Mitral Valve Prolapse
What is mitral valve prolapse?
The mitral valve allows blood to flow from the left atrium to the left ventricle in
the heart. Mitral valve prolapse (MVP) is the bulging (prolapse) of one or both of
the mitral valve flaps (leaflets) into the left atrium when the heart contracts. When
the flaps don't close properly, blood leaks backward. This is called regurgitation.
Regurgitation may cause a heart murmur, an abnormal sound in the heart caused by turbulent
blood flow. When regurgitation is present, it’s generally mild. But it can get worse
The mitral valve is located between the left atrium and the left ventricle and has
2 flaps. Normally the flaps are tightly closed by small tendon or "cords" that connect
the flaps to the muscles of the heart. This closure prevents blood from flowing backwards.
In MVP, the flaps enlarge and stretch inward toward the left atrium, sometimes "snapping"
during heart contraction. This may allow some back-flow or regurgitation of blood
into the left atrium.
MVP usually does not need to be treated because it is rarely a serious condition,
and it doesn't damage the heart. However, regular checkups with a doctor are advised.
What causes MVP?
The cause of MVP is unknown, but most cases are thought to be inherited. There are
2 forms of MVP: primary and secondary.
Primary MVP means the mitral valve is abnormal because of one or more of these changes:
One or both of the flaps are too large and thick
The flap surfaces are scarred
The tendon cords are thinner or longer than they should be
There are fibrin deposits on the flaps
Primary MVP is most often an isolated disease. But is can be linked to other valve
or skeletal problems. Some rare instances of MVP are hereditary.
In secondary MVP, another disease is linked to MVP. Often the valve flaps are not
thickened. Prolapse occurs for other reasons. The prolapse may be from:
Damage caused by decreased blood flow from coronary artery disease to the muscles
attached to the tendon cords
Functional changes in the heart muscle
Damage to valve structures caused by heart attack, rheumatic heart disease, valve
infection, or hypertrophic cardiomyopathy. Hypertrophic cardiomyopathy is when the
left ventricle of the heart is larger than normal.
Who is at risk for MVP?
MVP affects both sexes and people of all ages. Factors that may increase the risk
of MVP include:
Graves disease (a condition that affects the thyroid gland)
Certain connective tissue disorders, such as Marfan syndrome
Scoliosis and other skeletal problems
Some types of muscular dystrophy
What are the symptoms of MVP?
MVP may not cause any symptoms. Symptoms may vary depending on the degree of prolapse
present. The presence of symptoms doesn't necessarily match the severity of MVP.
These are the most common symptoms of MVP:
Fast or irregular heartbeats (palpitations). This may be the result of irregular heartbeats or just the sensation of the valve
closing when the heart rhythm is normal.
Chest pain. Chest pain linked to MVP is different from chest pain associated with coronary artery
disease. Usually the chest pain is not like classic angina, such as pain with exertion,
but it can happen often, can be very uncomfortable, and can affect your quality of
Depending on the severity of the mitral regurgitation or leak, the left atrium or
left ventricle may become enlarged, leading to symptoms of heart failure. These symptoms
include weakness, tiredness, dizziness, and shortness of breath.
The symptoms of mitral valve prolapse may look like other medical conditions or problems.
Always see a healthcare provider for a diagnosis.
How is mitral valve prolapse diagnosed?
You may have no noticeable symptoms. Your doctor may hear a click or murmur during
a routine physical exam. The "click" is created by the stretched flaps snapping against
each other during contraction. The murmur is caused by the blood leaking back into
the left atrium. This may be the only sign of MVP.
Along with a complete medical history and physical exam, your provider may order these
tests to diagnose MVP:
Electrocardiogram(ECG). This test records the strength and timing of the electrical activity of the heart.
It shows abnormal rhythms and can sometimes detect heart muscle damage. Small sensors
are taped to your skin to pick up the electrical activity.
Chest X-ray. An X-ray may be done to check your lungs and see if your heart is enlarged.
Transthoracic echocardiogram (echo or TTE).This is 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 your chest above the heart. Echocardiography is the most useful diagnostic
test for MVP.
For more severe symptoms, other tests may be done. These may include:
Stress test. This is also called treadmill or exercise ECG. ECG is done while you walk on a treadmill
to monitor the heart during exercise. Breathing and blood pressure rates are also
Cardiac catheterization. With this procedure, X-rays are taken after a contrast agent (dye) is injected into
an artery to look for any narrowing, blockages, or other changes in certain arteries.
The function of the heart and the valves may be checked, too.
Cardiac MRI. This is an imaging test that takes detailed pictures of the heart. It may be used
to get a more precise look at the heart valves and heart muscle, or to prepare for
heart valve surgery.
How is mitral valve prolapse treated?
MVP usually doesn't need to be treated because it is rarely a serious condition, and
it doesn't damage the heart. Regular checkups with your doctor are advised.
If you have heart rhythm changes, you may need medicines that control fast heart rhythms
or irregular heartbeats. In most cases, you will also need to limit stimulants, such
as caffeine and cigarettes, to control symptoms.
If you have atrial fibrillation or severe left atrial enlargement, you may need treatment
with an anticoagulant (blood thinner) to keep clots from forming. This can be in the
form of aspirin ,warfarin therapy, or other newer blood thinners
If you have symptoms of dizziness or fainting, it's important to stay well hydrated
by drinking plenty of fluids.
If severe mitral regurgitation is from a floppy mitral leaflet, tear (rupture) of
the cords, or extreme lengthening of the valve, you may need transcatheter mitral
valve repair, surgical repair, or valve replacement.
What are possible complications of mitral valve prolapse?
Rarely, bacteria that enter the bloodstream can cause endocarditis, an infection of
the inner lining of the heart chambers and valves. This risk is higher in people with
MVP because the deformed mitral valve flap can attract bacteria that are in the bloodstream.
Gum infections and tooth decay can cause endocarditis, so regularly flossing and brushing
your teeth can help prevent it. You may be at high risk for endocarditis if you have
had a valve replaced. You may need to take antibiotics before dental work and certain
types of surgery.
When should I call my healthcare provider?
Call your healthcare provider if your symptoms get worse or if you have new symptoms.
Key points about mitral valve prolapse
Mitral valve prolapse (MVP) is the bulging (prolapse) of one or both of the mitral
valve flaps 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).
Some things that may increase the risk of MVP include Graves disease, certain connective
tissue disorders such as Marfan syndrome, scoliosis and other skeletal problems, and
some types of muscular dystrophy.
People with MVP often have a click or murmur that’s heard during a routine physical
MVP usually does not need to be treated because it is rarely a serious condition,
and it does not damage the heart.
People with heart rhythm changes may need to be treated with medicines to control
tachycardias (fast heart rhythms).
MVP is usually harmless and does not shorten life expectancy.
Tips to help you get the most from a visit to your healthcare provider:
Know the reason for your visit and what you want to happen.
Before your visit, write down questions you want answered.
Bring someone with you to help you ask questions and remember what your provider tells
At the visit, write down the name of a new diagnosis, and any new medicines, treatments,
or tests. Also write down any new instructions your provider gives you.
Know why a new medicine or treatment is prescribed, and how it will help you. Also
know what the side effects are.
Ask if your condition can be treated in other ways.
Know why a test or procedure is recommended and what the results could mean.
Know what to expect if you do not take the medicine or have the test or procedure.
If you have a follow-up appointment, write down the date, time, and purpose for that
Know how you can contact your provider if you have questions.