Mitral Valve Prolapse

Mitral valve prolapse (MVP) is a heart issue in which your mitral valve flaps bow or flop back into your left atrium. This may prevent your valve from closing as tightly as it should between your left atrium and left ventricle. These two heart chambers collect and pump oxygen-rich blood out to your body.

Your mitral valve’s two tissue flaps (leaflets) open and shut with each heartbeat. This is how they manage blood moving from one chamber to the next.

Mitral valve prolapse, a common form of mitral valve disease, affects 2 to 3 out of every 100 people. MVP is often harmless. Many people have no symptoms and don’t even know they have it. That’s because their valve can still work well.

Some people with moderate or severe prolapse have symptoms because of blood backflow (regurgitation). You may need surgery for this, which can sound scary. But many people have had successful procedures.

Types of this condition

Mitral valve prolapse has two types:

• Primary: Happens randomly or because of a gene and may be quietly present at birth
• Secondary: Happens when you have certain other conditions, like connective tissue disease

Healthcare providers may also talk about MVP disease as classic and non-classic. This is based on how thick the mitral valve leaflets are.

Symptoms of mitral valve prolapse

Most people with MVP don’t have symptoms. But you may develop symptoms from blood leaking backward. If you do have mitral valve prolapse symptoms, they may include:

• Chest pain
• Shortness of breath when you exert yourself
• Dizziness
• Fatigue
• Cough
• Anxiety
• Heart palpitations
• Migraines

MVP symptoms don’t always mean you have a severe form of the condition.

When should I see my healthcare provider?

See a provider if you have MVP symptoms. Your provider will tell you how often you’ll need follow-up visits. You may also need regular imaging tests to check on your mitral valve’s health. Between visits, contact your provider if your symptoms get worse.

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 taking blood thinners (anticoagulants) and fall, seek care right away. Blood thinners raise your risk of internal bleeding.

Mitral valve prolapse causes

Valve tissue weakness (myxomatous degeneration) causes mitral valve prolapse. It’s not always clear what makes the tissue weak. In some cases, you can get MVP from a biological parent. Researchers have linked mitral valve prolapse with several genes, including MMVP, FLNA, DCHS1, DZIP1 and PLD1.

Some connective tissue disorders may cause this tissue weakness. These disorders include:

• Marfan syndrome
• Ehlers-Danlos syndrome
• Loeys-Dietz syndrome

Tissue weakness keeps the leaflets from closing tightly, which can allow blood to flow backward.

Risk factors

Mitral valve prolapse has many risk factors, including:

• Being over age 65
• Having rheumatic fever
• Having a connective tissue disorder
• Having scoliosis
• Having certain types of muscular dystrophy
• Having Graves’ disease
• Being female

How to lower your risk

There’s no specific way to prevent MVP. But you can reduce your risk of valve problems that come up as you get older. Some tips include:

• Build physical activity into your daily routine.
• Quit using tobacco products.
• Follow a heart-healthy eating plan.
• Maintain a weight that’s healthy for you.
• Manage conditions like high blood pressure and diabetes.
• Manage stress in various ways.

Complications of this condition

The main complication of MVP disease is mitral regurgitation. This means blood leaks the wrong way through your mitral valve from your left ventricle back into your left atrium.

MVP is one of the most common causes of mitral regurgitation. Men are more likely to develop severe mitral regurgitation. People with high blood pressure are also more likely to have backflow (regurgitation).

This backflow can get worse and cause an infection or put more pressure on your heart and lungs. If the leak is severe enough, you may need surgery or a procedure to help your mitral valve work as it should.

People who have mitral valve prolapse and regurgitation are at risk for other complications, including:

• Heart failure: Your heart can’t keep up with your body’s demand for blood and oxygen because your mitral valve isn’t working right.
• Endocarditis: When your mitral valve isn’t working well, your heart’s more likely to get an infection. This leads to endocarditis.
• Atrial fibrillation or ventricular arrhythmias: These abnormal heart rhythms can occur because of heart muscle scarring and stretching.
• Stroke: This can happen if you have atrial fibrillation.

How doctors diagnose this condition

Healthcare providers diagnose MVP disease through a physical exam and tests. With a stethoscope, they’ll hear a clicking sound if you have MVP. A murmur (whooshing sound) means you have backflow, as well.

Echocardiography is the main test providers use to diagnose MVP. It uses sound waves to check your heart’s structure and function. You may need one or both types of this test:

• Transthoracic: A provider moves an ultrasound transducer on different areas of your chest to get pictures of your heart’s valves and chambers.
• Transesophageal: For greater detail, a provider places a small ultrasound transducer down your esophagus to see your heart better.

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

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

How is it treated?

Treatment for MVP depends on whether your case is mild or severe. Many people with MVP don’t need treatment. If you have a mild form, you may just have regular checkups with your provider.

Medications

Mitral valve prolapse treatment may include medications. These can help manage symptoms and lower blood pressure. Medicines may include:

• Diuretics: By removing extra salt and water from your blood, these “water pills” leave less fluid for your heart to pump.
• Vasodilators: These widen your blood vessels so it’s easier for blood to move through.

If you have atrial fibrillation or a history of a stroke, you may need to take anticoagulants (blood thinners). These make you less likely to have a stroke.

Surgeries and procedures

Surgery or a less invasive procedure may be the best mitral valve prolapse treatment if your symptoms are getting worse. Options include:

• Mitral valve repair: Your surgeon repairs your mitral valve to help it function as it should. This lets you keep your valve and avoid some risks of valve replacement.
• Mitral valve replacement: For some people, getting a new mitral valve is the best or only option. Your surgeon will explain why, as well as the types of valves you could receive (mechanical or biological).
• Minimally invasive mitral valve repair: With a small cut, this is less invasive than open heart surgery.
• Transcatheter mitral valve replacement: Working with a catheter through a blood vessel, this option uses a smaller cut than other procedures.

Talk with your provider about which treatment is right for you based on your age, health history and other factors. Make sure you understand the benefits and risks of any mitral valve prolapse treatments.

What can I expect if I have this condition?

In most cases, mitral valve prolapse doesn’t cause problems or require treatment. This condition may not harm you and isn’t life-threatening. But in some people, it can lead to regurgitation and other issues like heart failure or abnormal heart rhythms.

If you have an MVP diagnosis, talk with your healthcare provider to learn how severe it is and what you can expect. Mitral valve prolapse can get worse as you age. That’s why it’s important to keep all of your appointments with your provider. They’ll monitor your mitral valve and discuss treatment options with you if needed.

Most people with MVP have a normal life expectancy. But some may have other medical conditions that can affect how long they live.

Mitral valve repair can help you live just as long as people without valve issues. But people who don’t get a valve repair for severe backflow face poor outcomes. Without repair, 2 out of 10 people don’t survive one year, and 5 out of 10 don’t survive five years.