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Mitral valve prolapse (MVP) occurs when the valve between your heart's left upper chamber (left atrium) and the left lower chamber (left ventricle) doesn't close properly. When the left ventricle contracts, the valve's flaps bulge (prolapse) upward or back into the atrium. Mitral (MIE-truhl) 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.

Alternative Names of Mitral Valve Prolapse are: click-murmur syndrome.

Complications of Mitral Valve Prolapse

Although most people with mitral valve prolapse never have problems, complications can occur. Complications tend to occur in middle-aged or older adults. They may include:

  • Mitral valve regurgitation. The most common complication is mitral valve regurgitation (mitral insufficiency) — a condition in which the valve leaks blood back into the left atrium. Having high blood pressure or being overweight increases your risk of mitral valve regurgitation. If the regurgitation is severe, you may need surgery to repair or even replace the valve in order to prevent the development of complications, such as heart failure.
  • Heart rhythm problems (arrhythmias). Irregular heart rhythms can occur in people with mitral valve prolapse. These most commonly occur in the upper chambers of the heart, and while they may be bothersome, they aren't usually life-threatening. People with severe mitral regurgitation, or severe deformity of their mitral valve, are most susceptible to serious rhythm problems.
  • Heart valve infection (endocarditis). The inside of your heart contains four chambers and four valves 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 used to recommend that some people with mitral valve prolapse take antibiotics before certain dental or medical procedures to prevent endocarditis, but not anymore. The American Heart Association advises that antibiotics are no longer necessary in most cases for someone with mitral valve regurgitation or mitral valve prolapse.

Causes of Mitral Valve Prolapse

When your heart is working properly, the mitral valve closes completely during contraction of the left ventricle and prevents blood from flowing back into your heart's upper left chamber (left atrium). But in some people with mitral valve prolapse, the mitral valve's flaps (leaflets) have extra tissue, bulging (prolapsing) like a parachute into their left atrium each time the heart contracts. The bulging may keep the valve from closing tightly. When blood leaks backward through the valve, it's called mitral regurgitation. This may not cause problems if only a small amount of blood leaks back into the atrium. More severe mitral valve regurgitation can cause symptoms, such as shortness of breath, fatigue, lightheadedness or a cough. 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 out, followed by a murmur resulting from blood flowing back into the atrium. Other names to describe mitral valve prolapse include:

  • Barlow's syndrome
  • Floppy valve syndrome
  • Ballooning mitral valve syndrome

Mitral valve prolapse often runs in families and may be linked to other conditions, such as:

  • Marfan syndrome
  • Ehlers-Danlos syndrome
  • Adult polycystic kidney disease
  • Ebstein's anomaly
  • Curvature of the spine (scoliosis)

Signs & Symptoms of Mitral Valve Prolapse

Although mitral valve prolapse is 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's typically because blood is leaking backward through the valve (regurgitation). Mitral valve prolapse symptoms can vary widely from one person to another. They tend to be mild, develop gradually and may include:

  • A racing or irregular heartbeat (arrhythmia)
  • Dizziness or lightheadedness
  • Difficulty breathing or shortness of breath, often when lying flat or during physical activity
  • Fatigue
  • Chest pain that's not caused by a heart attack or coronary artery disease

Diagnosis of Mitral Valve Prolapse

Doctors may diagnose mitral valve prolapse at any age. Your doctor is most likely to detect mitral valve prolapse by listening to your heart using a stethoscope. If you have mitral valve prolapse, your doctor may hear clicking sounds, which are common in mitral valve prolapse. Your doctor may also hear a heart murmur if you have blood leaking backward through your mitral valve (mitral valve regurgitation).

Other tests to diagnose mitral valve prolapse include:

  • Echocardiogram. An echocardiogram is usually done to confirm the diagnosis. An echocardiogram is a noninvasive, ultrasound evaluation of your heart. This test uses high-frequency sound waves to create images of your heart and its structures, including the mitral valve itself, and the flow of blood through it. The amount of leakage (regurgitation) can be measured.
  • Chest X-ray. An image is created by directing X-rays at your chest and positioning a large piece of photographic film or a digital recording plate against your back. The X-ray machine produces a small burst of radiation that passes through your body and produces an image on the film or digital plate. A chest X-ray shows a picture of your heart, lungs and blood vessels, and can help your doctor make a diagnosis.
  • 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 and structure, including mitral valve prolapse.
  • Stress test. Your doctor may order a stress test, usually a treadmill exercise test, to see if mitral valve regurgitation limits your ability to exercise. You may also have a stress test if you have chest pain and your doctor is trying to see if this is due to mitral valve prolapse or coronary artery disease.
  • Cardiac catheterization. If your doctor thinks you have a mitral valve prolapse so severe that you might need surgery, he or she may recommend cardiac catheterization and coronary angiograms before surgery. During a cardiac catheterization, a long, thin, flexible plastic tube (catheter) is inserted into your body. Dye is injected into the blood vessels of your heart. The dye is visible by X-ray machine. The machine rapidly takes a series of X-ray images (angiograms), offering a detailed look at your heart arteries to determine if you need coronary artery bypass at the same time as your valve surgery. Pressures in the heart's chambers may be measured, particularly if there is any concern about high blood pressure in the lung arteries (pulmonary hypertension) that might influence the decision to proceed with surgery.

If you have mitral valve regurgitation but don't have symptoms, your doctor may suggest you return for examinations to monitor your condition every three to five years, depending on how serious your condition is.

Treatments of Mitral Valve Prolapse

Most people with mitral valve prolapse, particularly people without symptoms, don't require treatment. However, if you have symptoms, your doctor may recommend medications or surgery, depending on the severity of your condition.

Medications

If you develop symptoms, your doctor might prescribe certain medications to treat mitral valve prolapse-related chest pain, heart rhythm abnormalities or other complications. Some medications you might be prescribed include:

  • Beta blockers. These drugs help prevent irregular heartbeats by making your heat 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.
  • Aspirin. If you have mitral valve prolapse and a personal or family history of strokes, your doctor might prescribe aspirin to reduce the risk of blood clots.
  • Prescription anticoagulants (blood thinners). These medications — warfarin (Coumadin) is commonly used — prevent your blood from clotting. If you have atrial fibrillation, a history of heart failure or a history of strokes, your doctor may suggest these drugs. They can have dangerous side effects, however, and must be taken exactly as prescribed.

Surgery

Though most people with mitral valve prolapse don't need surgery, your doctor may suggest surgical treatment if you have severe mitral valve regurgitation with or without symptoms. Severe mitral valve regurgitation can eventually cause heart failure, preventing it from effectively pumping blood. If regurgitation goes on too long your heart may be too weak for surgery.

If your doctor suggests surgery, there are two main options, repair or replacement of the mitral valve. Both valve repair and replacement require open heart surgery. Both procedures require significant recovery time.

  • Valve repair. Mitral valve repair is a surgery that preserves your own valve. For most people with mitral valve prolapse, this is the preferred surgical treatment to correct your condition.

Your mitral valve consists of two triangular-shaped flaps of tissue called leaflets. The leaflets of the mitral valve connect to the heart muscle through a ring called the annulus. The surgeon can modify the original valve (valvuloplasty) to eliminate backward blood flow. Surgeons also can repair the valve by reconnecting valve leaflets or by removing excess valve tissue so that the leaflets can close tightly. Sometimes repairing the valve includes tightening or replacing the ring around the valve (annulus). This is called an annuloplasty. It is important to ensure that your surgeon is experienced in performing mitral valve repair.

  • Valve replacement. Valve replacement is done when valve repair isn't possible. In valve replacement surgery, the damaged mitral valve is replaced by an artificial (prosthetic) valve. The two types of artificial valves are mechanical and tissue.

Mechanical valves may last a long time. However, if you have a mechanical valve, you must use an anticoagulant medication, such as warfarin (Coumadin), for the rest of your life to prevent blood clots from forming on the valve. If a blood clot forms on the valve and breaks free, it could travel to your brain and cause a stroke.

Tissue valves are made from animal tissue such as a pig's heart valve. These kinds of valves are called bioprostheses. They may wear out over time and need replacement. However, an advantage of the tissue valve is that you don't have to use long-term anticoagulant medication.

Antibiotics seldom recommended

Doctors used to recommend that some people with mitral valve prolapse take antibiotics before certain dental or medical procedures to prevent endocarditis, but not anymore. According to the American Heart Association, antibiotics are no longer necessary in most cases for someone with mitral valve regurgitation or mitral valve prolapse.

Still, if you've been told to take antibiotics before any procedures in the past, check with your doctor to see how these new recommendations apply to you.

Precautions during pregnancy

If you're pregnant and have mitral valve prolapse, your chances of a successful, uncomplicated pregnancy are good. Even so, doctors sometimes recommend antibiotics during childbirth if there's a risk of an infection that could affect the mitral valve.

Prevention of Mitral Valve Prolapse

You can't prevent mitral valve prolapse. However, you can lower your chances of developing the complications associated with it by making sure you take your medications, if any, as directed.

When to seek Medical Advice

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.


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