Mitral valve prolapse is a structural change in the mitral valve of the heart. Rather than closing tightly, one or both flaps of the valve billow into the left atrium of the heart.
People sometimes refer to this condition as Barlow’s syndrome or floppy valve syndrome. Most of the time, mitral valve prolapse causes few symptoms or complications initially. In some people, it does not cause any symptoms at all.
However, mitral valve prolapse may get worse over time. When it does, it can increase the risk of serious heart problems, including infections, life-threatening arrhythmia, and congestive heart failure.
As a result, a doctor who specializes in conditions relating to the heart, called a cardiologist, should continue to monitor a person with a diagnosis of mitral valve prolapse.
In this article, we explain what causes mitral valve prolapse and how to treat it.
The mitral valve is one of four valves in the heart. Valves control the flow of blood between the heart’s chambers.
The mitral valve sits between two chambers of the heart: the left atrium and the left ventricle. It controls blood flow from the atrium into the ventricle.
When the mitral valve functions correctly, it closes completely when the left ventricle contracts. In doing so, it prevents blood from moving back up into the left atrium, and the blood flows forward instead.
In people with mitral valve prolapse, the mitral valve structure is abnormal. As a result, blood may move from the left ventricle into the left atrium as the heart contracts due to the billowing of the flaps, or leaflets. This backward leakage of blood is called mitral regurgitation.
The amount of blood that backs up into the left atrium varies among people with the condition. In rare cases, a significant amount of blood regurgitates into the left atrium, causing problems.
Mitral valve prolapse occurs due to an abnormality of the mitral valve. Common abnormalities that cause mitral valve prolapse include:
- The leaflets of the mitral valve may be unusually long.
- The mitral valve opening may have become stretched and no longer close entirely.
- The leaflets of the valve may be too loose, causing them to push back into the atrium of the heart.
Doctors are not sure of the root cause, but they suspect that it might involve genetics. Many people with mitral valve prolapse have it from birth, and the condition tends to run in families.
Other people can get it as the heart “ages,” and the valve leaflets stretch and degenerate.
Some people with connective tissue disorders, such as Marfan syndrome, might also have mitral valve prolapse.
Many people with mitral valve prolapse will never experience symptoms. The diagnosis will often come as a surprise.
However, some people develop symptoms that get worse over time. These symptoms can vary from person to person, but may include the following:
- palpitations, or the feeling of the heart skipping a beat or beating too hard
- a racing heart
- irregular heartbeat
- dizziness or lightheadedness
- shortness of breath
- a cough
- chest pain and discomfort that is not due to a heart attack or another heart condition
Anyone with these symptoms should seek a consultation with a doctor.
In very rare cases, complications can occur and may include the following:
- heart failure
- infection of the inner tissues of the heart
Complications are rare, and most people with mitral valve prolapse can lead normal healthy lives.
Many other conditions cause symptoms similar to those of mitral valve prolapse. Anyone experiencing severe chest pain should seek emergency care to rule out a heart attack.
Most people discover that they have mitral valve prolapse during a stethoscope exam in a routine doctor’s visit. The doctor may detect a heart murmur with a clicking sound.
After detecting the sound, a doctor is likely to request tests to confirm the diagnosis and assess the severity of the condition. These tests may include:
- an echocardiogram
- an exercise stress echocardiogram
- an electrocardiogram (EKG), a test that records electrical impulses of the heart
People with mitral valve prolapse often do not need treatment. However, a doctor may recommend treatment if a person with mitral valve prolapse is experiencing symptoms or has a significant amount of blood regurgitating into the left atrium.
Several treatment options are available depending on the severity of the prolapse and symptoms. Treatments include the following options:
- close surveillance
In most cases, mindful management is sufficient to treat mitral valve prolapse. With this approach, a person with mitral valve prolapse will visit their doctor regularly for checkups and report any new symptoms that suggest that the condition is getting worse. They may also get regular echocardiograms.
If a person has a more severe case of mitral valve prolapse that causes symptoms, a doctor may prescribe medications to help manage the condition, although this approach has limited effectiveness.
A doctor may prescribe drugs called beta-blockers for people who only experience palpitations with minimal backflow.
For more significant symptoms or backflow, a doctor may prescribe a combination of medications, including:
- blood thinners to reduce the risk of blood clots, if the person has an arrhythmia called atrial fibrillation
- vasodilators to relax the blood vessels
- diuretics to remove excess sodium and fluid
- medications to regulate the heartbeat
A doctor may recommend surgery to treat mitral valve prolapse if:
- severe regurgitation is occurring
- the amount of regurgitation is progressing over time
- the heart muscle is starting to dilate or become weak
- significant symptoms are present that do not respond to medications
A doctor will generally only recommend surgery if a large amount of blood is moving back up into the atrium and causing severe symptoms or leading to other, more serious complications.
A surgeon might use open-heart surgery or a less invasive technique. The options for surgery include:
- Mitral valve repair: This procedure tightens the valve leaflets and helps stop blood flowing backward.
- Valve replacement: Surgeons may need to replace valves that it is not possible to repair with prosthetic valves.
- MitraClip: A minimally invasive procedure that “staples” the leaflets of the valve together to decrease the leakiness.
In most cases, mitral valve prolapse is not serious or life-threatening. Many people who have the condition experience no symptoms at all.
However, the condition may get worse over time and cause symptoms to develop.
Anyone who feels any sharp chest pain should speak to a doctor about it.
Do any other heart conditions cause mitral valve prolapse?
Endocarditis or prior infection of the heart valve can damage it, potentially resulting in abnormal mitral valve structure and function. Degenerative mitral valve prolapse is not genetic and can occur in older adults.Dr. Payal Kohli, MD, FACC Answers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.