Mitral Valve Prolapse

Mitral valve prolapse (MVP) is a common heart condition where the mitral valve, located between the upper and lower chambers on the left side of your heart, does not close properly. Instead of closing smoothly, one or both of its flaps (leaflets) bulge backward into the upper heart chamber (left atrium) when your heart beats. Most people with MVP have no symptoms and it is usually harmless.

What is Mitral Valve Prolapse?

Mitral valve prolapse (MVP) is a condition affecting the heart's mitral valve, which separates the left atrium from the left ventricle. In MVP, one or both of the valve's flaps, called leaflets, become floppy and bulge backward into the left atrium during the heart's contraction. This can sometimes lead to a small amount of blood leaking backward, known as mitral valve regurgitation.

Your heart has four valves that keep blood flowing in the correct direction. The mitral valve is crucial for ensuring blood moves from the left upper chamber (left atrium) to the left lower chamber (left ventricle) and then out to your body. When your heart beats, the mitral valve normally closes tightly to prevent blood from flowing back into the left atrium. In mitral valve prolapse, the leaflets of this valve become thickened or enlarged and don't close smoothly. Instead, they prolapse, or bulge, backward into the left atrium. This bulging often causes a characteristic clicking sound that a doctor can hear with a stethoscope. If blood leaks backward through the valve, it creates a whooshing sound called a heart murmur. While MVP is a common condition, it is usually benign, meaning it does not cause serious problems for most people.

Symptoms

Most people with mitral valve prolapse (MVP) do not experience any symptoms and may not even know they have the condition. When symptoms do occur, they are usually mild and can vary greatly from person to person. These symptoms often do not indicate a serious problem and can be managed effectively.

If you do experience symptoms, they might include a sensation of a rapid, fluttering, or pounding heartbeat (palpitations). You might also feel lightheaded or dizzy, especially when standing up quickly. Some individuals report feeling unusually tired (fatigue) or experiencing shortness of breath, particularly during physical activity or when lying flat. Chest pain, which is typically not related to a heart attack, can also occur. This pain might be sharp or dull, and it usually does not worsen with exertion. Other less common symptoms can include anxiety or migraine headaches. It's important to remember that these symptoms can also be caused by other conditions, so a proper diagnosis from a healthcare provider is essential.

Causes & risk factors

The exact cause of mitral valve prolapse (MVP) is often unknown, but it can sometimes be inherited, meaning it runs in families. In many cases, it's linked to a condition called myxomatous degeneration, where the valve tissue becomes abnormally thick and floppy. Certain medical conditions can also increase your risk of developing MVP.

Myxomatous degeneration is the most common underlying cause of MVP. This is a genetic change in the connective tissue of the mitral valve leaflets, causing them to become thickened, enlarged, and rubbery. This change makes the leaflets more likely to bulge backward into the left atrium when the heart contracts. While MVP can occur on its own, it is sometimes associated with other conditions. These include connective tissue disorders such as Marfan syndrome and Ehlers-Danlos syndrome, which affect the body's connective tissues. Other associated conditions can include scoliosis (a curvature of the spine), Graves' disease (an overactive thyroid), and Wolff-Parkinson-White syndrome (a heart rhythm disorder). Having a family history of mitral valve prolapse can also increase your risk. However, many people with MVP have no identifiable risk factors or associated conditions, and the cause remains a mystery.

How it's diagnosed

Mitral valve prolapse (MVP) is often first suspected during a routine physical exam when your doctor listens to your heart. The primary diagnostic tool is an echocardiogram, a non-invasive ultrasound of the heart, which provides detailed images of the mitral valve's structure and function, confirming the diagnosis and assessing its severity.

During a physical exam, your doctor may hear a distinct clicking sound through a stethoscope as the mitral valve leaflets prolapse. If blood leaks backward, they might also hear a whooshing sound, known as a heart murmur. These sounds are key indicators that suggest the presence of MVP. To confirm the diagnosis and evaluate the condition, an echocardiogram is the most important test. This ultrasound uses sound waves to create moving pictures of your heart, allowing your doctor to see the mitral valve's leaflets, how they move, and if any blood is leaking backward (mitral regurgitation). It can also measure the size and function of your heart chambers. Other tests may be used to gather more information or rule out other conditions. These can include an electrocardiogram (ECG) to check your heart's electrical activity, a chest X-ray to view the heart and lungs, or a cardiac MRI for more detailed images. Sometimes, a stress test might be performed if you experience symptoms during physical activity, to see how your heart functions under exertion.

Treatment options

Most people with mitral valve prolapse (MVP) do not require any specific treatment, especially if they have no symptoms or only mild ones. For those with bothersome symptoms, treatment focuses on managing them. In rare cases of severe mitral valve regurgitation, surgical intervention may be necessary to repair or replace the valve.

If you have no symptoms or only very mild ones, your doctor will likely recommend regular monitoring to watch for any changes in your condition. Lifestyle adjustments, such as maintaining a healthy diet, exercising regularly, and avoiding stimulants like caffeine, can help manage symptoms like palpitations. For individuals experiencing more noticeable symptoms, medications can be prescribed. Beta-blockers, for example, can help slow your heart rate and reduce the force of contractions, which can alleviate palpitations and chest pain. If you have a history of stroke or blood clots, your doctor might prescribe blood thinners to reduce the risk of future clots. Surgery is typically reserved for a small number of people who develop severe mitral valve regurgitation, where a significant amount of blood leaks backward, leading to symptoms like severe shortness of breath or heart enlargement. The goal of surgery is either to repair the existing valve, which is often preferred, or to replace it with an artificial valve if repair is not possible. Your doctor will discuss the best approach based on your specific condition.

Recovery & outlook

The outlook for most people with mitral valve prolapse (MVP) is excellent, as the condition is usually harmless and does not affect life expectancy. Many individuals live full, active lives without ever needing treatment. Regular monitoring with your doctor is often the main recommendation to ensure your heart health remains stable over time.

For the vast majority of people, mitral valve prolapse is a benign condition that causes no significant problems. You can expect to live a normal life with no restrictions on your activities. Regular check-ups with your doctor, including periodic echocardiograms, are important to monitor the valve and detect any changes, such as the development or worsening of mitral regurgitation. Complications from MVP are rare. The most common complication is mitral valve regurgitation, where the backward leakage of blood becomes severe enough to strain the heart. Other rare complications can include heart rhythm problems (arrhythmias), an infection of the heart valves (infective endocarditis), or, very rarely, a stroke. If complications do arise, they are usually manageable with medication or, in severe cases, surgery. With appropriate medical care and monitoring, even those who develop complications can often maintain a good quality of life. Your doctor will help you understand your specific outlook and any necessary steps for ongoing care.

When to see a doctor

You should contact your doctor if you experience new or worsening symptoms that might be related to mitral valve prolapse (MVP). While MVP is often harmless, changes in symptoms could indicate a need for evaluation. Seek immediate medical attention if you have severe chest pain, extreme shortness of breath, or sudden dizziness.

It is important to inform your doctor if you notice any new symptoms or if existing symptoms, such as palpitations, chest pain, or shortness of breath, become more frequent or severe. These changes could signal that your mitral valve prolapse is progressing or that you are developing a complication, and your doctor may want to perform additional tests. While MVP-related chest pain is usually not serious, severe chest pain, especially if accompanied by shortness of breath, sweating, or pain radiating to your arm or jaw, could be a sign of a heart attack or another serious condition. In such cases, you should seek emergency medical care immediately. Similarly, if you experience sudden, severe shortness of breath, fainting, or prolonged periods of lightheadedness or dizziness, it is crucial to get prompt medical attention. These symptoms could indicate a significant change in your heart function or a serious heart rhythm issue that requires urgent assessment and treatment.

Frequently asked questions

Is mitral valve prolapse a serious heart condition?

For most people, mitral valve prolapse (MVP) is not a serious heart condition. It is often harmless and does not cause symptoms or affect life expectancy. Only a small percentage of individuals develop complications that require treatment.

Can I exercise with mitral valve prolapse?

Yes, in most cases, you can exercise with mitral valve prolapse. Regular physical activity is generally encouraged for heart health. However, if you have severe mitral regurgitation or significant symptoms, your doctor might recommend specific exercise guidelines. Always discuss your exercise plans with your healthcare provider.

What foods should I avoid if I have MVP?

There are no specific foods you must avoid solely because of mitral valve prolapse. However, if you experience palpitations, your doctor might suggest limiting stimulants like caffeine. A heart-healthy diet, rich in fruits, vegetables, and whole grains, is generally recommended for everyone.

Is mitral valve prolapse hereditary?

Mitral valve prolapse can sometimes be hereditary, meaning it can run in families. If a close family member has MVP, your risk might be higher. However, many people with MVP have no family history of the condition.

What is the difference between mitral valve prolapse and mitral regurgitation?

Mitral valve prolapse (MVP) describes the bulging of the mitral valve leaflets backward into the left atrium. Mitral regurgitation is when blood leaks backward through the mitral valve. MVP can lead to mitral regurgitation, but not everyone with MVP will have significant regurgitation.

Do I need antibiotics before dental procedures if I have MVP?

Current guidelines generally do not recommend routine antibiotics before dental procedures for most people with uncomplicated mitral valve prolapse. Antibiotics are typically reserved for individuals with a higher risk of heart infection, such as those with a history of infective endocarditis or a prosthetic heart valve. Always consult your doctor or dentist about your specific situation.

Sources

• MedlinePlus — Mitral Valve Prolapse
• Mayo Clinic — Mitral Valve Prolapse
• Cochrane Library — Mitral Valve Prolapse