What is Mitral Valve Prolapse?

One of the more challenging aspects of my practice of cardiology is having to explain to patients that a diagnosis made by their general doctor many years before may not be accurate. Many patients carry the label of mitral valve prolapse (MVP) for 20+ years, diagnosed by a primary care doctor who heard a murmur, without echocardiogram verification and labeled them as having MVP. More often than not, this label is incorrect, and impacts their psychological well-being, in addition to making it more difficult for them to obtain life insurance due to having a “cardiac condition”. The emotional and mental stigma of having a “heart condition” is frightening to people, and can influence their willingness to partake in physical activities and just live their lives for fear of some future cardiac event. I have lost track of how many patients have come to me as new patients, carrying this diagnosis, only to find out that their echocardiogram shows no evidence of prolapse of their mitral valve, and that their heart is functioning properly.

In cardiology, we have diagnostic tools that illustrate the structure of the heart with a high degree of accuracy. Echocardiograms are very valuable tools that show us the size of the cardiac chambers, the movement of the valves, the degree of leakage of the valves, the thickness of the heart muscle, and the overall strength of the heart muscle. We can visualize the mitral valve as if we were looking down on it, and we can also visualize the mitral valve as if we sliced it in a long axis, like slicing an apple from stem to bottom.

The mitral valve of the heart is the “door” that regulates the flow of oxygenated blood from the left atrium to the left ventricle. Valve movements are dictated by pressure gradients – there is no neurologic control or “logic” built in that tells the valve when to open or close – when the pressure above the valve exceeds the pressure below the valve, it opens. When the pressure below the valve exceeds that above the valve, it closes. Prolapse of the mitral valve occurs when the leaflets of a closed mitral valve bulge up into the atrium. See the diagram below showing the mitral valve leaflets in red.

In some cases, the mitral valve may have some leakage where the bulging leaflets meet. Previously, cardiology practice guidelines recommended prescribing antibiotics for these patients prior to dental procedures. Recently, the guidelines have been updated and antibiotics are not recommended for routine dental cleanings. Primary mitral valve prolapse can occur from lengthening of the tendon tissues that connect the valve leaflets to the heart muscle. It can also occur if the leaflets themselves are excessively large, thickened, or have fibrin deposits on the leaflets. Secondary mitral valve prolapse, which is MVP that occurs as a direct result of another condition including a heart attack that compromises the blood flow to the papillary muscle, rheumatic valve disease, valve leaflet infection, or thickened heart muscle disease such as Hypertrophic Obstructive Cardiomyopathy. Thyroid conditions such as Graves disease, connective tissue disease such as Marfans, and spine disease like scoliosis can make one more likely to develop mitral valve prolapse. The condition affects both genders, as well as people of all ages.

Symptoms of mitral valve prolapse include palpitations, dizziness, chest pain, racing heartbeat or shortness of breath. Management focuses on treating the symptoms, since most patients never develop any complications from this condition. Occasionally, valve leakage, heart rhythm abnormalities can occur. In rare conditions, mitral valve infection called endocarditis can occur. Clearly, those conditions need medical treatment, since they can be life threatening if left untreated. Common medications used to treat prolapse with regurgitation include diuretics, beta blockers, and anti-arrhythmic agents. If atrial fibrillation is present, blood thinners may be required to reduce risk of a stroke. We have even seen the development of “Mitral Valve Centers” where they claim to specialize in mitral valve disorders and frequently prescribe antidepressants and anxiolytics (“nerve pills”) to patients under the assumption that there is a significant anxiety component to this disease. This practice has never been validated in the medical literature, and I would advise against the routine use of addictive anxiety medication for this condition.

If you have symptoms of mitral valve prolapse, a cardiac evaluation can definitively tell if you have this condition, or not. The medications available for treatment are effective, and allow patients to live full lives, with no restrictions on activity. Mitral valve prolapse without heart muscle pathology or symptoms is usually harmless, and does not affect life expectancy. Mitral valve prolapse with structural damage to the valve apparatus can be readily treated to help restore normal valve function. Daily physical exercise, staying well hydrated and eating a heart-healthy diet along with regular heart checkups are the most important things you can do to prevent this condition from limiting you.

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