The heart contains four valves that serve a critical role in directing blood flow through its chambers and into the body. These valves are designed to open and close in a precise sequence, allowing blood to flow in one direction and preventing backflow. When functioning properly, the valves work in harmony to maintain efficient circulation. However, certain conditions can affect the structure or function of these valves, leading to potential issues. One such condition is mitral valve prolapse (MVP), a relatively common finding that is often detected when a heart murmur is heard during a routine examination. While MVP is not usually associated with symptoms early on, it can be monitored safely over time and typically does not require treatment unless complications develop. In this article, we’ll explore what MVP is, what causes it, and the treatment options that may be considered when needed.
What is the mitral valve?
The mitral valve is one of four valves in the heart. It sits between the left atrium (the upper left chamber) and the left ventricle (the lower left chamber). Its job is to ensure that blood flows in one direction, from the left atrium to the ventricle and does not leak backward.
The valve has two thin flaps, or leaflets, that open and close with each heartbeat. When the valve is working properly, it closes shut tightly. In MVP, these leaflets become floppy and bulge (or ‘prolapse’) back into the atrium during the heartbeat.
What causes mitral valve prolapse?
Mitral valve prolapse (MVP) occurs when the valve leaflets become thickened, elongated, or overly flexible, allowing them to bulge backward into the left atrium during the heart’s contraction. The underlying cause is often related to the structure of the connective tissue within the valve.
1. Inherited or familial MVP: In many people, MVP has a genetic component and tends to run in families. This form is often linked to subtle abnormalities in the valve tissue from birth, which may become more apparent with age. Inherited MVP typically follows an autosomal dominant pattern, meaning only one copy of the altered gene is needed for the condition to be passed on.
2. Connective tissue disorders: MVP is more common in individuals with certain connective tissue conditions, such as Marfan syndrome and Ehlers-Danlos syndrome. In these disorders, the body produces abnormal collagen or elastin, which weakens the supportive structures of the valve and causes it to become excessively mobile or redundant. These cases often present at a younger age and may be associated with more significant valve dysfunction.
3. Myxomatous degeneration: This is a descriptive term for a pathological change where the valve tissue becomes thickened and gelatinous due to excess mucopolysaccharide deposition. It is the most common microscopic feature seen in MVP and is part of the spectrum of connective tissue abnormality. Myxomatous valves are more prone to prolapse and leaking, otherwise known as egurgitation.
4. Age-related changes: As we age, the heart and its structures undergo normal wear and tear. In some individuals, this can lead to weakening or stretching of the mitral valve apparatus, including the chordae tendineae (the cords that anchor the leaflets), making prolapse more likely. Age-related MVP is often mild and detected incidentally during investigations for other conditions.
5. Inflammatory and infectious causes: Rarely, damage to the mitral valve can result from infections such as rheumatic fever, which was once a common cause of valve disease in many parts of the world. Although less frequent today due to improved antibiotic access, rheumatic fever can scar the mitral valve and disrupt its normal function. Inflammation from other conditions, such as infective endocarditis or autoimmune diseases, can also damage the valve tissue or its supporting structures.
6. Secondary to other cardiac conditions: In some cases, MVP may develop as a secondary consequence of other heart problems, such as dilated cardiomyopathy, a condition that results in enlargment of the heart and in particular the left ventricle. In these scenarios, changes in the size or shape of the left ventricle can pull on the mitral valve apparatus, resulting in leaflet displacement or functional prolapse.
Overall, the cause of mitral valve prolapse can range from benign, inherited variations in valve structure to changes associated with systemic disease or aging. Understanding the underlying cause helps guide how closely the condition should be monitored and whether further evaluation or treatment is needed.
How common is it?
Mitral valve prolapse affects around 2 to 3 percent of the general population. In my practice as a cardiologist, I often see it diagnosed during routine check-ups or investigations for unrelated symptoms. It tends to be slightly more common in women and is frequently picked up in adolescence or early adulthood.
What’s reassuring is that for most people, MVP is a benign condition. Many individuals go through life without ever experiencing symptoms or needing treatment. Once diagnosed, we usually keep an eye on it over time with periodic heart ultrasounds—but in the majority of cases, it never progresses to something more serious. It’s a diagnosis that understandably brings some concern at first, but with the right information and follow-up, most people find it doesn’t interfere with their daily life or long-term health.
What are the symptoms?
In many cases, MVP does not cause any symptoms. In my practice, I am referred patients for further assessment who have had a murmur heard by their healthcare practitioner and a follow up echocardiogram scan confirms the findings.
When symptoms do occur, they may include:
- Shortness of breath, particularly when exerting
- Palpitations (a sensation of rapid or irregular heartbeats)
- Fatigue or light-headedness
- Shortness of breath, especially when lying down or after exertion
- Occasionally, anxiety or panic-like symptoms
These symptoms are not always directly caused by the valve problem and may also be related to other conditions, including changes in the autonomic nervous system or mild mitral regurgitation (leakage of blood backward through the valve).
How is mitral valve prolapse diagnosed?
MVP is usually detected during a routine physical examination. Your healthcare professional may hear a distinctive clicking sound or a murmur using a stethoscope. The diagnosis is confirmed with an echocardiogram, a non-invasive ultrasound of the heart that shows how the valve moves during each beat.
In some cases, further imaging tests or monitoring may be needed, especially if there is concern about the amount of mitral regurgitation or irregular heart rhythms.
Does mitral valve prolapse cause complications?
For most people, mitral valve prolapse (MVP) is benign and does not cause long-term issues.
However, complications can occasionally arise, including:
- Mitral regurgitation: This is the most common complication, where the valve does not close properly and blood leaks backward into the atrium.
- Heart rhythm disturbances: Palpitations or arrhythmias may occur, although serious rhythm problems are rare. One more common condition is called atrial fibrillation where the heart rate becomes irregular.
- Endocarditis: An infection of the heart valves. People with significant prolapse or regurgitation may have a slightly higher risk and should take precautions before certain dental or surgical procedures.
- Rarely, heart failure or need for valve repair: In severe cases with worsening mitral regurgitation, surgical repair or replacement may be required.
How is it managed?
Management depends on the severity of the prolapse and whether symptoms or complications are present:
- No symptoms or mild cases: Often, no treatment is required. Regular follow-up with a cardiologist is recommended.
- Palpitations or mild symptoms: Lifestyle changes such as avoiding caffeine or alcohol, staying hydrated, and regular physical activity may help. In some cases, beta blockers or other medications are prescribed.
- Significant mitral regurgitation: May require medications such as ACE inhibitors or surgical intervention if the valve becomes too leaky.
- Endocarditis prevention: Good oral hygiene is essential. Antibiotics are generally no longer recommended before dental work unless there is a history of valve replacement or previous endocarditis but always check with your healthcare professional for specific advice for your condition.
Living well with mitral valve prolapse
For most people, a diagnosis of mitral valve prolapse does not change their ability to live a full and active life. In fact, many of my patients are surprised to learn they have it, often picked up during a routine check-up, and are reassured to hear that it is usually nothing to worry about.
The key is regular follow up. Keeping up with your scheduled heart check-ups allows us to monitor how the valve is functioning over time and to step in early if anything changes. Most of the time, though, no treatment is needed, just observation and a focus on general heart health.
Simple habits go a long way. Staying active, managing stress, getting enough rest, and eating well all contribute to your overall wellbeing. If you experience palpitations, shortness of breath, or any new symptoms, it is important to speak with your doctor, but remember, most people with MVP continue to live long, healthy lives without any restrictions.
With the right information and support, you can feel confident in managing MVP and focusing on the things that matter most in life.
Conclusion
Mitral valve prolapse is a common condition that is usually harmless. For those who do experience symptoms, effective treatments are available. With regular monitoring and a focus on heart health, most people with MVP can look forward to a good quality of life. If you have concerns or symptoms, speak with your doctor or cardiologist for individualised advice.
