Mitral Valve Prolapse (MVP)

Table of Contents

Mitral valve prolapse (MVP) occurs when one of the heart valves does not function properly. The valve flap “droops” and does not close tightly. Most people who have MVP are born with the condition. This condition also tends to run in families.

In general, MVPs do not cause problems. It is rare that blood can leak into the wrong direction through the drooping valve, which can cause: 

  • Palpitations (feeling of having a fast-beating and pounding heart)
  • Shortness of breath
  • Cough
  • Fatigue, dizziness, or anxiety
  • Migraines
  • Chest pain

In people with mitral valve prolapse (MVP), they do not require treatment due to the lack of symptoms and complications. Medications can help relieve symptoms or prevent complications of MVP. Only a few patients will require surgery to repair or replace the mitral valve.

MVP puts you at risk for infective endocarditis – a type of heart infection. To prevent this, you will be prescribed with antibiotics prior to certain dental treatments or surgeries. Only people at high risk of endocarditis require antibiotics.

Normal Mitral Valve 

The mitral valve controls blood flow between the upper and lower chambers of the left side of the heart. The upper chamber is called the left atrium. The lower chamber is called the left ventricle. The mitral valve allows blood flow from the left atrium to the left ventricle, but not in the reverse direction. The heart also has a right atrium and ventricle, separated by a tricuspid valve.

With every heartbeat, the atria contracts and pushes blood into the ventricles. The mitral and tricuspid valve flaps open to allow blood to pass. Then, the ventricles contract to pump blood out of the heart. When the ventricles contract, the mitral and tricuspid valve flaps close – forming a tight seal that prevents blood from flowing back up into the atria.

Mitral Valve Prolapse

In MVP, when the left ventricle contracts, one or both of the flaps from the mitral valve droop or protrude (prolapse) into the left atrium. This can prevent the valve from forming a tight seal. As a result, blood can leak from the ventricles back into the atria. The backflow of blood is called regurgitation.

MVP does not always cause backflow. In fact, most people who have MVP experience no backflow and never have any associated symptoms or problems. The backflow can get worse over time and can change the size of the heart and increase pressure in the left atrium and lung. Backflow also increases the risk of heart valve infection.

Medication can treat symptoms of MVP and help prevent complications. Some people may require surgery to repair or replace their mitral valve.

Causes and Risk Factors of Mitral Valve Prolapse

Causes

The exact cause of mitral valve prolapse (MVP) is unknown. Most people who experience it are born with this condition. Additionally, MVP also tends to run in families. This condition is more common in people born with connective tissue disorders.

In people who have MVP, the mitral valve may be abnormal in the following ways:

  • The valve flap may be too large and thick.
  • The valve flap may “droop.” The flap and its supporting “string” are  overstretched, and portions of the valve droop or protrude back into the atria.
  • The valve opening may become loose

All the factors above can prevent the valve from forming a tight seal. Some people’s valves are abnormal in more than one way.

Risk Factors

Mitral valve prolapse (MVP) affects people of all ages. However, aging increases the risk of developing the disease.

Certain conditions are associated with MVP, including:

  • History of rheumatic fever
  • Connective tissue disorders, such as Marfan’s syndrome or Ehlers-Danlos syndrome
  • Graves’ disease
  • Scoliosis and other skeletal problems
  • Several forms of muscular dystrophy

Signs, Symptoms, and Complications of Mitral Valve Prolapse 

Signs and Symptoms

Most people who have mitral valve prolapse (MVP) are not affected by this condition. They experience no symptoms or major mitral valve backflow.

When MVP causes signs and symptoms, they may include:

  • Palpitations (feeling of having a fast-beating and pounding heart)
  • Shortness of breath
  • Cough
  • Fatigue, dizziness, or anxiety
  • Migraines
  • Chest pain

Symptoms of MVP vary from person to person. Mild symptoms can get worse over time, especially when complications occur.

Complications

MVP complications are rare cases. In the event they do occur, complications are usually caused by backflow of blood through the mitral valve. Mitral valve backflow is more common to occur in men and people who have high blood pressure. People who experience severe backflow may need valve surgery to prevent complications. Mitral valve backflow causes blood to flow from the left ventricle back into the left atrium. Blood can even withdraw from the atria into the lungs – causing shortness of breath.

The backflow of blood compresses the muscles of the atria and ventricles. Over time, tension can lead to arrhythmias. Backflow also increases the risk of infective endocarditis (IE). IE is an infection of the inner lining of your heart chambers and valves.

Arrhythmia

Arrhythmia is a condition associated with the rate or rhythm of the heartbeat. Arrhythmia is generally harmless. However, other types of arrhythmias can be serious or even life-threatening, such as ventricular arrhythmias.

If the heartbeat is too slow, too fast, or irregular – the heart may not be able to pump enough blood. Lack of blood flow can damage the brain, heart, and other organs.

An arrhythmia caused by MVP is atrial fibrillation (AF). In AF, the walls of the atrium vibrate instead of beating normally. As a result, the atria is unable to pump blood to the ventricles in the way they should.

AF is rarely life-threatening – unless the atria contracts very rapidly or a blood clot forms in the atria. Blood clots can occur when a certain amount of blood “accumulates” in the atria instead of flowing into the ventricles. If it breaks and travels through the bloodstream, the blood clot can reach the brain and cause a stroke.

Mitral Valve Infection

Defective mitral valve flaps can attract bacteria in the bloodstream. The bacteria sticks to the valve and can cause a serious infection called infective endocarditis (IE). Signs and symptoms of a bacterial infection include fever, chills, body aches, and headaches.

IE is a rare condition, but it can be a serious condition if it occurs. MVP is the most common heart condition that puts people at risk for this infection.

If you have MVP, you can take steps to prevent IE. Floss and brush your teeth regularly. Gum infection and tooth decay can cause IE.

Diagnosis of Mitral Valve Prolapse 

Mitral valve prolapse (MVP) is often diagnosed during routine physical exams. Your doctor will listen to your heart with a stethoscope.

The stretched valve flap can make a clicking sound when closing. If the mitral valve leaks blood back into the left atrium, the doctor may hear a murmur or whooshing sound.

However, these abnormal heart sounds can come and go. Your doctor may not hear it during the test even if you have MVP. Hence, you may also be required to undergo additional tests and procedures to diagnose MVP.

Diagnostic Tests and Procedures 

Echocardiography

Echocardiography (echo) is the most useful to diagnose MVP. This painless test uses sound waves to produce a moving picture of your heart.

Echo shows the size and shape of your heart and how well your heart chambers and valves are working. This test can also show areas of the heart muscle that are not contracting normally due to poor blood flow or heart muscle injury. Echo can show mitral valve flaps prolapse and blood backflow through the leaking valve.

There are several types of echo, including stress echo. Stress echo is done before and after a stress test. During a stress test, you will be asked to exercise or take medications to make your heart work harder and beat faster. Stress echo can help identify whether you have decreased blood flow to your heart (a sign of coronary heart disease).

Echo can also be done by placing a small probe in your esophagus to take a closer look at the mitral valve. The esophagus is the tube from the mouth that leads to your stomach.

The probe uses sound waves to produce an image of your heart. This form of echo is called transesophageal echocardiography or transesophageal echocardiography (TEE).

Doppler Ultrasound

The Doppler ultrasound is part of the echo test. Doppler ultrasound shows the speed and direction of blood flow through the mitral valve.

Other Tests

Other tests that can help diagnose MVP include:

  • Chest X-ray. This test is used to look for fluid in your lungs or to see if your heart is enlarged.
  • EKG (electrocardiogram). An EKG is a simple test that records the electrical activity of your heart. An EKG can show how fast your heart beats and whether you have a regular or irregular heart rhythm. This test also records the strength and timing of electrical signals as they pass through your heart.

Treatment for Mitral Valve Prolapse

Most people with mitral valve prolapse (MVP) do not require treatment as MVP shows no symptoms and complications.

Even people who do have symptoms may not require treatment. The presence of symptoms does not necessarily indicate a significant backflow of blood through the valve.

People who have MVP and troubled mitral valve backflow can be treated with medications, surgery, or both.

The objectives of MVP treatment are: 

  • Correct the underlying mitral valve problem, if necessary
  • Prevent infective endocarditis, arrhythmias, and other complications
  • Relieve symptoms

Medications

Beta blockers medicines can be used to treat palpitations and chest pain in people who experience minor or no mitral valve backflow.

If you experience symptoms and significant backflow, your doctor may prescribe:

  • Blood thinners to reduce the risk of blood clots if you have atrial fibrillation.
  • Digoxin to strengthen your heart rate.
  • Diuretics (water pills) to remove excess sodium and fluid in your body and lungs.
  • Medicines such as flecainide and procainamide to regulate your heart rhythm.
  • Vasodilators to widen the blood vessels and ease the workload on the heart. Examples of vasodilators are isosorbide dinitrate and hydralazine.

Consume all the medicines regularly, according to your doctor’s prescription. Make sure you do not increase the dose unless told otherwise. 

Surgery

Surgery is performed only if the mitral valve is very abnormal and blood flows back into the atrium. The main objective of surgery is to relieve symptoms and reduce the risk of heart failure.

The timing of the operation is also important. If it is done too early and your leaky heart valve is working well enough, you may run unnecessary risks from the surgery. If it is too late, you may have irreparable heart damage.

Surgical Approach

Traditionally, heart surgeons repair or replace the mitral valve by making an incision (cut) in the sternum and exposing the heart.

Few but a growing number of surgeons are using another approach that involves one or more small incisions in the side of the chest wall. This results in less cuts, less blood loss, and a shorter length of hospital stay. However, not all hospitals practise this method.

1. Valve Repair and Replacement

In mitral valve surgery, the valve is repaired or replaced – with repair being the more preferred option. Repair has a smaller chance than replacement to weaken the heart. Repair also lowers the risk of infection and reduces the need for lifelong use of blood thinners.

If repair is not an option, the valve can be replaced. Mechanical and biological valves are used as replacement valves.

The mechanical valve is man-made and can last a lifetime. People who wear mechanical valves will have to take blood thinners for the rest of their lives.

After surgery, you will have to stay in the hospital’s intensive care unit for 2 to 3 days. Overall, most people who have mitral valve surgery spend about 1 to 2 weeks in the hospital. Complete recovery can take several weeks to several months, depending on your health condition before the operation. If you have valve repair or replacement, you may need antibiotics before dental work and surgery. This procedure allows bacteria to enter your bloodstream. Antibiotics can help prevent infective endocarditis – a serious heart valve infection. Discuss with your doctor whether you need to take antibiotics before the procedure.

2. Transcatheter Valves

The interventional cardiologist may be able to repair a leaky mitral valve by implanting a device using a catheter (tube) inserted through a large blood vessel. This approach is less invasive. Currently, the device is only approved for people with severe mitral regurgitation who cannot undergo surgery.

Treatment for Patients Diagnosed with Mitral Valve Prolapse

Most people who have mitral valve prolapse (MVP) have no symptoms or related problems and do not require treatment to resume daily activities. If symptoms and complications do occur, you can manage them with medications prescribed by your doctor. However, some people may need transcatheter valve therapy or heart valve surgery to relieve their symptoms and prevent complications. It is rare that mitral valve prolapse can cause arrhythmias and other problems.

Continuous Care

Continuous care is important to treat MVP. You can ask your doctor how often you should schedule follow-up visits and see your doctor if your symptoms get worse. Consult your doctor regarding:

  • Medications
  • Lifestyle changes for better heart health

Medications

Take all of your medicines as prescribed by your doctor, including blood thinners and high blood pressure medications. In addition, avoid taking birth control pills as they can increase your risk of developing blood clots.

The following are some heart-healthy lifestyle habits that you can implement: 

  • Heart-healthy diet
  • Maintain a healthy weight
  • Manage stress
  • Engage in regular physical activity
  • Quit smoking

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