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Mitral Valve Prolapse

Topic Overview

The heart

What is mitral valve prolapse?

Your mitral valve controls blood flow on the left side of your heart. The valve opens and closes with each heartbeat. It works like a one-way gate, letting blood flow from your upper heart chamber to your lower chamber.

When you have mitral valve prolapse (MVP) , the valve closes after blood flows through. But the valve bulges backward a little. It looks like a tiny parachute or balloon as it bulges. (See a picture of mitral valve prolapse.)

Mitral valve prolapse is the most common heart valve problem. It is more common in people who have a family history of this problem.

Is mitral valve prolapse a serious heart problem?

No. Mitral valve prolapse is not dangerous. It usually does not damage your heart. You can live a normal life without changing your activities or how you eat.

But a few people with this condition develop another problem. If the valve does not close tightly enough, blood can leak (regurgitate) into the upper chamber. This is called mitral valve regurgitation. The heart then has to work harder to pump this extra blood. Over time, this can damage the heart.

What are the symptoms?

You probably will not have any symptoms from mitral valve prolapse. You may not even know you have it until a doctor hears a "clicking" sound or a murmur when listening to your heart.

But some people may feel that their heart is beating too fast or "pounding." This feeling is called palpitations. Others may have brief chest pain.

What causes mitral valve prolapse?

Mitral valve prolapse is caused by a physical change in the valve. Physical changes such as thickening and abnormal shapes cause most of the cases of MVP. What causes these physical changes is not known. A valve problem may be passed down through family members.

How is mitral valve prolapse diagnosed?

In most cases, mitral valve prolapse is found during a regular doctor visit. If your doctor hears a certain "click" or murmur sound when listening to your heart, he or she may want you to have a test to check for mitral valve prolapse. This test is called an echocardiogram.

Will you need treatment?

You will probably not need treatment for mitral valve prolapse. Your doctor may want you to have regular exams every 3 to 5 years. A normal lifestyle and regular exercise are recommended for most people.

Cause

Mitral valve prolapse (MVP) is caused by a physical change in the valve. Physical changes such as thickening or abnormal shapes cause most of the cases of MVP. What causes these physical changes is not known. MVP may be passed down through family members.

Some people who have other inherited diseases (ones that run in families) may also have MVP. But this link is not common. Inherited diseases associated with MVP include:

Conditions that affect the mitral valve, connective tissue, and heart muscle can cause mitral valve prolapse, but this is rare.

Other conditions, such as osteogenesis imperfecta and hyperthyroidism, are linked with mitral valve prolapse.

Symptoms

For most people with mitral valve prolapse (MVP), the effect on the heart is minor, and they have no symptoms.

Some people with MVP have shortness of breath, chest pain, or heart palpitations. But it is not clear that these symptoms are caused by MVP. Doctors don't know exactly why some people have these symptoms.

In rare cases, people who develop severe mitral valve regurgitation may have symptoms of heart failure (such as shortness of breath, fluid buildup, and fatigue) or symptoms of arrhythmia (such as lightheadedness and weakness).

What Increases Your Risk

If someone in your family has mitral valve prolapse (MVP), you are more likely to develop it yourself.

Inherited conditions can increase your risk of MVP, but this is rare. These conditions include Marfan's syndrome or Ehlers-Danlos syndrome.

Any change in the shape of the valve can increase your risk of MVP. These changes can result from a birth (congenital) defect or a disease that affects the parts of the heart or how the heart works.

Diseases that increase your risk of developing MVP

Diseases that damage the mitral valve or affect the parts of the heart or how the heart works may increase your risk of getting MVP. But this cause is not common. Examples of these diseases include:

Factors that may increase the risk for MVP complications

  • Being male. Men with MVP are more likely than women to have complications.
  • Age. Older people who have MVP are more likely than younger people to have complications.
  • Family history. Those who have a family member with MVP are more likely to have complications.
  • Structural abnormalities. Those who have thickened valve flaps (leaflets) are more likely to have complications.

When to Call a Doctor

Call 911 or other emergency services immediately if you have:

  • Symptoms of a stroke or transient ischemic attack (TIA), such as sudden numbness, tingling, or weakness in or an inability to move part or all of one side of the body; vision changes that come on suddenly; or sudden difficulty speaking or understanding speech.
  • Symptoms of a heart attack, such as chest pain or pressure, sweating, shortness of breath, or pain, pressure, or a strange feeling in the back, neck, jaw, upper belly, or in one or both shoulders or arms.

Call a doctor immediately if you have mitral valve prolapse (MVP) and you have:

  • Symptoms of heart failure, such as shortness of breath at rest, with mild exertion, while lying down, or that wakes you from sleep, and leg swelling.
  • Symptoms of infection, such as a fever with no other obvious cause. Be alert for signs of infection if you recently had any dental, diagnostic, or surgical procedure.
  • Irregular heartbeats and have started having fainting episodes (syncope) or you notice an increase in fainting episodes.

Call your doctor for an appointment if you have noticed new symptoms or an increase in symptoms such as:

  • Chest pain, palpitations, or shortness of breath.
  • A decreased ability to exercise at your usual level.
  • Excessive fatigue (without another reason).

Who to see

The following health professionals can evaluate symptoms that may be related to mitral valve prolapse and can order the tests you may need:

Exams and Tests

Since most people with mitral valve prolapse (MVP) do not have symptoms, MVP is usually discovered during a routine health exam.

In some women who are only mildly affected by MVP, the condition may become undetectable after middle age.

Medical history and physical exam

Your doctor may suspect MVP if he or she hears a click or murmur while listening to your heartbeat. This click or murmur happens because the mitral valve is not shaped normally. MVP may be discovered if you have a test called an echocardiogram that is done for another reason.

If your doctor thinks you may have MVP, he or she will ask if you have a family history of MVP or heart disease and will conduct a physical exam to check for MVP. During the exam, he or she will listen closely to your heart.

To confirm the diagnosis, your doctor may request an echocardiogram if you haven't had one. Your doctor may also evaluate you for other heart conditions.

Echocardiogram

An echocardiogram is the most useful test for confirming that you have mitral valve prolapse. It is also useful to rule out MVP. Echocardiograms require careful review by an experienced doctor, because MVP is difficult to detect with this test. Some people who have MVP will have a normal echocardiogram.

Regular echocardiograms are not needed if you do not have symptoms or complications of MVP.

Early detection and regular exams

Screening for MVP is not recommended or necessary.

If you have MVP, you will have regular follow-up exams. How often you need these exams is based on whether you have complications like mitral valve regurgitation or thickened valve flaps (leaflets). If you do not have symptoms or complications, your doctor may suggest an exam every 3 to 5 years.1

Treatment Overview

Most people with mitral valve prolapse (MVP) do not have symptoms and do not need treatment. Regular checkups every 3 to 5 years are usually all that is required. A normal lifestyle and regular exercise are recommended for most people who have MVP.1

If you have symptoms, such as chest pain or palpitations, you might take a beta-blocker medicine.

Ongoing Concerns

Complications of mitral valve prolapse (MVP) are not common. Most people with MVP do not have significant problems and do not need treatment. Complications of MVP develop mostly in people who have:

  • A mitral valve murmur during contraction (systole).
  • Thickened mitral valve flaps (leaflets).
  • An enlarged upper left heart chamber (atrium) or lower left heart chamber (ventricle).

Complications of MVP include:

Living With Mitral Valve Prolapse

Most people with mitral valve prolapse (MVP) have no symptoms and do not need treatment for their condition. Your doctor will advise you to exercise regularly, especially if you do not have symptoms. Controlling your weight and blood pressure as well as eating a healthy diet are important. These healthy habits are part of a heart-healthy lifestyle.

A healthy lifestyle is also important if you have complications of mitral valve prolapse. People who have heart palpitations can try lifestyle changes to help, such as limiting alcohol and caffeine, not smoking, and avoiding secondhand smoke.

If you do not have other heart problems or an artificial heart valve, antibiotics are not recommended before dental or medical procedures. In the past, antibiotics were given before certain procedures to people who had MVP to help prevent an infection in the heart called endocarditis. But MVP does not raise your risk enough that you need antibiotics for prevention.

More information

Medications

People with mitral valve prolapse (MVP) usually do not need medicines, especially if they do not have mitral valve regurgitation.

Medicines cannot correct bulging (prolapse) of the mitral valve or prevent many of the complications that can develop. But medicine is sometimes used to control symptoms.

Beta-blockers are used to relieve symptoms of palpitations or chest pain that might happen with mitral valve prolapse. Beta-blockers do not improve how the mitral valve works.

Other Places To Get Help

Organizations

American Heart Association (AHA)
7272 Greenville Avenue
Dallas, TX  75231
Phone: 1-800-AHA-USA1 (1-800-242-8721)
Web Address: www.heart.org
 

Visit the American Heart Association (AHA) website for information on physical activity, diet, and various heart-related conditions. You can search for information on heart disease and stroke, share information with friends and family, and use tools to help you make heart-healthy goals and plans. Contact the AHA to find your nearest local or state AHA group. The AHA provides brochures and information about support groups and community programs, including Mended Hearts, a nationwide organization whose members visit people with heart problems and provide information and support.


National Heart, Lung, and Blood Institute (NHLBI)
P.O. Box 30105
Bethesda, MD  20824-0105
Phone: (301) 592-8573
Fax: (240) 629-3246
TDD: (240) 629-3255
Email: nhlbiinfo@nhlbi.nih.gov
Web Address: www.nhlbi.nih.gov
 

The U.S. National Heart, Lung, and Blood Institute (NHLBI) information center offers information and publications about preventing and treating:

  • Diseases affecting the heart and circulation, such as heart attacks, high cholesterol, high blood pressure, peripheral artery disease, and heart problems present at birth (congenital heart diseases).
  • Diseases that affect the lungs, such as asthma, chronic obstructive pulmonary disease (COPD), emphysema, sleep apnea, and pneumonia.
  • Diseases that affect the blood, such as anemia, hemochromatosis, hemophilia, thalassemia, and von Willebrand disease.

References

Citations

  1. Bonow RO, et al. (2008). 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). Circulation, 118(15): e523–e661.

Other Works Consulted

  • Adams DH, et al. (2011). Mitral valve regurgitation. In V Fuster et al., eds., Hurst’s The Heart, 13th ed., vol. 2, pp. 1721–1737. New York: McGraw-Hill.
  • Bonow RO, et al. (2008). 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). Circulation, 118(15): e523–e661.
  • Bonow RO, Otto CM (2012). Management of valvular heart disease. In RO Bonow et al., eds., Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine, 9th ed., vol. 2, pp. 1530–1539. Philadelphia: Saunders.
  • Otto CM, Bonow RO (2012). Valvular heart disease. In RO Bonow et al., eds., Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine, 9th ed., vol. 2, pp. 1468–1539. Philadelphia: Saunders.

Credits

By Healthwise Staff
E. Gregory Thompson, MD - Internal Medicine
Rakesh K. Pai, MD, FACC - Cardiology, Electrophysiology
Last Revised January 23, 2013

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