Mitral valve prolapse
Mitral valve prolapse: Pts' complete guide
Mitral valve prolapse (MVP) is a relatively common heart valve condition that affects between 2–3% of the population. It occurs when the leaflets of the mitral valve (the valve between the left atrium and left ventricle) become floppy or thickened and bulge (prolapse) back into the left atrium during the heart’s contraction.
While many cases of MVP are mild and harmless, in some people it can cause mitral regurgitation (backward leakage of blood), leading to symptoms such as palpitations, chest pain, shortness of breath, or in rare cases, complications such as arrhythmias, endocarditis, or heart failure.
Mitral valve prolapse is sometimes referred to as “click-murmur syndrome” because of the characteristic clicking sound and heart murmur doctors can hear during examination. It is often diagnosed incidentally during a routine check-up or echocardiogram.
Many people with MVP have no symptoms at all and live normal lives. However, some patients develop noticeable symptoms, particularly if mitral regurgitation is present.
Common Symptoms
Palpitations – awareness of fast or irregular heartbeat
Chest pain or discomfort (not always related to exertion, can be sharp or stabbing)
Shortness of breath, especially during exertion or when lying flat
Fatigue, reduced exercise tolerance
Dizziness or lightheadedness
Anxiety and panic attacks (sometimes associated with MVP syndrome)
Rare but Serious Symptoms
Fainting (syncope) due to arrhythmias.
Stroke or transient ischaemic attack (TIA) due to clot formation in the heart.
Sudden worsening of symptoms if severe mitral regurgitation develops.
You should seek medical attention if you experience:
Frequent palpitations or irregular heartbeat
Chest pain lasting more than a few minutes
Unexplained fainting spells
Shortness of breath or exercise intolerance
Swelling in ankles or feet (suggestive of heart failure)
Family history of sudden cardiac death or severe valve disease
Emergency care is needed if you have severe chest pain, collapse, or sudden shortness of breath.
MVP is diagnosed using a combination of history, physical exam, and imaging.
1. Medical History & Examination
Doctor listens for the click-murmur during auscultation.
Family history of MVP or connective tissue disorders (e.g., Marfan syndrome) may be relevant.
2. Echocardiography (Echo)
Transthoracic echocardiography (TTE): Gold standard test for diagnosis.
Identifies prolapse of mitral valve leaflets and assesses degree of regurgitation.
Transoesophageal echo (TOE): Provides more detailed images, useful before surgery.
3. Electrocardiogram (ECG)
May show arrhythmias such as atrial fibrillation or premature ventricular contractions.
4. Holter Monitoring
24-48 hour ECG monitoring to detect intermittent arrhythmias.
5. Exercise Stress Test
Evaluates impact of MVP on exercise tolerance and rhythm stability.
6. Cardiac MRI
Provides additional structural details in complex cases.
Treatment depends on symptoms and severity of valve dysfunction.
1. No Treatment (Observation)
Most patients with mild MVP and no significant regurgitation require only monitoring.
Regular echocardiograms to check progression.
2. Medications
Beta-blockers: Reduce palpitations, chest discomfort, and arrhythmias.
Anti-arrhythmic drugs: For significant rhythm disturbances.
Anticoagulants (blood thinners): If atrial fibrillation or history of stroke is present.
Diuretics or heart failure medications: If severe regurgitation leads to fluid retention.
3. Surgical / Interventional Treatment
Mitral valve repair: Preferred over replacement; involves reshaping or reinforcing the valve to prevent prolapse.
Mitral valve replacement: Used when repair is not feasible.
Transcatheter edge-to-edge repair (MitraClip): Option for high-risk surgical patients with severe regurgitation.
Living with mitral valve prolapse
Most patients live normal, active lives with MVP.
Lifestyle tips:
Heart-healthy diet, low in saturated fats and salt
Regular exercise (avoid extreme exertion if severe regurgitation present)
Avoid excessive caffeine and stimulants if palpitations occur
Quit smoking and limit alcohol
Good dental hygiene is important to reduce risk of infective endocarditis.
Regular follow-ups with a cardiologist are essential.
Patients with connective tissue disorders (e.g., Marfan, Ehlers-Danlos) require closer monitoring.
Most people with MVP have an excellent prognosis.
Severe complications occur in only a minority of patients.
Risk increases if severe mitral regurgitation, atrial fibrillation, or left ventricular dysfunction develops.
With timely surgical or interventional treatment, long-term outcomes are very good.
- Mitral valve prolapse is one of the most common valve conditions, affecting 2–3% of people.
- It occurs when valve leaflets bulge into the atrium during heart contraction.
- Many cases are mild and asymptomatic.
- The condition is more common in women but can affect anyone.
- Mitral valve prolapse is sometimes associated with connective tissue disorders.
- The hallmark finding is a mid-systolic click with or without a murmur.
- Most people never need treatment beyond monitoring.
- A small number develop severe mitral regurgitation needing surgery.
- MVP is not usually life-threatening when properly monitored.
- Regular follow-up ensures timely treatment and excellent outcomes.
- Do I have mitral valve regurgitation in addition to prolapse?
- How often should I have an echocardiogram?
- What symptoms should I watch out for that may signal worsening?
- Do I need medication for palpitations or arrhythmias?
- Am I at increased risk of stroke or endocarditis?
- Will I eventually need valve surgery or repair?
- What lifestyle changes can help me manage MVP?
- Is it safe for me to exercise normally?
- Do I need to take antibiotics before dental or surgical procedures?
- What is my long-term outlook with this condition?
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