Valvular Disease Mitral Prolapse

Mitral valve prolapse, sometimes called mitral valve prolapse syndrome, is one of the most common heart conditions in the US. Often associated with heart palpitations, mitral valve prolapse affects up to fifteen million Americans. Mitral valve prolapse affects women almost twice as often as men.

The Mitral Valve

The mitral valve is one of four heart valves. The mitral valve connects the left atrium to the left ventricle, opening to allow blood flow between the two heart chambers, and then closing to prevent blood from flowing back into the atrium.

The mitral valve is a bicuspid heart valve — it only has two valve flaps. None of the other heart valves are bicuspid — they all have three flaps.

Mitral Valve Prolapse

In cases of mitral valve prolapse, either one or both of the bicuspid mitral valve flaps “billow” or “balloon” back into the left atrium as they close. This increases the risk of blood escaping back into the atrium (mitral valve regurgitation). Mitral valve prolapse has several other names:

  • click-murmur syndrome
  • balloon mitral valve
  • Barlow’s syndrome
  • floppy valve syndrome.

Causes of Mitral Valve Prolapse

Mitral valve prolapse often has no obvious cause. A family history of mitral valve prolapse increases the risk of the disease, so genetics may play a role in some cases. Certain birth defects, such as Marfan syndrome, may also cause the condition, as can connective tissue diseases.

Secondary causes of mitral valve prolapse include rheumatic fever (a complication of strep throat now rare in America), endocarditis (an infection of the heart lining) and coronary artery disease.

Certain physical attributes are linked to a higher than normal risk of mitral valve prolapse. Some 25 percent of mitral valve prolapse cases occur in individuals with spinal abnormalities, high arched palates and “loose” joints.

Mitral Valve Prolapse Symptoms and Heart Palpitations

Mitral valve prolapse is usually a benign heart condition, causing no symptoms. When symptoms are present, patients often experience heart palpitations. Heart palpitations are noticeable irregularities in heart beat. A feeling that the heart has “skipped a beat” or is beating erratically is a sign of possible palpitations.

In most cases heart palpitations are not serious health problems or cause for alarm. However, heart palpitations can also signal potentially fatal heart arrhythmias (irregular heart rhythms), so palpitations should be reported to a medical professional.

In addition to palpitations, mitral valve prolapse can cause a number of other symptoms:

  • anxiety
  • chest pain
  • fatigue
  • mood swings
  • panic attacks
  • shortness of breath.

Emotional stress appears to aggravate symptoms of mitral valve prolapse, as does unaccustomed physical activity. Women report increased symptoms and heart palpitations during menopause and menstruation.

Diagnosing Mitral Valve Prolapse

Mitral valve prolapse generates a noticeable high-pitched “click” when heard through a stethoscope. This click is often followed by a heart murmur. Once mitral valve prolapse is suspected, a definitive diagnosis is usually made by echocardiography. In fact, some cases of mitral valve prolapse are diagnosed when echocardiogram tests are ordered for other conditions.

Complications of Mitral Valve Prolapse

Mitral valve prolapse does not often cause serious complications — the average complication rate for all cases is only two percent a year. In addition to palpitations, mitral valve regurgitation (when blood flows back into the atrium) is a common complication. Severe mitral valve regurgitation can increase the severity of palpitations and other symptoms, and can cause heart failure if left untreated.

Other mitral valve prolapse complications include pulmonary hypertension (high blood pressure in the lungs), ruptured mitral valve chordae (the tissue that holds the bicuspid flaps in place) and blood clots.

Mitral Valve Prolapse Treatment

Most cases of mitral valve prolapse produce no symptoms and require no treatment. Surgical repair or replacement of the mitral valve is required only if mitral valve regurgitation causes severe symptoms.

Palpitations, anxiety and panic attack symptoms can sometimes be relieved with beta-blocker medication. People with mitral valve prolapse at risk of blood clots or strokes may receive blood-thinning medications to lower the risk of embolism.

In general, a heart-healthy diet and doctor-approved exercise program is recommended for most mitral valve prolapse patients. Avoiding cigarettes and oral birth contraceptives reduces the risk of blood clots.

Surgery and Mitral Valve Prolapse

People with mitral valve prolapse should inform their health professionals of the condition. Preventive antibiotics may be required before dental or medical surgery to lower the risk of infectious endocarditis, a bacterial infection of the heart that can further damage the mitral valve.

Pregnancy and Mitral Valve Prolapse

Pregnancy has an unusual effect on mitral valve prolapse. While menopause and menstruation are both associated with an increase in symptom severity, mitral valve prolapse symptoms are often alleviated by pregnancy. Changes to the heart during pregnancy appear to alleviate the symptoms.

Even though pregnancy is not seriously affected by mitral valve prolapse, the condition must still be taken into account. Some women may benefit from prophylactic antibiotics prior to delivery or caesarean section to avoid the risk of post-partum endocarditis. In most cases of normal delivery or uncomplicated caesarean section, however, antibiotics are not required.