Mitral Valve Prolapse: Symptoms, Causes, and Treatment Options

What is typical mitral valve prolapse?

I recently experienced chest pain and difficulty breathing, which was quite distressing and occurred sporadically.
I have already sought medical attention, and the doctor informed me that these are symptoms of mitral valve prolapse.
I have been prescribed medication, which has provided some improvement.
The doctor reviewed my electrocardiogram, which was normal.
During my third visit, an echocardiogram was performed, and the doctor confirmed that I have typical mitral valve prolapse.
Can this condition lead to valvular heart disease? Is it a congenital heart defect? Is medication the only treatment option?

Ba Bi, 20~29 year old female. Ask Date: 2006/03/16

Dr. He Dongjin reply Cardiology

Dear Barbie,
First, let's understand the structure of the heart.
The heart contains four chambers, divided into the right and left atria and the right and left ventricles, similar to the compartments of a house.
There are valves separating the atria and ventricles, functioning like doors that allow blood to flow in one direction and prevent backflow.
The mitral valve is located between the left atrium and the left ventricle.
Mitral valve prolapse occurs when congenital or acquired factors cause the annulus of the mitral valve to enlarge, resulting in a relative reduction in the size of the mitral valve, which cannot close properly and partially bulges into the left atrium.
Additionally, the mitral valve may undergo degenerative myxomatous changes or become elongated, causing part of it to be forced into the left atrium during closure, leading to what is known as mitral valve prolapse.

Statistics indicate that approximately 5-10% of the population has mitral valve prolapse, with an unclear etiology, but the vast majority is related to congenital genetics.
It is more common in females than in males, with a ratio of about 3 to 1.
Most patients are asymptomatic and discover mitral valve prolapse during routine examinations or evaluations for other conditions.
Those who do experience symptoms typically present with at least two of the following: chest pain, palpitations, fatigue, shortness of breath, dizziness, insomnia, anxiety, panic, or even syncope.
These symptoms do not originate from the heart but are due to excessive sympathetic nervous system activation, leading to a syndrome often referred to as autonomic dysregulation syndrome.
Mitral valve prolapse is essentially another manifestation of this syndrome and does not have a causal relationship with other symptoms.

In some patients, the mitral valve fails to close tightly, resulting in some blood flowing backward into the left atrium during left ventricular contraction, clinically referred to as mitral regurgitation.
The diagnosis of mitral valve prolapse can be made through clinical auscultation, where a characteristic click or murmur may be heard, but electrocardiograms and chest X-rays have limited diagnostic value.
The most important examination is echocardiography, which can not only visualize mitral valve prolapse but also detect any mitral regurgitation or associated conditions such as rheumatic heart disease or ischemic heart disease.

Medications can only provide symptomatic relief and cannot eradicate mitral valve prolapse.
Surgery is only applicable in cases of severe mitral regurgitation affecting cardiac function or in cases of infective endocarditis, and it does not alleviate the aforementioned symptoms.
Most patients can achieve some degree of symptom relief through medication.
Patients should also come to terms with their condition and accept it.
After being diagnosed with mitral valve prolapse through echocardiography, patients should be aware of situations that may trigger their symptoms and strive to avoid these circumstances.
With proper medication as prescribed by their physician, most symptoms can be well controlled.

Changhua Hospital cares about you.

Reply Date: 2006/03/16

More Info

Mitral Valve Prolapse (MVP) is a condition where the two leaflets of the mitral valve bulge (prolapse) into the left atrium during the heart's contraction. This can lead to various symptoms and complications, and understanding these aspects is crucial for effective management.

Symptoms of Mitral Valve Prolapse
Many individuals with MVP may remain asymptomatic, but when symptoms do occur, they can include:
1. Chest Pain: Often described as sharp or stabbing, it can be mistaken for angina or other cardiac issues.

2. Palpitations: A sensation of a racing or irregular heartbeat, which can be distressing.

3. Shortness of Breath: Particularly during exertion or when lying flat, which may be related to the heart's inability to pump effectively.

4. Fatigue: General tiredness can occur, especially if the heart is not functioning optimally.

5. Anxiety: Some patients report increased anxiety levels, possibly due to the awareness of their heart condition.

Causes of Mitral Valve Prolapse
MVP can be caused by several factors:
1. Genetic Factors: It is often hereditary, meaning it can run in families. Certain connective tissue disorders, such as Marfan syndrome or Ehlers-Danlos syndrome, can also predispose individuals to MVP.

2. Structural Abnormalities: The valve leaflets may be too large or the chordae tendineae (the cords that hold the valve in place) may be elongated or weakened.

3. Age: MVP can develop with age, as the heart and valves undergo changes.

Treatment Options
Treatment for MVP depends on the severity of symptoms and the presence of complications, such as mitral regurgitation (leakage of blood backward through the valve). Here are the common treatment options:
1. Medications: If symptoms are present, medications such as beta-blockers may be prescribed to help manage palpitations and anxiety. Diuretics may be used if there is fluid retention.

2. Lifestyle Modifications: Patients are often advised to maintain a healthy lifestyle, including regular exercise, a balanced diet, and avoiding stimulants like caffeine that can exacerbate symptoms.

3. Regular Monitoring: Regular follow-up with a cardiologist is essential to monitor the condition, especially if there are changes in symptoms or if mitral regurgitation develops.

4. Surgery: In severe cases where there is significant mitral regurgitation or if the patient experiences debilitating symptoms that do not respond to medication, surgical options may be considered. This can involve repairing the valve or, in rare cases, replacing it.

Complications and Concerns
While MVP itself is often benign, it can lead to complications such as:
- Mitral Regurgitation: This can occur if the valve does not close properly, leading to blood leaking back into the left atrium.

- Endocarditis: An infection of the heart lining, which can occur more frequently in individuals with structural heart abnormalities.

- Arrhythmias: Irregular heartbeats can occur, which may require treatment if they are symptomatic.

Conclusion
In your case, it is reassuring that your electrocardiogram (ECG) was normal, and your symptoms have improved with medication. MVP is not classified as a congenital heart disease but rather a structural abnormality that can be present from birth or develop over time. Regular follow-up with your healthcare provider is essential to monitor your condition and adjust treatment as necessary. If you experience worsening symptoms or new concerns, do not hesitate to seek further evaluation.

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