Mitral Valve Prolapse

Overview

Mitral valve prolapse (MVP) is a common condition affecting the mitral valve, which controls blood flow between the upper and lower chambers on the left side of the heart. In MVP, one or both of the valve's flaps (leaflets) are slightly enlarged or floppy and bulge backward into the upper chamber when the heart contracts. Doctors may hear a characteristic clicking sound, sometimes with a murmur.

For most people, mitral valve prolapse is harmless and causes no problems, and it is often discovered by chance during a routine examination or scan. In a minority, the valve does not close tightly and allows some blood to leak backward (mitral regurgitation), which may need monitoring or, occasionally, treatment. Understanding which form you have helps guide the right follow-up.

The mitral valve sits between the left atrium and the left ventricle and normally snaps shut when the ventricle contracts, keeping blood moving forward. In prolapse, the leaflets are a little too floppy and balloon backward, which can produce the characteristic clicking sound a doctor may hear. Being told you have a heart valve condition can sound worrying, but in the great majority of people MVP is a benign anatomical variation that requires nothing more than occasional reassurance. The level of attention it needs depends mainly on whether, and how much, the valve leaks.

Symptoms

Most people with mitral valve prolapse have no symptoms. When symptoms do occur, they are often mild and may include:

• Awareness of the heartbeat or palpitations (a fluttering or skipped-beat sensation)
• Chest discomfort that is usually brief and not related to exertion
• Fatigue
• Shortness of breath, especially if a significant leak develops
• Lightheadedness or, rarely, fainting

Symptoms do not always reflect how severe the valve problem is. If a significant leak develops over time, breathlessness on exertion and tiredness can become more noticeable and should be assessed.

Causes

Mitral valve prolapse happens when the valve leaflets and the cords that support them are slightly stretchy or enlarged, allowing the leaflets to bulge backward. The exact cause is often unknown, but contributing factors include:

• Inherited tendency: MVP can run in families.
• Connective tissue differences: The valve tissue is sometimes more elastic than usual.
• Connective tissue disorders: Conditions such as Marfan syndrome are associated with MVP.

In most people it is simply a normal variation in how the valve is built rather than a sign of underlying heart disease.

Risk Factors

• A family history of mitral valve prolapse
• Connective tissue disorders such as Marfan syndrome
• Certain inherited conditions affecting the heart and skeleton

Diagnosis

Mitral valve prolapse is often first suspected when a doctor hears a click or murmur while listening to the heart. The key test to confirm it is:

• Echocardiogram: An ultrasound of the heart that shows the valve leaflets bulging and measures any leakage of blood.

Additional tests may include an electrocardiogram (ECG) to check the heart rhythm and, if palpitations are troublesome, monitoring of the heartbeat over a day or more to capture intermittent symptoms. The echocardiogram is central because it not only confirms the prolapse but also grades how much, if any, blood leaks back through the valve, which is the main factor in deciding how closely the condition needs to be followed. If a significant leak is present, repeat echocardiograms over time track whether it is stable or slowly worsening.

Treatment

Treatment depends on whether the valve leaks and how much.

• No treatment for most: If there is no significant leak, no treatment is needed beyond reassurance and sometimes periodic check-ups.
• Managing symptoms: Palpitations or chest discomfort may be helped by lifestyle measures or, occasionally, medication.
• Monitoring leakage: If there is mitral regurgitation, regular echocardiograms track its severity.
• Surgery: If the valve leaks severely or causes the heart to strain over time, repair or replacement of the valve may be recommended. Valve repair is often preferred when possible.

Routine antibiotics before dental work are no longer recommended for most people with MVP; your cardiologist can advise on your individual situation.

For the small number of people whose valve leaks severely, surgery to repair the valve, when feasible, generally gives better long-term results than replacing it and is often timed before the heart begins to strain. Decisions about surgery are based on the degree of leakage, the size and function of the heart on echocardiography, and symptoms, and are made together with a cardiologist. The key reassurance for most people, though, is that they will never need any of this: with no significant leak, mitral valve prolapse is compatible with a completely normal life and activity level.

Living With MVP

• Attend follow-up appointments and echocardiograms as advised
• Stay physically active; most people with MVP can exercise normally, but check with your doctor if you have a significant leak
• Limit caffeine, alcohol, and stimulants if they trigger palpitations
• Maintain general heart-healthy habits
• Report new or worsening breathlessness, palpitations, or chest pain

When to See a Doctor

See a doctor if you have palpitations, chest discomfort, breathlessness, or fatigue that concern you, or if you have been told you have a heart murmur. Seek emergency care immediately if you have:

• Severe or crushing chest pain, especially spreading to the arm, neck, or jaw
• Sudden severe shortness of breath
• Fainting or near-fainting
• A very fast, irregular heartbeat with dizziness

These symptoms could signal a heart emergency and need urgent assessment, regardless of a prior MVP diagnosis.

Related Topics

Frequently Asked Questions

References

1. American Heart Association. Mitral Valve Prolapse.
2. Mayo Clinic. Mitral valve prolapse.
3. National Heart, Lung, and Blood Institute (NHLBI). Heart Valve Disease.
4. MedlinePlus, U.S. National Library of Medicine. Mitral valve prolapse.