Staten Island Heart's Doctors, Board Certified Cardiologists, Specializing in the treatment, care and prevention of Cardiovascular Disease. Located in Staten Island, New York.
Mitral Valve Prolapse
What is mitral valve prolapse?
The mitral valve is a heart valve made of two tissue leaflets. It is located between the left atrium and the left ventricle, the upper and lower chambers on the left side of the heart. Mitral valve prolapse occurs when, instead of closing normally to form a flat surface, one or both leaflets prolapse, or bulge, up into the left atrium. If the prolapse is severe, the leaflets may not close properly and may allow leakage of blood through the valve.
How does it occur?
Mitral valve prolapse is a very common valve abnormality in adults. It occurs in more than 5% of the population. Prolapse usually affects only the mitral valve. The valve leaflets are stretched lengthwise and are thickened and no longer close normally. Another type of prolapse occurs in people with hereditary diseases of connective tissue. These individuals have abnormal elasticity of their skin and other body tissues, as well as skeletal abnormalities. Among this group are people with Marfan syndrome or with Ehlers-Danlos syndrome. Prolapse of otherwise-normal mitral valve leaflets can occur when the muscles that control and support the valve become damaged by a heart attack or scar tissue.
What are the symptoms?
The majority of people with mitral valve prolapse have no symptoms as a result of the abnormality. Some types of chest pain, shortness of breath, anxiety, and panic attacks seem to be associated with mitral prolapse. The reason for these symptoms is not well understood. The most common symptom is chest palpitations, irregular heartbeats of which the person is very aware. Symptoms of dizziness, near fainting, and low blood pressure together with low body weight can occur with mitral valve prolapse. Other features in people with this disorder are bone abnormalities of the spine, a hollow chest, and long fingers and toes.
How is it diagnosed?
A careful physical examination is required. With heart muscle contraction, the stretched valve leaflets create a "click" sound that can be heard with a stethoscope. If there is some leakage of the valve, a heart murmur can be heard. Your doctor may ask you to stand, sit, lie down, or squat during examination to better hear the subtle sounds.
The echocardiogram, an ultrasound examination of the heart, is the best way to confirm mitral valve prolapse. The picture generated by the sound waves shows the prolapse, any thickening of the valve leaflets, and any leakage of blood through the prolapsed valve. It also identifies a set of patients with severely thickened and stretched valve leaflets who are at a higher risk of serious complications.
What are the complications?
The constant beating of the heart stresses the abnormal mitral valve structure and may result in worsening leakage of blood through the valve. This leakage is called mitral regurgitation. It may worsen with time and seems to be more common in men and in people with high blood pressure. In a few cases, the mitral regurgitation may become severe enough to require heart valve replacement surgery, but this is unusual.
Occasionally, a portion of the tissue strands that support the mitral valve will be overstretched and will rupture, causing a sudden increase in mitral regurgitation. If the regurgitation is severe enough, valve surgery may be necessary. Prolapsed heart valves have a tendency to become infected, particularly if mitral regurgitation is present. Infection accelerates the valve damage and worsens the disease. Your doctor may give you antibiotics at appropriate times to reduce this risk. Heart rhythm abnormalities are common. Most are minor and of no concern except when they cause symptoms. There does seem to be a slightly higher risk of sudden cardiac death in mitral valve prolapse patients if significant mitral regurgitation is present. It is not known whether the heart rhythm abnormalities lead to the higher risk. Some studies have shown a slight increase in the risk of stroke for people with mitral prolapse. The true risk is unknown.
What is the treatment?
Most people with mitral valve prolapse require no treatment at all. If you have associated mitral regurgitation, preventive antibiotics should be taken prior to dental procedures or insertion of instruments or tubes into your urinary tract. The heart rhythm abnormalities associated with mitral valve prolapse sometimes become very uncomfortable. In such cases, drugs such as beta-blockers may be very effective. No drug is yet known that reliably reduces the slightly increased risk of sudden death in people with prolapse. If stroke like symptoms have been noted, the use of an aspirin a day is recommended. Aspirin use is probably not necessary or helpful for those people who do not have stroke like symptoms. Severe mitral regurgitation from mitral valve prolapse may eventually require heart valve replacement surgery.
How does it occur?
Mitral valve prolapse is a very common valve abnormality in adults. It occurs in more than 5% of the population. Prolapse usually affects only the mitral valve. The valve leaflets are stretched lengthwise and are thickened and no longer close normally. Another type of prolapse occurs in people with hereditary diseases of connective tissue. These individuals have abnormal elasticity of their skin and other body tissues, as well as skeletal abnormalities. Among this group are people with Marfan syndrome or with Ehlers-Danlos syndrome. Prolapse of otherwise-normal mitral valve leaflets can occur when the muscles that control and support the valve become damaged by a heart attack or scar tissue.
What are the symptoms?
The majority of people with mitral valve prolapse have no symptoms as a result of the abnormality. Some types of chest pain, shortness of breath, anxiety, and panic attacks seem to be associated with mitral prolapse. The reason for these symptoms is not well understood. The most common symptom is chest palpitations, irregular heartbeats of which the person is very aware. Symptoms of dizziness, near fainting, and low blood pressure together with low body weight can occur with mitral valve prolapse. Other features in people with this disorder are bone abnormalities of the spine, a hollow chest, and long fingers and toes.
How is it diagnosed?
A careful physical examination is required. With heart muscle contraction, the stretched valve leaflets create a "click" sound that can be heard with a stethoscope. If there is some leakage of the valve, a heart murmur can be heard. Your doctor may ask you to stand, sit, lie down, or squat during examination to better hear the subtle sounds.
The echocardiogram, an ultrasound examination of the heart, is the best way to confirm mitral valve prolapse. The picture generated by the sound waves shows the prolapse, any thickening of the valve leaflets, and any leakage of blood through the prolapsed valve. It also identifies a set of patients with severely thickened and stretched valve leaflets who are at a higher risk of serious complications.
What are the complications?
The constant beating of the heart stresses the abnormal mitral valve structure and may result in worsening leakage of blood through the valve. This leakage is called mitral regurgitation. It may worsen with time and seems to be more common in men and in people with high blood pressure. In a few cases, the mitral regurgitation may become severe enough to require heart valve replacement surgery, but this is unusual.
Occasionally, a portion of the tissue strands that support the mitral valve will be overstretched and will rupture, causing a sudden increase in mitral regurgitation. If the regurgitation is severe enough, valve surgery may be necessary. Prolapsed heart valves have a tendency to become infected, particularly if mitral regurgitation is present. Infection accelerates the valve damage and worsens the disease. Your doctor may give you antibiotics at appropriate times to reduce this risk. Heart rhythm abnormalities are common. Most are minor and of no concern except when they cause symptoms. There does seem to be a slightly higher risk of sudden cardiac death in mitral valve prolapse patients if significant mitral regurgitation is present. It is not known whether the heart rhythm abnormalities lead to the higher risk. Some studies have shown a slight increase in the risk of stroke for people with mitral prolapse. The true risk is unknown.
What is the treatment?
Most people with mitral valve prolapse require no treatment at all. If you have associated mitral regurgitation, preventive antibiotics should be taken prior to dental procedures or insertion of instruments or tubes into your urinary tract. The heart rhythm abnormalities associated with mitral valve prolapse sometimes become very uncomfortable. In such cases, drugs such as beta-blockers may be very effective. No drug is yet known that reliably reduces the slightly increased risk of sudden death in people with prolapse. If stroke like symptoms have been noted, the use of an aspirin a day is recommended. Aspirin use is probably not necessary or helpful for those people who do not have stroke like symptoms. Severe mitral regurgitation from mitral valve prolapse may eventually require heart valve replacement surgery.
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