backward through the valve, called regurgitation, which may cause a heart murmur.

Watch an animation of mitral valve prolapse.

Is mitral valve prolapse dangerous?

In most cases, it’s harmless. Most people who have the condition are unaware of it and their health isn’t affected. However, in some cases treatment is required.

What causes MVP?

The most common cause of MVP is abnormally stretchy valve leaflets (called myxomatous valve disease). Mitral valve prolapse occurs in around 2% of the population. A person can be born with the genetic risk of developing MVP. It also can be caused by other health problems, such as some connective tissue diseases.

How’s mitral valve prolapse detected?

Because most patients with MVP don’t have symptoms, a murmur may be detected during a routine physical exam when listening to the heart with a stethoscope. Common symptoms include bursts of rapid heartbeat (palpitations), chest discomfort and fatigue.

What should I do if a murmur is detected?

Even for those who aren’t having symptoms, if a murmur is detected suggesting mitral valve prolapse, an echocardiogram (echo) is recommended. The echo uses ultrasound to evaluate the characteristics of the valve cusps and how much blood may be leaking (regurgitation) from the valve when the heart contracts. Another test may be cardiac magnetic resonance imaging (CMR), also known as cardiac MRI. The test results and extent of your symptoms will guide your health care team in determining if further testing is needed.

Does mitral valve prolapse need to be treated?

In many instances, having MVP won’t impact your health and requires no treatment. Talk with your health care team about how to prevent complications from MVP based on your level of risk. If you’re prescribed medication, take it as directed.

People with an abnormal mitral valve may need mitral valve repair or replacement if:

• Symptoms are getting worse
• Mitral regurgitation becomes severe
• The left ventricle or left atrium of the heart become enlarged
• Arrhythmias develop
• The heart function (ejection fraction) decreases

MVP rarely becomes a serious condition. However, in the most serious cases it can cause abnormal heartbeats (arrhythmias) that may eventually become life-threatening.

When mitral valve prolapse is severe enough to cause significant valve leakage, called “regurgitation,” it can lead to serious complications such as heart attack and stroke. This happens because when the valve leaks, it can cause the atrium to enlarge. An enlarged atrium may lead to heart rhythm problems such as atrial fibrillation, which may cause blood clots to form. When clots travel from the heart to the arteries or the brain, it can lead to a stroke or heart attack.

Know the signs and symptoms of heart attack and stroke.

Do people with MVP need to take antibiotics before dental procedures?

The use of antibiotics before having a dental procedure is no longer recommended by the American Heart Association for patients with mitral valve prolapse, regardless of whether they have associated symptoms. 

Additional resources:

• Print our handy pre-surgery checklist: Facing and Recovering from Major Surgery (PDF)(link opens in new window) | Spanish (PDF)
• Patient guide: Understanding Your Heart Valve Problem (PDF)(link opens in new window) | Spanish (PDF)

Written by American Heart Association editorial staff and reviewed by science and medicine advisors. See our editorial policies and staff.

Last Reviewed: Feb 9, 2021

Mitral valve prolapse | Blog “Health Plus”

Mitral valve prolapse (MVP) is a pathology in which the functions of the valve, which is located between the ventricle of the heart and the atrium, are impaired. This pathology is most often detected by chance, since in half of the cases it does not have any symptoms. At the same time, mitral valve prolapse is not a serious pathology of the heart and, with adequate treatment, its prognosis is very favorable.

MVP is most often congenital, but sometimes it also occurs due to weakening of the connective tissue of the heart valves.

In the first case, mitral valve prolapse is hereditary. Usually, congenital MVP is not accompanied by any special symptoms and, moreover, does not require serious complex treatment.

The situation is different with secondary prolapse. It usually occurs against the background of some disease that disrupts the structure of chords, valves or papillary muscles. These diseases include: ischemic heart disease, myocardial infarction, rheumatism, chest trauma.

Mitral valve prolapse is usually diagnosed incidentally if the patient is scheduled for cardiac ultrasound for any reason. Ultrasound examination allows you to identify the specific degree of prolapse and the amount of regurgitation.

In MVP 1st degree leaflet swelling is insignificant and does not exceed 5 mm.

In grade 2 , leaflets bulge within 9 mm, and in grade 3 mitral valve prolapse, leaflet bulge exceeds 10 mm.

If this pathology is detected, the doctor may prescribe additional studies that will determine the features of the heart. These additional studies include ECG and Holter ECG. Since violations of the heart can occur under certain conditions (during sleep, during physical exertion, etc.), it is relevant to conduct a Holter ECG. In this case, observation is carried out within a day, and not in a few minutes, as with a conventional ECG.

Treatment of mitral valve prolapse in some cases is not required, as it does not cause serious problems in the work of the heart. In other cases, the treatment of MVP is necessary – if the heart rhythm is seriously loaded or pain in the heart occurs. With a combination of PMK and neurotic disorders, the doctor prescribes tranquilizers to the patient, he is recommended to do auto-training or muscle relaxation.

The patient needs to change his lifestyle in such a way as to exclude overwork and overload, including emotional, as well as intoxication. In the treatment of MVP, spa treatment, massage, acupuncture perfectly help. With hyperventilation syndrome, it is recommended to do special breathing exercises. In the presence of asthenic disorders, the patient will benefit from taking multivitamins.

Even if the examination shows that MVP is not dangerous for health , the patient needs to regularly visit a doctor, as prolapse progresses with age and can lead to complications.

Conservative treatment for MVP is aimed at preventing the development of myocardial neurodystrophy in a patient and at preventing infective endocarditis. With the development of the disease, if changes in the work of the heart increase, and the valves strongly bend, surgical intervention may be required.

If any of the above symptoms are detected, you should contact a cardiologist.
You can make an appointment by calling 8 (928) 337-60-60.

“In Russia they started to do this quite recently”: heart surgeons from Volgograd performed a unique heart surgery 0002 Another unique operation the heart was performed by surgeons from the Volgograd State Medical University. The technique of clipping the mitral valve, which was used by scientists, was first used in the Southern Federal District. In Russia, this method has become available quite recently.

Such surgeries in Russia have recently started to be performed

Photo: VolgGMU

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How was V1.RU told in clinic No. 1 of VolgGMU? since last year, only 64 such operations have been performed throughout the country. It was first performed in Volgograd.

– A 70-year-old resident of the city of Volzhsky was admitted with complaints of weakness, fatigue and shortness of breath with minimal physical exertion, – V1. RU was told at the clinic of the Volgograd State Medical University. The general condition of the doctors was assessed as relatively stable. Examination revealed mitral valve prolapse of the third degree in the patient. This is a cardiac anomaly in which there is a reverse flow of blood from the ventricle to the left atrium.

Modern technologies allow cardiac surgeons to perform the finest work

Photo: VolgGMU

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The disease most often affects the elderly. But for most of them, treatment with the so-called open method is not suitable – due to the high risk of serious complications. Transcatheter clipping of the mitral valve has become an alternative method of treatment for patients with this pathology.

– Clips are installed for patients with mitral insufficiency, – doctors said, – we use them for patients who have a high surgical risk, older patients who have a low ejection fraction.

Professor Mozgovoy personally supervised the operation

Photo: VolgGMU

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Transcatheter valve clipping is a minimally invasive operation. That is, medical instruments are introduced to the mitral valve through a puncture in the femoral vein and the interatrial septum.

— A special device is inserted through these punctures, which allows delivering a special clip to the mitral valve, — says Professor Pavel Mozgovoy, Head of the Cardiac Surgery Department of the Clinic No. , the degree of mitral insufficiency decreases.

Putting a clip on the mitral valve is far from an easy task

Photo: VolgGMU

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Volgograd cardiac surgeons have already performed four operations on patients with mitral valve prolapse. Vera Svintsova was one of the first to receive such surgical assistance.