Understanding Mitral Valve Prolapse

There has been a lot of confusion about this common cardiac diagnosis

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Mitral valve prolapse (MVP) is a common cardiac diagnosis. Unfortunately, it is also one of the most commonly misunderstood. So, if you have been told you have MVP, it is important for you to understand what it is, what problems it may cause (and not cause), and what you should do about it.

What Is MVP?

MVP is a congenital abnormality that produces an excess of tissue on the mitral valve (the valve that separates the left atrium from the left ventricle). This excess of tissue allows the mitral valve to become somewhat “floppy.” As a result, when the left ventricle contracts, the mitral valve can partially prolapse (or flop) back into the left atrium. This prolapse allows some of the blood in the left ventricle to flow backwards (that is, to regurgitate) into the left atrium. (Learning about the heart's chambers and valves can help you better understand this process.)

There is often a genetic predisposition to MVP. If a person has true MVP, it is likely that as many as 30 percent of his/her close relatives may also have it.

How Is MVP Diagnosed?

Often, MVP is first suspected when the doctor hears a classic "click-murmur" sound while listening to a person’s heart. The click is caused by the snapping sound made by the prolapsing of the mitral valve; the murmur is caused by the subsequent regurgitation of blood back into the left atrium. The diagnosis of MPV is confirmed with an echocardiogram.

It is now clear that in the early decades of echocardiography, cardiologists were overexuberant in diagnosing MVP. That is, they detected a certain amount of what they deemed to be mitral valve prolapse in people whose mitral valves were actually functioning within the range of normal. Consequently, many thousands of people whose hearts were actually normal were inappropriately diagnosed with this form of heart disease. In fact, in some studies up to 35 percent of all people tested were said to have MVP. The vast majority of these people actually had no, or only trivial amounts, of actual prolapse.

In recent years, the echocardiographic criteria for diagnosing MVP have been formally tightened up. Subsequent studies have shown that the actual incidence of “real” MVP is roughly 2 percent to 3 percent of the general population. 

Unfortunately, it seems clear that some physicians still habitually over-diagnose this condition.

Why Is MVP Significant?

MVP can produce two different types of clinical problems. It can lead to a significant degree of mitral regurgitation, and it can make a person more prone to develop infectious endocarditis (infection of the heart valve).

The significance of MVP is almost entirely related to how much mitral regurgitation it is causing. Significant mitral regurgitation (which, again, is a leaky mitral valve) eventually can lead to enlargement of the cardiac chambers, weakening of the heart muscle, and ultimately, to heart failure. Fortunately, the large majority of people with MVP do not have significant mitral regurgitation—only about 10 percent of people with MVP will ever develop serious mitral regurgitation over their lifetimes.

While people with MVP do have a somewhat increased risk of developing infectious endocarditis, that risk is still very small. In fact, because endocarditis is so rare, the most recent guidelines from the American Heart Association no longer recommend prophylactic antibiotics for patients with MVP.

What Is the Prognosis With MVP?

The vast majority of patients with MVP can expect to lead completely normal lives, without any symptoms due to their MVP, and without any decrease in life expectancy. In general, the prognosis is closely related to the degree of mitral regurgitation that is present. Most patients with MVP who have minimal mitral regurgitation have an excellent prognosis.

What Other Clinical Problems Have Been Attributed to MVP?

Because MVP is so commonly diagnosed (even when it may not actually be present), it has been associated with a myriad of conditions that probably do not really have anything to do with the MVP itself. The confusion arose in the early days of echocardiography, when MVP was being grossly over-diagnosed. Whenever a patient complained of certain symptoms or problems, doctors would order an echocardiogram—and about 35 percent of the time, they would find “MVP.” So numerous clinical problems have been blamed on MVP over the past few decades, when an actual clinical association may not be there at all.

Here are the more common conditions that have been associated with MVP, but whose actual relationship to MVP is tenuous at best:

Anxiety, chest painpalpitations. While it is commonly believed that MVP causes these symptoms, most individuals with MVP do not experience them, and most individuals with anxiety, chest pain, and palpitations do not have MVP. A true association with MVP has never been demonstrated.

Stroke or sudden death. It has never been shown that MVP itself causes either stroke or sudden death, or that the incidence of MVP is higher than normal in patients who experience these problems. While patients with severe mitral regurgitation from any cause have an increased risk of stroke and sudden death, those with mild MVP probably have the same risk as the general population. Read more about MVP and sudden death.

The dysautonomia syndromes. The dysautonomia syndromes, which include such things as chronic fatigue syndromevasovagal (or neurocardiogenic) syncopepanic attacksfibromyalgia, and irritable bowel syndrome, are often blamed on MVP. It is not at all clear that people with MVP actually have an increased risk of developing symptoms associated with the dysautonomias (such as palpitations, anxiety, fatigue, aches, and pains). But in their desperation to make a diagnosis in patients complaining of such symptoms, and thus ordering every test known to man, doctors have found (naturally) that a proportion of these difficult patients have MVP. Doctors have thus coined the phrase "Mitral Valve Prolapse Syndrome" to explain it. Whether the MVP itself actually has anything to do with these symptoms is very doubtful.

A Word From Verywell

If you have been told you have MVP, you should make sure you understand from your physician the degree of mitral regurgitation you have, and that your doctor has outlined a schedule for follow-up evaluations. If you have no mitral regurgitation, you simply need to have a physical examination every five years or so. If there is some degree of significant mitral regurgitation, yearly echocardiograms ought to be considered.

If you also have symptoms such as chest pain or palpitations, these symptoms ought to be evaluated as separate issues. If your doctor merely writes these symptoms off as being due to MVP, without ever performing a fuller evaluation, consider seeking another opinion.

If you think you may have one of the dysautonomia syndromes, make sure your doctor is well-versed in managing these conditions. Don't waste time with a doctor who seems too willing to write off your symptoms as "just part of MVP." The dysautonomias are real, honest-to-goodness physiologic disorders, which are separate from MVP, and which deserve to be treated and not brushed off.

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