Mitral valve prolapse
- Reviewed by Robert H. Shmerling, MD, Senior Faculty Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing
What is mitral valve prolapse?
Mitral valve prolapse is a malfunction of the heart's mitral valve.
Normally, the mitral valve opens when the heart relaxes, allowing blood to flow from the upper part of the heart (the left atrium) into the lower part (the left ventricle). When the heart contracts to pump blood out of the left ventricle to the rest of the body, the mitral closes to prevent blood from returning to the left atrium.
With mitral valve prolapse, however, a slight deformity of the mitral valve prevents the valve from closing normally. This appears as an abnormal floppiness, or prolapse, of the valve. The result is that small amounts of blood leak back into the left atrium, with very little effect on the heart's overall ability to pump blood.
In some people, the leak worsens to create a significant backflow of blood into the left atrium. This is called mitral regurgitation. People with severe mitral regurgitation can develop symptoms such as shortness of breath, fatigue, and leg swelling. In severe cases, heart surgery is needed to repair the damaged valve.
In most people with mitral valve prolapse, the cause is unknown. However, in a small number of patients, mitral valve prolapse may be related to another medical condition, such as an inherited abnormality in the way the body produces collagen (connective tissue) or rheumatic heart disease (a rare complication of strep throat).
Health experts estimate that mitral valve prolapse currently affects up to 3% of people in the United States. In some studies, the condition is more common in women than in men. The condition can run in families, suggesting that the condition can be inherited.
Symptoms of mitral valve prolapse
Most people with mitral valve prolapse do not have any symptoms, and the condition is discovered only when a doctor hears a certain clicking sound with or without a heart murmur during a routine physical examination. In the past, mitral valve prolapse was blamed for symptoms such as chest pains, palpitations, and lightheadedness. Although a person with mitral valve prolapse can also have these types of symptoms, mitral valve prolapse is not the cause.
People who have mitral regurgitation that continues to get worse can have symptoms of congestive heart failure (fatigue, shortness of breath, leg swelling).
Diagnosing mitral valve prolapse
Your doctor will review your medical history, including any history of heart disease, excessive fatigue, leg swelling, or shortness of breath.
You and your doctor may not suspect that you have mitral valve prolapse until your doctor hears a sound called a systolic click with the stethoscope during the cardiac portion of a routine physical examination. The systolic click is an abnormal heart sound related to the malfunction of the mitral valve in mitral valve prolapse. Some people also have a heart murmur, an abnormal heart sound caused by turbulent blood flow.
Your doctor may suspect mitral valve prolapse if he or she hears the typical click. To confirm the diagnosis and assess its severity, he or she may order an echocardiogram. This is a painless test that uses sound waves to map out your heart structure. If significant mitral regurgitation is seen on the echocardiogram, a cardiac MRI may be recommended. The MRI can provide more detailed information to help direct treatment and assess prognosis.
If you have symptoms such as chest pain, dizziness, or palpitations, further tests may be needed to determine the cause.
Expected duration of mitral valve prolapse
Mitral valve prolapse is a lifelong condition. However, most people with the condition do not have any symptoms.
Preventing mitral valve prolapse
In most cases, mitral valve prolapse cannot be prevented.
Treating mitral valve prolapse
If you have mitral valve prolapse but do not have any symptoms, then you will not need treatment. In the past, your doctor may have recommended antibiotics prior to certain procedures and dental appointments, but current guidelines from the American Heart Association indicate that antibiotics are no longer recommended for most patients with mitral valve prolapse. Some people who have mitral valve prolapse with chest pains or palpitations take a beta blocker medication such as propranolol (Inderal), metoprolol (Lopressor), or atenolol (Tenormin) to treat symptoms.
If mitral valve prolapse develops into severe mitral regurgitation, the abnormal mitral valve may need to be repaired or replaced surgically.
When to call a professional
Call your doctor immediately if you have palpitations or an abnormal pulse, especially if these symptoms have also made you feel lightheaded or faint. Also call your doctor immediately if you have chest pain at any age.
Prognosis
Most people with mitral valve prolapse never have symptoms, and the condition never significantly affects lifestyle or life expectancy. When surgery is performed to reconstruct or replace the mitral valve, it is successful in about 95% of cases.
Additional info
American Heart Association (AHA)
https://www.americanheart.org/
National Heart, Lung, and Blood Institute (NHLBI)
https://www.nhlbi.nih.gov/
About the Reviewer
Robert H. Shmerling, MD, Senior Faculty Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing
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