Mitral Valve Prolapse: Symptoms, Treatment, and Follow-Up Care

Mitral valve prolapse

Hello Doctor: I would like to ask, I had an ultrasound examination today, and the report indicated that I have mitral valve prolapse, which seems to be congenital.
However, there is no medication treatment; is this okay? Do I need to have regular follow-ups? Also, during the ultrasound examination, the device pressed against my chest and moved back and forth, causing a painful sensation as if a heavy object was pressing down.
Is this related to muscle or nerve issues, or is it related to the heart? What should I pay attention to regarding mitral valve prolapse? Are there any potential complications? Thank you for your response!

Youzi, 20~29 year old female. Ask Date: 2010/04/06

Dr. He Dongjin reply Cardiology

When pressing the probe against the chest and sliding it back and forth, there may be a pain sensation, as if a heavy object is pressing down.
This could indicate a muscular or neurological issue.
As for mitral valve prolapse, it is often associated with tall and slender body types, which are typically desired by young women aspiring to be models.
However, from a physician's perspective, this slender physique and sensitive personality are characteristic of patients with mitral valve prolapse, also known as "mitral valve prolapse syndrome." Approximately 5% of the population is affected by this condition, with a notably higher prevalence in females, who are twice as likely to be affected compared to males.
The most prominent features of these patients are being slim and tall.
During embryonic development, if the connective tissue of the valve undergoes myxomatous degeneration, leading to elongated and lax valve leaflets, prolapse may occur later in life.
When the heart contracts, the elongated leaflets cannot close properly, resulting in the backflow of blood from the left ventricle into the left atrium.
In addition to the characteristic "click" of the prolapsed valve, heart murmurs may also be heard.
Patients with this abnormal constitution often experience a variety of symptoms from head to toe, including dizziness, insomnia, palpitations, chest pain, anxiety, fatigue, chest tightness, numbness throughout the body, shortness of breath, and gastrointestinal discomfort.
These symptoms may be related to autonomic nervous system dysregulation, which involves either excessive or insufficient responses from the sympathetic or parasympathetic nervous systems.
Clinically, patients may present with various types of arrhythmias, including sinus tachycardia (the most common), bradycardia, ventricular tachycardia, atrial flutter, atrial fibrillation, or even cardiac arrest.
The chest pain associated with mitral valve prolapse can sometimes be difficult to distinguish from angina or myocardial infarction.
The underlying cause may be due to the elongated valve leaflets opening and closing excessively, which can overstretch the cardiac muscle, leading to localized hypoxia, arrhythmias, and autonomic nervous system dysregulation.
Mitral valve prolapse is also frequently found in patients with congenital heart defects (such as atrial septal defects), hypertrophic cardiomyopathy, and certain congenital connective tissue disorders (such as Marfan syndrome).
Although patients with prolapse symptoms may seem to have widespread health issues, over 90% of cases are benign.
Aside from being somewhat anxious, they do not pose significant health risks.
Regular exercise, adequate rest, and occasional use of small doses of beta-blockers or sedatives may be sufficient for management.
Only a small percentage of patients (about 1%) may experience complications such as heart failure, endocarditis, arrhythmias, stroke, or sudden death.
Therefore, patients with mitral valve prolapse, especially those with significant heart murmurs, should have follow-up examinations at least once a year.

Reply Date: 2010/04/06

More Info

Mitral valve prolapse (MVP) is a condition where the two leaflets of the mitral valve do not close smoothly or evenly, but instead bulge (prolapse) upward into the left atrium during the heart's contraction. This condition is often benign and can be congenital, meaning it is present from birth. Many individuals with MVP experience no symptoms and do not require treatment. However, some may experience symptoms such as palpitations, chest pain, fatigue, or anxiety.

Symptoms of Mitral Valve Prolapse
While many people with MVP are asymptomatic, some may experience:
1. Palpitations: A sensation of the heart racing or skipping beats.

2. Chest Pain: This can be sharp or dull and may not necessarily correlate with physical activity.

3. Fatigue: Feeling unusually tired or weak, especially after exertion.

4. Shortness of Breath: Particularly during physical activity or when lying flat.

5. Anxiety: Some patients report increased anxiety levels, which may be related to the heart's rhythm disturbances.

Treatment Options
In most cases, MVP does not require treatment. However, if symptoms are present or if there is significant mitral regurgitation (where blood leaks backward into the left atrium), treatment options may include:
1. Medications: Beta-blockers may be prescribed to help manage palpitations and anxiety.

2. Regular Monitoring: If you are asymptomatic, your doctor may recommend regular echocardiograms to monitor the condition.

3. Surgery: In severe cases, surgical intervention may be necessary to repair or replace the mitral valve.

Follow-Up Care
Regular follow-up is essential, especially if you have symptoms or if your echocardiogram shows significant mitral regurgitation. Your healthcare provider may recommend:
- Echocardiograms: To monitor the structure and function of the mitral valve over time.

- Physical Activity Guidance: Most individuals with MVP can lead normal, active lives, but your doctor may provide specific recommendations based on your symptoms.

- Awareness of Symptoms: Be vigilant about any new or worsening symptoms, such as increased chest pain or shortness of breath, and report these to your healthcare provider.

Concerns About the Echocardiogram
Regarding the discomfort you experienced during the echocardiogram, it is not uncommon for patients to feel pressure or discomfort when the transducer is pressed against the chest. This sensation is typically due to the pressure applied by the technician to obtain clear images of the heart. It is unlikely to be related to the heart itself or a muscular issue unless you have pre-existing conditions affecting your chest muscles or ribs.

Complications of Mitral Valve Prolapse
While MVP is generally a benign condition, potential complications can include:
1. Mitral Regurgitation: This is the most common complication, where the valve does not close properly, leading to blood leaking back into the left atrium.

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

3. Arrhythmias: Some patients may develop irregular heartbeats, which can lead to further complications.

Conclusion
In summary, if your MVP is asymptomatic and your healthcare provider has not recommended treatment, it is likely that you do not need to worry. However, regular follow-up and monitoring are essential to ensure that any changes in your condition are addressed promptly. If you experience any new symptoms or if your current symptoms worsen, it is important to consult your healthcare provider for further evaluation and management.

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