Diagnosing Mitral Valve Prolapse

Mitral valve prolapse is often diagnosed during a routine physical examination when your doctor hears a sound called a systolic click when listening to your heart with a stethoscope. The systolic click is an abnormal heart sound caused by the malfunction of the mitral valve. Some people also have a heart murmur, an abnormal heart sound caused by turbulent blood flow.

An echocardiogram can help determine the severity of the prolapse. This is a painless test that uses sound waves to map out your heart structure.

If you have symptoms such as chest pain, dizziness or palpitations, further tests may be needed to determine the cause.

Who Does Mitral Valve Prolapse Affect

Mitral valve prolapse affects people of all ages. Its seen in children, teens and adults. Some people are born with mitral valve prolapse, including those who have connective tissue disorders.

MVP is more common in women and people assigned female at birth. However, men and people assigned male at birth are more likely to develop severe mitral valve regurgitation.

MVP affects 2% to 3% of the general population.

How Do I Know If I Need Treatment For Mitral Valve Prolapse

About 1 in 10 people with mitral valve prolapse need their valve repaired or replaced. You may need valve repair or replacement if:

• Your symptoms are getting worse over time.
• Your mitral valve is too leaky .
• Tests show your heart is becoming enlarged. Valve problems and other issues like high blood pressure can cause your left atrium or left ventricle to get bigger. Doctors call this condition left ventricular hypertrophy.
• You develop an arrhythmia.
• Your heart cant pump enough blood out to your body. You may hear your provider mention your ejection fraction. This number refers to how much blood your left ventricle can pump out through your aorta. If your ejection fraction gets too low, it can lead to heart failure.

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Mitral Valve Prolapse Surgery

Although most patients with mitral valve prolapse require no treatment or treatment with oral medications, the prognosis is usually good. Rarely, surgery for mitral valve replacement or repair may be require. People who require surgery usually have severe mitral regurgitation causing worsening heart failure and progressive heart enlargement. Rarely, rupture of one or more chordae can cause sudden, severe mitral regurgitation and heart failure requiring surgical repair.

Mitral valve repair is preferable, if possible, to mitral valve replacement as the surgical treatment for mitral valve regurgitation. After mitral valve replacement, lifelong blood thinning medications are necessary to prevent blood from clotting on the artificial valves. After mitral valve repair, these blood-thinning medications are unnecessary. Due to the success of valve repair, it is being performed earlier in people with mitral regurgitation, thus reducing the risk of abnormal heart rhythms, heart failure, and death.

How Is It Treated

In most cases, no treatment is necessary.

• Medications. Although no longer routinely recommended, you may need to take antibiotics prior to some dental and medical procedures. This is to prevent infections. Ask your doctor if you will need to take antibiotics. If symptoms include chest pain, anxiety, or panic attacks, a beta-blocker medication can be prescribed. Ask your doctor whether you may continue to participate in your usual athletic activities.
• Surgery. In very rare cases, the blood leakage may become severe. In these few cases, the mitral valve may need to be surgically repaired or replaced.
• Lifestyle modifications. You may be able to prevent symptoms through certain lifestyle changes, such as limiting your intake of caffeine, avoiding certain medications that speed up your heart rate, and exercising regularly as recommended by your doctor.

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Treating Mitral Valve Prolapse

As long as mitral valve prolapse is not causing any symptoms, no treatment is needed.

Doctors once recommended that people with mitral valve prolapse take antibiotics before having dental work and other procedures. New guidelines from the American Heart Association say that antibiotics are no longer recommended for people with mitral valve prolapse.

Individuals who have mitral valve prolapse and chest pain or palpitations can take a beta-blocker, such as propranolol , metoprolol or atenolol , to treat symptoms.

If mitral valve prolapse turns into severe mitral regurgitation, the defective mitral valve may need to be repaired or replaced. This can be done with open-heart surgery. A newer option is to repair the faulty valve from inside the heart using a small tube called a catheter equipped with a device to anchor the mitral valve’s leaflets in place.

Relationship Between Chest Pain And Mitral Valve Regurgitation

Before you should understand the relationship between mitral valve regurgitation and chest pain, it is essential for you to understand about mitral valve regurgitation in a well manner.

Mitral valve regurgitation indicates a condition when the valve becomes leaky. We know that mitral valve is one among the four different valves of a human heart. These valves allow the flow of blood from four different heart chambers out to your body. Mitral valve remains present between ones left ventricle and left atrium. In regular cases, mitral valve avoids backward flow of the blood within the left atrium from ones left ventricle.

However, if an individual suffers from mitral valve regurgitation, a few amount of blood leaks in the backward direction from the valve and thereby, fails to flow in the forward direction within the ventricle, as takes place in regular condition. Accordingly, your heart has to work very hard to get the blood out towards other parts of your body. In case your regurgitation becomes worse, blood starts to move backward within the lungs.

As discussed before, chest pain is one of the common symptoms associated with mitral valve regurgitation and mitral valve prolapse. Even though the pain may force you to bother a bit or sometimes, it may be frightening one, it never increases your risks related to cardiac problems, heart attack or your death.

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Can Mitral Valve Prolapse Be Prevented

Theres no specific way to prevent mitral valve prolapse. But you can reduce your risk of acquired heart valve disease . Some tips include:

• Build physical activity and planned exercise into your daily routine. Be sure to check with your provider about any exercise limitations.
• Quit smoking and using tobacco products.
• Keep a healthy weight.
• Manage conditions like high blood pressure and diabetes. Take medications as prescribed.
• Manage stress however feels best to you. This could include yoga, taking deep breaths and talking with others, among other methods.

Following these tips can also help you stay strong enough for surgery, should you need it.

Talk with your provider about how to make lifestyle changes that feel doable to you. Start small, and remember that every small change you make can add up to make a big impact down the road.

What Are The Symptoms

People with mitral valve prolapse often have no symptoms at all. But the most common symptoms of mitral valve prolapse are:

• Irregular heartbeat
• Sensation of missed heart beats
• Shortness of breath
• Intestinal problems

Mitral valve prolapse can be heard through a stethoscope. A small blood leakage will sound like a murmur. When the mitral valve balloons backward, it may produce a clicking sound. Both murmurs and clicks are telltale signs of MVP. An echocardiogram can confirm the diagnosis. You may also be asked to wear a Holter monitor for a day or two to continuously record the electrical activity of your heart .

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How Do You Treat Mitral Valve Prolapse

Many people with mitral valve prolapse dont need treatment. If you have a mild form, your provider may simply keep an eye on things. They may prescribe beta-blockers to manage symptoms like dizziness or heart palpitations.

If you have atrial fibrillation or a past history of a stroke, you may need to take anticoagulants . Talk with your provider about which medications, if any, are right for you.

Some people with MVP need surgery. There are two main surgical options:

• Mitral valve repair. Your surgeon repairs your valve to help it function as it should. Surgeons prefer this option whenever possible. It allows you to keep your valve and avoid some risks and complications associated with valve replacement.
• Mitral valve replacement. For some people, getting a new valve is the best or only option. Your surgeon will explain why this is the case and also the different types of valves you could receive .

Repair and replacement are often done through traditional open surgery. But technology has opened up minimally invasive and percutaneous methods, too.

The best treatment plan for you depends on many factors, including:

• Your health history.
• Your current health condition.
• Whether you have other heart issues that need to be repaired. Sometimes, valve repair and coronary artery bypass grafting can be done at the same time.

Prognosis For Mitral Valve Prolapse

Mitral valve prolapse is usually benign, but severe myxomatous degeneration of the valve can lead to MR. In patients with severe MR, incidence of LV or left atrium enlargement, arrhythmias , infective endocarditis, stroke, need for valve replacement, and death is about 2 to 4%/year. Men are less likely to have MVP, but those who do are more likely to progress to severe MR.

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What Causes Mitral Valve Prolapse

The cause of Mitral Valve Prolapse is unknown, but is thought to be linked to heredity. Primary and secondary forms of Mitral Valve Prolapse are described below.

• Primary Mitral Valve Prolapse. Primary Mitral Valve Prolapse is distinguished by thickening of one or both valve flaps. Other effects are fibrosis of the flap surface, thinning or lengthening of the chordae tendineae, and fibrin deposits on the flaps. The primary form of Mitral Valve Prolapse is seen frequently in people with Marfan’s Syndrome or other inherited connective tissue diseases, but is most often seen in people with no other form of heart disease.

• Secondary Mitral Valve Prolapse. In secondary Mitral Valve Prolapse, the flaps are not thickened. The prolapse may be due to ischemic damage to the papillary muscles attached to the chordae tendineae or to functional changes in the myocardium. Secondary Mitral Valve Prolapse may result from damage to valvular structures during acute myocardial infarction, rheumatic heart disease, or hypertrophic cardiomyopathy .

Doctor’s Notes On What Is Mitral Valve Prolapse

Mitral valve prolapse is a heart valve abnormality in which the mitral valve does not work properly because one or both leaflets of the valve bulge , which results in an uneven closure of the valve during each heartbeat. In many cases, the cause of mitral valve prolapse is unknown. In other instances, it may be inherited such as in individuals with Marfan’s syndrome.

In most cases, people with mitral valve prolapse have no symptoms. When symptoms of mitral valve prolapse do occur they may include

• irregular heartbeat or palpitations, especially while lying on the left side
• chest pain, which may be sharp, dull, or pressing, and lasting from a few seconds to several hours
• fatigue and weakness, even after little exertion

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How Can Parents Help

Kids with mitral valve prolapse who have no other medical conditions usually dont need special medical care. Those who want to play sports can do so if:

• They dont have mitral regurgitation.
• Their mitral valve prolapse isnt causing symptoms.

Kids with a leaky valve or symptoms need their doctors OK to play sports. This may involve getting more tests.

Any heart condition can cause worry. But mitral valve prolapse isnt likely to affect your child’s everyday life and activities. If you have any questions or concerns, speak with your doctor.

What Is Lee Health’s Approach

Lee Health provides the most advanced valve repair/replacement surgeries and treatments using a multidisciplinary approach. Lee Health regularly handles the most complex cases in the region with excellent outcomes.

Lee Health is a leader in the use of robotic surgery for valve replacement. Robotic surgery makes it possible to perform valve surgery through smaller incisions with greater control and accuracy. Lee Health was the first in the region to perform valve surgery with robotic assistance.

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Etiology Of Mitral Valve Prolapse

Mitral valve prolapse is most often caused by

• Myxomatous degeneration of the mitral valve leaflets and chordae tendineae

In myxomatous degeneration, the fibrous collagen layer of the valve thins and mucoid material accumulates. The chordae become longer and thinner and the valve leaflets enlarge and become rubbery. These changes result in floppy valve leaflets that can balloon back into the left atrium when the left ventricle contracts. Rupture of a degenerate chorda can allow part of the valve leaflet to flail into the atrium, which typically causes severe regurgitation.

• Crisp mid-systolic click

Typically, mitral valve prolapse causes no visible or palpable cardiac signs.

MVP alone often causes a crisp mid-systolic click as the subvalvular apparatus abruptly tightens. The click is heard best with the diaphragm of the stethoscope over the left apex when the patient is in the left lateral decubitus position. MVP with MR causes a click with a late-systolic MR murmur. The click moves closer to the 1st heart sound with maneuvers that decrease left ventricle size the same maneuvers cause an MR murmur to appear or become louder and last longer. These effects occur because decreasing LV size causes papillary muscles and chordae tendineae to pull together more centrally beneath the valve, resulting in quicker, more forceful prolapse with earlier, more severe regurgitation. Conversely, squatting or isometric handgrip delays the S1 click and shortens the MR murmur.

What Is The Mitral Valve

The mitral valve is located between the left atrium and the left ventricle and is composed of two flaps. Normally the flaps are held tightly closed during left ventricular contraction by the chordae tendineae . In Mitral Valve Prolapse, the flaps enlarge and stretch inward toward the left atrium, sometimes “snapping” during systole, and may allow some backflow of blood into the left atrium .

Frequently Asked Questions About the Mitral Valve

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What Should I Do If A Murmur Is Detected

Even for those who arent having symptoms, if a murmur is detected suggesting mitral valve prolapse, an echocardiogram is recommended. The echo uses ultrasound to evaluate the characteristics of the valve cusps and how much blood may be leaking from the valve when the heart contracts. Another test may be cardiac magnetic resonance imaging , also known as cardiac MRI. The test results and extent of your symptoms will guide your health care team in determining if further testing is needed.

Mitral Valve Prolapse Overview

Your heart consists of four chamber with different functions. There are also some valves that control blood flow from one chamber to another, one of which is mitral valve. Mitral Valve Prolapse is a condition when part of mitral valve slips backward into the left atrium.

The valve slip happens when left ventricle, the main heart muscle, squeezes during heartbeat. Despite it may cause chest pain, MVP is not considered a serious condition. It only needs to be monitored, though. Mitral Valve Prolapse is also commonly associated with other health conditions. But until today, experts are not sure what exactly causes MVP.

There are two conditions that may happen in mitral valve, mitral valve prolapse and mitral valve stenosis. Even though both disorders can cause chest pain, MVP is different with mitral valve stenosis. Mitral valve is constricted and stiff in mitral valve stenosis. While in MVP, the mitral valve slips backward because of abnormal size or damage.

Mitral valve prolapse chest pain can run in families. If you have family or relative with MVP, you have a chance to experience such condition in the future. Though the cause is still unknown, it can be triggered by abnormal condition of cartilage.

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Diagnosis Of Mitral Valve Prolapse

A doctor may suspect mitral valve prolapse after listening to someone’s heart with a stethoscope. The abnormal movement of the mitral valve can make a distinct sound, called a “click.” If mitral regurgitation is also present, a doctor may hear a heart murmur caused by the backward flow of blood.

Definite diagnosis of mitral valve prolapse requires an echocardiogram, which is an ultrasound of the heart. A doctor can watch the abnormal valve movement on a video of the beating heart. Mitral regurgitation, if present, will also be seen with an echocardiogram.

What Is Mitral Valve Prolapse

The mitral valve is a valve that lets blood flow from one chamber of the heart, the left atrium, to another called the left ventricle. In mitral valve prolapse, part of the mitral valve slips backward loosely into the chamber called the left atrium. This happens when the main heart muscle, called the left ventricle, squeezes during each heartbeat. Mitral valve prolapse differs from mitral valve stenosis. In mitral valve stenosis, the mitral valve is stiff and constricted.

In mitral valve prolapse, the valve slips backward due to the abnormal size of or damage to the mitral valve tissues. For most people with mitral valve prolapse, the cause is unknown.

Mitral valve prolapse can run in families. It can also be caused by conditions in which cartilage is abnormal . Nearly 8 million people in the U.S. have mitral valve prolapse.

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What Are The Signs & Symptoms Of Mitral Valve Prolapse

Mitral valve prolapse usually doesn’t cause symptoms or affect everyday life. Many cases arent found until someone is an adult.

Kids who do get symptoms might:

• feel dizzy or lightheaded
• feel short of breath or have trouble breathing after being very active
• feel that the heart is skipping beats or beating very quickly
• have chest pain that comes and goes