Mitral Valve Prolapse

What is mitral valve prolapse?

Mitral valve prolapse (MVP) is a condition in which your mitral valve bows or flops back into your left atrium. That’s why it’s sometimes called “floppy valve syndrome.” This floppiness may prevent your valve from closing as tightly as it should.

MVP is a common form of mitral valve disease, and often it’s harmless. Many people have no symptoms and don’t even know they have it. That’s because their valve can still function well. But some people with moderate or severe prolapse have symptoms and may need treatment.

The main complication of MVP is mitral regurgitation. This means blood leaks the wrong way through your valve. MVP is one of the most common causes of mitral regurgitation. If the leak is severe enough, you may need surgery or a procedure to help your valve work as it should.

What is the mitral valve?

Your mitral valve is the door that connects your left atrium with your left ventricle. These are the two chambers of your heart responsible for collecting oxygen-rich blood from your lungs and then pumping it out to your body.

Your mitral valve is made of two strong flaps of tissue called leaflets or cusps. These leaflets open and shut with each heartbeat to manage blood flow out of your left atrium and into your left ventricle.

The leaflets are attached to a ring of tough, fibrous tissue called the annulus. This ring gives your mitral valve its shape. The leaflets are also supported by chordae tendineae. These are tough, fibrous strings. They look a bit like strings that support a parachute.

Mitral valve prolapse is a type of myxomatous valve disease. This means the tissue of your mitral valve leaflets and chordae are abnormally stretchy. This causes the valve “floppiness” that defines mitral valve prolapse.

Is mitral valve prolapse considered heart disease?

Mitral valve prolapse is a form of heart valve disease. And heart valve diseases fall under the big umbrella of cardiovascular disease. Cardiovascular diseases are any conditions that affect your heart or blood vessels.

Who does mitral valve prolapse affect?

Mitral valve prolapse affects people of all ages. It’s 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 does mitral valve prolapse affect my body?

Mitral valve prolapse may not harm your body. But in some cases, it can lead to mitral valve regurgitation, known as a leaky valve. People who have mitral valve prolapse and regurgitation are at risk for complications including:

• Heart failure.
• Infective endocarditis.
• Atrial fibrillation.
• Ventricular arrhythmias, which can lead to sudden cardiac death.

If you’ve been diagnosed with mitral valve prolapse, talk with your provider to learn more about how it’s affecting your body. It’s important to know the level of severity and what you can expect down the road.

What are the symptoms of mitral valve prolapse?

Mitral valve prolapse doesn’t cause symptoms for most people. And those who do have symptoms might not have a severe form of the condition. Symptoms and severity don’t always go hand-in-hand when it comes to mitral valve prolapse. Still, it’s important to share any and all symptoms with your provider.

Symptoms may include:

• Anxiety.
• Blood pressure that gets too low when you stand up (orthostatic hypotension).
• Chest pain.
• Dizziness.
• Fatigue.
• Heart palpitations. These can feel like bursts of rapid heartbeat or an awareness of your heartbeat.
• Migraines.

What causes mitral valve prolapse?

Mitral valve prolapse is caused by valve tissue weakness. This condition is known as myxomatous degeneration. It’s not always clear what causes this tissue weakness. In some cases, it may be passed down within families. Mitral valve prolapse has been associated with several genes, including FLNA, DCHS1, DZIP1 and PLD1.

Some connective tissue disorders may cause myxomatous degeneration. These include Marfan syndrome, Ehlers-Danlos syndrome and Loeys-Dietz syndrome.

How is mitral valve prolapse diagnosed?

Mitral valve disease is diagnosed through a physical exam and tests.

Physical exam

Your provider can learn a lot by listening to your heart with a stethoscope. If you have mitral valve prolapse, your provider will hear a clicking sound followed by a murmur. This condition is also called “click-murmur syndrome” because of its distinctive sound.

During your exam, your provider will also discuss your medical history and family history with you. Since mitral valve prolapse sometimes runs in families, this information is important to know.

If your provider suspects you have MVP or another valve issue, they’ll recommend at least one test to confirm the diagnosis.

Tests to diagnose mitral valve prolapse

Echocardiography is the main method used to diagnose MVP. An echocardiogram (echo) uses ultrasound technology to check your heart’s structure and function. There are different types of echo tests. Your may need one or both of the following types:

• Transthoracic echocardiogram. This is the traditional form that many people are familiar with. Your provider places electrodes (small stickers) on your chest. They then place a wand (called an ultrasound transducer) on different areas of your chest. This process provides pictures of your heart’s valves and chambers.
• Transesophageal echocardiogram. You may need this type of test so your provider can see your heart in greater detail. Instead of using a wand on the outside of your chest, your provider uses equipment that can take pictures inside your chest. A long, thin tube (called an endoscope) guides a small ultrasound transducer down your esophagus. You’ll be sedated and given medication to ease discomfort in your throat.

Your provider may recommend additional tests to learn more about your heart. These include:

• Electrocardiography (ECG/EKG).
• Chest X-ray.
• Cardiac catheterization.

How do you treat mitral valve prolapse?

Many people with mitral valve prolapse don’t 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 (blood thinners). 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 (mechanical or biological).

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 age.
• 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 (CABG) can be done at the same time.

Talk with your provider about which treatment plan is best for you. As with all interventions, the benefits need to outweigh the risks. People over age 80 face higher risks with surgery. Other factors can impact your risks, too. Make sure you understand both the benefits and risks of any surgery or procedure.

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 (severe regurgitation).
• 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 can’t 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.

Can mitral valve prolapse be prevented?

There’s no specific way to prevent mitral valve prolapse. But you can reduce your risk of acquired heart valve disease (valve problems that come up as you get older). 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.
• Follow a heart-healthy eating plan.
• 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.

How long can you live with mitral valve prolapse?

The life expectancy for people with mitral valve prolapse depends on many factors. These include:

• Whether the prolapse is causing regurgitation.
• Other associated heart issues or medical conditions.
• Whether and when you receive treatment.

Mitral valve repair can help you live just as long as people without valve issues. One study shows that the life expectancy of people who had repair is the same as the life expectancy for the general population. This held true for people age 40 to 89.

So, if you have mitral valve prolapse, it’s important to get regular checkups and tell your provider about any new or changing symptoms. This will allow you to get treatment if and when you need it.

People who have severe regurgitation but don’t have their valve repaired face poor outcomes. They have a 20% chance of dying within one year and a 50% chance of dying within five years.

Talk with your provider about your specific situation and prognosis.

When should I worry about mitral valve prolapse?

Talk with your provider to learn what you can expect and when you should be concerned. It’s common for people with mitral valve prolapse to feel anxiety and concern over their condition. But in many cases, mild symptoms are not a reason to worry. Your provider can prescribe medication to manage things like a fast heartbeat or heart palpitations.

But it’s important to recognize symptoms when they happen. No symptom is too small to share with your provider. Even if you think it’s nothing, tell your provider about what you’re feeling. They’ll make sure you get checked when needed so you can feel comfortable going about your daily life.

What should I avoid if I have mitral valve prolapse?

Some people with mitral valve disease may need to avoid intense exercise. It’s essential that you talk with your provider to learn about limitations specific to you and your diagnosis. Activity restrictions depend on many factors. These include whether you have:

• A history of fainting (passing out).
• Certain arrhythmias, including supraventricular tachycardia.
• Severe mitral valve regurgitation.
• A reduced left ventricular ejection fraction.
• A history of blood clots.
• Family history of sudden cardiac death linked to mitral valve prolapse.

Many people with MVP don’t have activity restrictions, but check with your provider before starting any new workout plan, just to be safe.

Does mitral valve prolapse get worse with age?

Mitral valve prolapse can get worse as you get older. That’s why it’s important to keep all your appointments with your healthcare provider. They’ll monitor your valve and discuss treatment options with you if needed.

Valve disease is more common among people who are over age 65. This is partly because of the wear and tear that your heart from daily life. But heart problems like coronary artery disease or heart attacks can also take a toll on your valves, including your mitral valve. This is especially true for people over age 75.

Talk with your provider to learn more about how aging affects your mitral valve.

When should I see my healthcare provider?

Your provider will let you know how often you need to come in for follow-ups. It’s important to keep all your appointments. You may also need regular tests (like echocardiograms) to check on the health of your mitral valve.

When to seek emergency care

Call 911 or your local emergency number if you experience:

• Chest pain.
• Fainting, dizziness or extreme weakness.
• Sudden and severe shortness of breath.
• An unexpected side effect from your medication.

If you’re on blood thinners (anticoagulants) and fall, you need to seek care right away. That’s because blood thinners raise your risk of internal bleeding. Even if you feel OK, it’s important to get checked by a medical professional. Internal bleeding can be fatal if not treated.

What questions should I ask my provider?

If you just learned you have mitral valve prolapse, you probably have many questions. It’s OK to take your time and learn a little bit at a time. As you learn more about your condition, you’ll think of new questions to ask your provider. Here are a few to get you started:

• How severe is my condition?
• How can I manage my symptoms?
• Do I need valve repair or replacement? If so, could you break down each step of the procedure and recovery for me?
• How can I keep my condition from getting worse?
• What lifestyle changes should I make?
• What physical activities or exercises should I avoid?
• How often should I return for follow-ups?

If you feel confused or don’t understand something, ask your provider to explain it again. You may also want to ask about available resources and support groups. Many people benefit from talking with others who are going through similar medical experiences. Together, you can learn more about your condition and what to expect going forward.

A note from Cleveland Clinic

Mitral valve prolapse is a common condition that may not change your life at all. But if it leads to mitral regurgitation (leaky valve), you may need treatment to prevent or minimize damage to your heart. This often involves valve repair surgery or a minimally invasive procedure to help your valve work better. Talk with your provider about the risks and benefits of valve repair, and ask about all available options.

If you need valve repair, it’s important to choose a hospital that does these types of procedures every day. High-volume hospitals are prepared to use the latest technology to reduce your risks and give you the best possible outcomes.