Mitral Valve Prolapse

What is mitral valve prolapse (MVP)?

Mitral valve prolapse, also known as click-murmur syndrome, Barlow's syndrome, balloon mitral valve, or floppy valve syndrome, is the bulging of one or both of the mitral valve flaps (leaflets) into the left atrium during the contraction of the heart. One or both of the flaps may not close properly, allowing the blood to leak backward (regurgitation). This regurgitation may result in a murmur (abnormal sound in the heart due to turbulent blood flow). Mitral regurgitation (backward flow of blood), if present at all, is generally mild.

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Mitral valve prolapse is the most common form of valvular heart disease, occurring in 2 percent to 6 percent of the population.

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 MVP, 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 MVP?

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

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• primary MVP
  Primary MVP 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 MVP is seen frequently in persons with Marfan's Syndrome or other inherited connective tissue diseases, but is most often seen in persons with no other form of heart disease.
• secondary MVP
  In secondary MVP, 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 MVP 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 MVP?

Mitral valve prolapse may not cause any symptoms. The following are the most common symptoms of MVP. 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 MVP. The palpitations are usually associated 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 rare cases, patients may experience palpitations without observed dysrhythmias (irregular heart rhythm).
• chest pain
  Chest pain associated with MVP is different from chest pain associated with coronary artery disease (feels different, has different trigger, and different period of duration) 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 physician for a diagnosis.

How is MVP diagnosed?

Persons with MVP often have no symptoms and detection of a click or murmur may be discovered during a routine examination.

MVP 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 MVP 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 detects heart muscle damage. 
• echocardiogram (Also called echo.) - a noninvasive test that uses sound waves to produce a study of the motion of 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 MVP. 

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 the narrowing, occlusions, and other abnormalities of specific arteries. In addition, the function of the heart and the valves may be assessed. 

How is MVP treated?

Specific treatment for mitral valve prolapse will be determined by your physician 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 MVP is rarely a serious condition. Regular check-ups with a physician are advised. Because MVP is the most frequent cause of mitral valve bacterial endocarditis (an infection of the lining of the heart), one may be advised to take antibiotics before dental, urinary, or bowel procedures, or general surgery, particularly when mitral regurgitation is present.

Persons 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 MVP?

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

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