Mitral valve prolapse
Mitral valve prolapse occurs when the flaps (leaflets) of the heart's mitral valve bulge (prolapse) like a parachute into the heart's left upper chamber (left atrium) as the heart contracts.
Mitral (MY-trul) valve prolapse sometimes leads to blood leaking backward into the left atrium, a condition called mitral valve regurgitation.
In most people, mitral valve prolapse isn't life-threatening and doesn't require treatment or changes in lifestyle. Some people with mitral valve prolapse, however, require treatment.
Although mitral valve prolapse is usually a lifelong disorder, many people with this condition never have symptoms. When diagnosed, people may be surprised to learn that they have a heart condition.
When signs and symptoms do occur, it may be because blood is leaking backward through the valve. Mitral valve prolapse symptoms can vary widely from one person to another. They tend to be mild and develop gradually. Symptoms may include:
- A racing or irregular heartbeat (arrhythmia)
- Dizziness or lightheadedness
- Difficulty breathing or shortness of breath, often during physical activity or when lying flat
When to see a doctor
If you think you have any of the above symptoms, make an appointment with your doctor. Many other conditions cause the same symptoms as mitral valve prolapse, so only a visit to your doctor can determine the cause of your symptoms.
If you're having chest pain and you're unsure if it could be a heart attack, seek emergency medical care immediately.
If you've already been diagnosed with mitral valve prolapse, see your doctor if your symptoms worsen.
The mitral valve controls the flow of blood between the upper and lower chambers of the left side of the heart. When your heart is working properly, the mitral valve closes completely when the heart pumps and prevents blood from flowing back into the upper left chamber (left atrium).
But in some people with mitral valve prolapse, one or both of the mitral valve leaflets have extra tissue or stretch more than normal, which causes them to bulge like a parachute into the left atrium each time the heart contracts.
The bulging may keep the valve from closing tightly. In some cases, blood may leak backward through the valve (mitral valve regurgitation).
This may not cause problems if only a small amount of blood leaks back into the left atrium. More severe mitral valve regurgitation can cause symptoms such as shortness of breath, fatigue or lightheadedness.
Another name for mitral valve prolapse is click-murmur syndrome. When a doctor listens to your heart using a stethoscope, he or she may hear a clicking sound as the valve's leaflets billow back, followed by a whooshing sound (murmur) resulting from blood flowing back into the atrium.
Other names to describe mitral valve prolapse include:
- Barlow's syndrome
- Floppy valve syndrome
- Billowing mitral valve syndrome
- Myxomatous mitral valve disease
Mitral valve prolapse can develop in any person at any age. Serious symptoms of mitral valve prolapse tend to occur most often in men older than 50.
Mitral valve prolapse can run in families and may be linked to several other conditions, such as:
- Marfan syndrome
- Ehlers-Danlos syndrome
- Ebstein anomaly
- Muscular dystrophy
- Graves' disease
Although most people with mitral valve prolapse never have problems, complications can occur. They may include:
Mitral valve regurgitation. The most common complication is a condition in which the valve leaks blood back into the left atrium.
Being male or having high blood pressure increases your risk of mitral valve regurgitation.
If regurgitation is severe, you may need surgery to repair or replace the valve in order to prevent heart failure.
Heart rhythm problems (arrhythmias). Irregular heart rhythms most commonly occur in the upper chambers of the heart. They may be bothersome, but aren't usually life-threatening.
People with severe mitral valve regurgitation or severe deformity of their mitral valve are most at risk of having rhythm problems, which can affect blood flow through the heart.
Heart valve infection (endocarditis). The inside of your heart is lined by a thin membrane called the endocardium. Endocarditis is an infection of this inner lining.
An abnormal mitral valve increases your chance of getting endocarditis from bacteria, which can further damage the mitral valve.
Doctors may diagnose mitral valve prolapse at any age. Your doctor is most likely to diagnose mitral valve prolapse while listening to your heart with a stethoscope during a physical examination.
If you have mitral valve prolapse, your doctor may hear a clicking sound, which is common with this condition. Your doctor may also detect a heart murmur, which would be due to blood leaking back into the left atrium.
Other tests that may be used to evaluate your heart may include:
Echocardiogram. An echocardiogram is a noninvasive ultrasound evaluation of your heart. It's usually done to confirm the diagnosis and determine the severity of your condition.
This test uses high-frequency sound waves to create images of your heart. It helps doctors see the flow of blood through your mitral valve and measure the amount of blood leakage (regurgitation).
Your doctor may recommend a transesophageal echocardiogram. In this test, your doctor inserts a flexible tube with a small device (transducer) attached into your throat and down into your esophagus — the tube that connects the back of your mouth to your stomach. From there, the transducer can be positioned to obtain more-detailed images of your heart and mitral valve.
- Chest X-ray. A chest X-ray shows a picture of your heart, lungs and blood vessels and can help your doctor make a diagnosis. It can help show if your heart is enlarged.
Electrocardiogram (ECG). In this noninvasive test, a technician will place probes on your chest that record the electrical impulses that make your heart beat.
An ECG records these electrical signals and can help your doctor detect irregularities in your heart's rhythm.
Stress test. Your doctor may order a stress test to see if mitral valve regurgitation limits your ability to exercise. In a stress test, you exercise or take certain medications to increase your heart rate and make your heart work harder.
You may also have a stress test if your doctor is trying to determine if you have another condition such as coronary artery disease.
Coronary angiogram. This test uses X-ray imaging to see your heart's blood vessels. It isn't generally used to diagnose mitral valve prolapse but may reveal the condition when you're being tested for another suspected diagnosis.
In some cases, your doctor may recommend a coronary angiogram to gather more information about the severity of your condition.
Most people with mitral valve prolapse, particularly people without symptoms, don't require treatment.
If you have mitral valve regurgitation but don't have symptoms, your doctor may suggest you return regularly for follow-up examinations to monitor your condition, depending on the severity of your condition.
However, if you have symptoms and if a significant amount of blood is leaking through the mitral valve, your doctor may recommend medications or surgery.
Medications can treat mitral valve prolapse-related heart rhythm abnormalities or other complications. Some medications you might be prescribed include:
- Beta blockers. These drugs help prevent irregular heartbeats by making your heart beat more slowly and with less force, which reduces your blood pressure. Beta blockers also help blood vessels relax and open up to improve blood flow.
- Water pills (diuretics). Your doctor may prescribe diuretics to drain fluid from your lungs.
- Heart rhythm medications. If you have an arrhythmia, your doctor may prescribe a medication to treat it, such as propafenone (Rythmol SR), sotalol (Betapace, Sorine, Sotylize), flecainide and amiodarone (Pacerone). The medications help control your heart rhythm by normalizing electrical signals in heart tissue.
- Aspirin. If you have mitral valve prolapse and a history of strokes, your doctor might prescribe aspirin to reduce the risk of blood clots.
Blood thinners. If you have atrial fibrillation, a history of heart failure or a history of strokes, your doctor may suggest a blood thinner to prevent your blood from clotting. They include warfarin (Coumadin, Jantoven), heparin, dabigatran (Pradaxa), rivaroxaban (Xarelto), apixaban (Eliquis) and edoxaban (Savaysa).
Blood thinners can have dangerous side effects, however, and must be taken exactly as prescribed.
Though most people with mitral valve prolapse don't need surgery, your doctor may suggest surgical treatment if you have severe mitral valve regurgitation, whether you have symptoms or not.
Severe mitral valve regurgitation can eventually cause heart failure, preventing your heart from effectively pumping blood. If regurgitation goes on too long, your heart may be too weak for surgery.
Surgery involves repairing or replacing the mitral valve. Valve repair and replacement may be performed using open-heart surgery or minimally invasive surgery. Minimally invasive surgery involves smaller incisions and may have less blood loss and a quicker recovery time.
For most people, mitral valve repair is the preferred surgical treatment. During surgery, your surgeon will modify your own valve to stop backward blood flow by reconnecting the flappy valve tissue or by removing excess tissue. Your surgeon may also reinforce the ring around the heart valve to prevent blood from leaking backward.
If mitral valve repair isn't possible, your surgeon may replace it with an artificial valve that is man-made (mechanical) or is made from human tissue or taken from cows or pigs.
Mechanical valves can last a lifetime but you'll need to take a blood thinner to prevent blood clots from forming on the valve. If a blood clot broke free, it could cause a stroke. You generally won't need to take a blood thinner with a valve made from human or animal tissue, but those valves only last about 10 years.
Transcatheter valve therapy
If you have severe mitral regurgitation and can't have surgery, your doctor may recommend a less invasive approach called transcatheter valve therapy. The new technique allows your doctor to repair a valve by implanting a device using a tube (catheter) inserted in a blood vessel in your groin and guided to your heart.
Antibiotics seldom recommended
Doctors used to recommend that some people with mitral valve prolapse take antibiotics before certain dental or medical procedures. However, the American Heart Association has said antibiotics are no longer necessary in most cases for someone with mitral valve regurgitation or mitral valve prolapse.
If you've been told to take antibiotics before any procedures in the past, check with your doctor about whether it's still necessary.
Lifestyle and home remedies
Most people with mitral valve prolapse lead normal, productive and symptom-free lives.
Doctors generally won't recommend restrictions on your lifestyle or any limitations on your personal exercise or dietary program. However, ask your doctor if he or she recommends any changes to your lifestyle. If you have severe mitral valve regurgitation, your doctor may recommend certain exercise limitations.
Your doctor may recommend regular follow-up visits to evaluate your condition.
Preparing for an appointment
Because appointments can be brief, and because there's often a lot to discuss, it's a good idea to be prepared for your appointment. Here's some information to help you get ready for your appointment and know what to expect from your doctor.
What you can do
- Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance.
- Write down any symptoms you're experiencing, including any that may seem unrelated to mitral valve prolapse.
- Write down key personal information, including a family history of heart disease, heart defects, genetic disorders, strokes, high blood pressure or diabetes, and any major stresses or recent life changes.
- Make a list of all medications, vitamins or supplements that you're taking.
- Take a family member or friend along, if possible. Sometimes it can be difficult to remember all the information provided to you during an appointment. Someone who accompanies you may remember something that you missed or forgot.
- Be prepared to discuss your diet and exercise habits. If you don't already follow a diet or exercise routine, be ready to talk to your doctor about any challenges you might face in getting started.
- Write down questions to ask your doctor.
Your time with your doctor is limited, so preparing a list of questions will help you make the most of your time together. List your questions from most important to least important in case time runs out. For mitral valve prolapse, some basic questions to ask your doctor include:
- What is likely causing my symptoms or condition?
- What are other possible causes for my symptoms or condition?
- What kinds of tests will I need?
- Do I need treatment? What kind?
- What are the alternatives to the primary approach that you're suggesting?
- I have other health conditions. How can I best manage them together?
- Are there any restrictions that I need to follow?
- Should I see a specialist?
- If I need surgery, which surgeon do you recommend for mitral valve repair?
- Is there a generic alternative to the medicine you're prescribing for me?
- Are there any brochures or other printed material that I can take home with me? What websites do you recommend visiting?
In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment at any time that you don't understand something.
What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:
- When did you first begin experiencing symptoms?
- Have your symptoms been continuous or occasional?
- How severe are your symptoms?
- What, if anything, seems to improve your symptoms?
- What, if anything, appears to worsen your symptoms?
Last Updated Feb 7, 2020