Mitral Valve Prolapse (MVP)

Mitral valve prolapse (MVP) is a common heart valvular condition in which the mitral valve bulges back into the atrium. This abnormal valve can allow blood to leak backwards from the left ventricle into the left atrium causing what is called mitral regurgitation or a ‘leaky valve’. Mitral valve prolapse is the most common cause of mitral regurgitation.

Minor symptoms such as mild chest pain or palpitations may occur, although it is usually not serious. MVP can progress to serious mitral insufficiency or be associated with serious complications including infective endocarditis and arrhythmias.

Another name for mitral valve prolapse is Barlow’s syndrome or click- murmur syndrome.

 

Those at risk of mitral valve prolapse include:

• • Thin females between 15-30 years
  • Inheritance or family history of mitral valve prolapse
  • Connective tissue disorders: Marfan’s syndrome; Ehlers-Danlos syndrome; osteogenesis imperfecta; cystic medial necrosis
  • Association with other diseases including: congenital heart diseases (especially atrial septal defect); rheumatic fever; ischemic heart disease; Ebstein’s anomaly; cardiomyopathy; Graves disease; polycystic kidney disease; minor chest wall deformities and scoliosis

The mitral valve is a funnel shaped valve with the apex in the left ventricle. The mitral valve consists of two leaflets (cusps) which connect to a ring called the mitral annulus. Heart valves only open in one direction. Once all of the blood has emptied out of the left atrium, the mitral valve tightly closes to ensure no backflow of blood.

In mitral valve prolapse, the valve’s leaflets have extra tissue, prolapsing or bulging like a parachute into the left atrium each time the heart contracts. Bulging of the valve prevents the valve from closing tightly. This can lead to mitral regurgitation which is a backflow of blood due to a leaky valve. A small amount of blood backflow usually does not cause any problems, but severe mitral regurgitation can cause symptoms including shortness of breath, fatigue, lightheadedness or cough.

Many people with mitral valve prolapse never have symptoms and only learn about their condition on routine examination.

Symptoms of MVP are typically because of the complications of mitral regurgitation. Symptoms tend to be mild, and develop over time.

Symptoms may include:

• • Chest pain (not caused by coronary artery disease or heart attack) is the most common symptom due to MVP
  • Dizziness or syncope
  • Shortness of breath, especially with increased physical activity or when lying flat
  • Fatigue
  • Palpitations- the sensation of feeling the heart beat
  • Cough
  • Numbness or tingling
  • Panic and anxiety disorders

 

Complications of mitral valve prolapse include:

• • Mitral regurgitation
  • Infective endocarditis
  • Atrial fibrillation
  • Blood clots (systemic thromboembolism)
  • Stroke

• • Chest discomfort, palpitations, or fainting spells that get worse
    
  • Long-term illnesses with fever
    

If you have already been diagnosed with MVP, call your physician if your symptoms worsen.

If you are having chest pain and you are unsure about if it could be a heart attack, seek emergency medical care immediately.

Mitral valve prolapse is usually diagnosed during a routine visit with your physician.

Diagnosis is based around three parameters including patient history, physical examination, and tests.

 

1. Patient history

 

• • Family history of mitral valve prolapse or associated conditions
    
  • Patients may complain of symptoms of shortness of breath in states with an increased heart rate
    

 

2. Physical examination

 

During a routine physical examination, your health care provider will notice the following:

• • Detect visible skeletal abnormalities
  • During auscultation a specific type of murmur will be heard as a ‘click’ caused by the sound of turbulent blood flowing backwards through the mitral valve.

 

3. Tests

 

The following tests may be performed:

• • Electrocardiogram (EKG) – a noninvasive test performed in our clinic which determines the electrical activity of your heart. This test may be used to detect left atrial enlargement, and commonly atrial fibrillation.
  • Chest X-ray- a simple test performed in our office showing the size and shape of the heart to determine whether the left atrium is enlarged. Also reveals the presence of fluid in the lungs.
  • Cardiac color-Doppler study- use to confirm the presence and determine the severity of mitral regurgitation.
  • Echocardiogram (ECHO)- a noninvasive test using sound waves to determine the size and function of the heart’s chambers and the structure and function of the heart valves.
  • Cardiac catheterization- a hospital procedure used to diagnose the type and severity of your heart condition. A thin tube (catheter) is inserted into an artery in your arm or groin to reach the heart. A contrast dye will be given to view the arteries and seen under x-ray guidance.

 

 

Most people with mitral valve prolapse without symptoms do not require treatment.

Symptomatic patients may require medical management or surgery depending on the severity of their condition.

 

Medications will not correct a defective mitral valve, although medications can reduce the symptoms by reducing the workload of the heart and regulating the heart rhythm.

• • Beta blockers- this lowers the heart rate and decreases blood pressure. This helps relieve symptoms of palpitations and chest pain.
  • Anticoagulants- these are sometimes referred to as “blood thinners” which prevent blood clots from forming and traveling to other parts of the body
  • Anti-arrhythmic medications- used to treat atrial fibrillation or other rhythm disturbances associated with mitral regurgitation
  • Diuretics- these are sometimes referred to as ‘water pills’ which helps excrete excess water
  • Aspirin- used to reduce the risk of blood clots, especially in those with a family history of stroke

Most people with mitral valve prolapse do not require surgery. Surgery may be needed for those with severe mitral regurgitation with or without symptoms.

Severe mitral valve prolapse can lead to complications such as heart failure and arrhythmias; therefore surgery is required to relieve symptoms if present and prevent complications.

The treatment of choice for people with severe mitral regurgitation is surgical repair or replacement of the mitral valve.

• • Mitral valve repair: repair of the mitral valve is preferred over mitral valve replacement. This procedure improves ventricular function and does not require lifelong therapy with an anticoagulant when compared to valve replacement. During valve repair, the valve will be reshaped to prevent or reduce the backwards flow of blood.
    
  • Mitral valve replacement: valve replacement is done when repair is not possible. The entire mitral valve will be replaced by a surgeon. A mechanical (metal) or tissue valve (organic) may be used to replace the impaired valve. A mechanical valve requires life-long anticoagulation therapy such as warfarin (Coumadin) to prevent blood clot formation. Tissue valves usually come from a pig or cow. Blood does not clot easily on tissue valves so patients may only need Coumadin or aspirin for only a short time. Tissue valves may wear out faster than mechanical valves and may need to be replaced sooner.

Tissue Valve                                                Mechanical Valve

Mitral valve prolapse rarely affects your daily activities. Mild mitral valve prolapse usually does not cause symptoms. If symptoms occur, they can be treated and controlled with medications.

For those who have severe mitral regurgitation, the clinical outcomes are greatly improved for those who undergo surgery.

There is also a risk that the new valve will stop working and may need to be replaced.

 

Mitral valve prolapse itself often can not be prevented, although some of the complications may be prevented.

• • Routine visits to your physician to monitor your condition and/or progression of your condition.
  • Reduce risk factors of coronary artery disease: Lower blood pressure, obesity, high cholesterol, and sugar. It is a good idea to maintain a healthy weight with a BMI below 25.
  • Practice good oral hygiene: gum infections may also cause inflammation of the heart tissue called endocarditis.