Mitral valve prolapse

Definition

Mitral valve prolapse is a heart problem in which the valve that separates the upper and lower chambers of the left side of the heart does not close properly.

Alternative Names

Barlow syndrome; Floppy mitral valve; Myxomatous mitral valve; Billowing mitral valve; Systolic click-murmur syndrome; Prolapsing mitral leaflet syndrome

Causes, incidence, and risk factors

The mitral valve helps blood on the left side of the heart flow in one direction. It closes to keep blood from moving backwards when the heart beats (contracts).

Mitral valve prolapse is the term used when the valve does not close properly. It can be caused by many different things.

In most cases, it is harmless. Patients usually do not know they have the problem, and it does not affect their health. In a small number of cases, the prolapse can cause blood to leak backwards. This is called mitral regurgitation.

Mitral valve prolapse often affects thin women who may have minor chest wall deformities, scoliosis, or other disorders. Some forms of mitral valve prolapse seem to be passed down through families (inherited).

Mitral valve prolapse is also seen with some connective tissue disorders, especially Marfan syndrome and other rare genetic disorders.

Symptoms

Many patients with mitral valve prolapse do not have symptoms. The group of symptoms found in patients with mitral valve prolapse is called "mitral valve prolapse syndrome" and includes:

• Chest pain (not caused by coronary artery disease or a heart attack)
• Dizziness
• Fatigue
• Panic attacks
• Sensation of feeling the heart beat (palpitations)
• Shortness of breath with activity or when lying flat (orthopnea)

When mitral regurgitation occurs, symptoms may be related to this leaking. 

Signs and tests

The doctor will perform a physical exam and use a stethoscope to listen to your heart and lungs. The doctor may feel a thrill (vibration) over the heart, and hear a heart murmur ("midsystolic click"). The murmur gets longer and louder when you stand up.

Blood pressure is usually normal.

Echocardiogram is the most common test used to diagnose mitral valve prolapse. The following tests may also be used to diagnose mitral valve prolapse or a leaky mitral valve:

• Cardiac catheterization
• Chest x-ray
• CT scan of the chest
• ECG (may show arrhythmias such as atrial fibrillation)
• MRI of the heart

Treatment

Most of the time, there are no (or few) symptoms, and treatment is not needed.

In the past, most patients with heart valve problems were given antibiotics before dental work or invasive procedures such as colonoscopy. The antibiotics were given to prevent an infection of the damaged heart.

However, antibiotics are now used much less often before dental work and other procedures. Check with your health care provider to see if you need antibiotics.

A number of drugs may be prescribed when mitral regurgitation or other heart problems are also present.

Although it is not very common, you may need surgery to repair or replace your mitral valve if it becomes leaky (regurgitation). You may need mitral valve repair or replacement if:

• Your symptoms are getting worse
• The left ventricle of your heart is enlarged
• Your heart function gets worse

Support Groups

Expectations (prognosis)

Most of the time, mitral valve prolapse is harmless and does not cause symptoms. Symptoms that do occur can be treated and controlled with medicine or surgery.

Some abnormal heartbeats (arrhythmias) in people with mitral valve prolapse can be life-threatening. If the valve leakage becomes severe, your outlook may be similar to that of people who have mitral regurgitation from any other cause.

Complications

Calling your health care provider

Call your health care provider if you have:

• Chest discomfort, palpitations, or fainting spells that get worse
• Long-term illnesses with fevers

Prevention

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References

Bonow RO, Carabello BA, Chatterjee K, de Leon AC Jr., Faxon DP, Freed MD, et al. 2006 Writing Committee Members: American College of Cardiology/American Heart Association Task Force. 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): endorsed by the Society of Cardiovascular Anesthesiologists, Scoiety for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation. 2008;118:e523-e661.

Carabello BA. Valvular heart disease. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 75.

Nishimura RA, Carabello BA, Faxon DP, Freed MD, Lytle BW, O'Gara PT, et al. ACC/AHA 2008 guideline update on valvular heart disease: focused update on infective endocarditis: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol. 2008;52:676-685.

Otto CM, Bonow RO. Valvular heart disease. In: Bonow RO, Mann DL, Zipes DP, Libby P, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 9th ed. St. Louis, Mo: WB Saunders; 2011:chap 66.