What are the other Names for this Condition? (Also known as/Synonyms)

• Barlow's Syndrome
• Familial Mitral Valve Prolapse
• Prolapsed Mitral Valve (PMV)

What is Mitral Valve Prolapse? (Definition/Background Information)

• The heart pumps blood in and out of the heart. There are valves within the four heart chambers that control the blood flow and prevent it from flowing the wrong way
• If due to any reason, the mitral valve (located between the two left chambers controlling the blood flow out of the left ventricle, into the left atrium) does not close properly, then it leads to a common valvular heart disease called Mitral Valve Prolapse (MVP)
• This condition can be a precursor to some heart-related complications and may turn out to be either life-threatening, moderately serious, or a mild and asymptomatic condition
• Mitral Valve Prolapse can be caused by a host of conditions, such as hereditary factors, connective tissue disorders, scoliosis, adult polycystic kidney disease, endocarditis, rheumatic fever, and many others
• Individuals past the age of 50 years, have a greater chance of developing MVP. Nevertheless, it is found in all age groups

Who gets Mitral Valve Prolapse? (Age and Sex Distribution)

• The incidence of Mitral Valve Prolapse is around 1 in 20-50 (or may be higher)
• But, it is generally observed with an advancing age. Men over the age of 50 years and chronically thin women (with chest wall abnormalities) are higher prone to be affected by this defect
• MVP can occur as a congenital defect in young children too
• Individuals of all race and ethnic groups are affected

What are the Risk Factors for Mitral Valve Prolapse? (Predisposing Factors)

Some of the potential risk factors of Mitral Valve Prolapse include:

• Any damage to the heart valves, such as caused by endocarditis infection, rheumatic heart disease, or swelling of the heart ventricles, especially at a young age
• Stress and other physical factors causing a high blood pressure, leading to a coronary heart disease, congestive heart failure, etc.
• Certain diseases and disorders may cause the heart valves to widen. They include connective tissue disorders (such as Marfan syndrome and Ehlers-Danlos syndrome), Ebstein’s anomaly, scoliosis (curved spine disorder), and adult polycystic kidney disease
• Family medical history of MVP, mitral regurgitation, and certain other genetic disorders

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one's chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Mitral Valve Prolapse? (Etiology)

In a Mitral Valve Prolapse (also known as Click-Murmur Syndrome), either the valve flaps do not close completely (due to thickening or shortening of one of the flap/leaflet, or an extra tissue growth), or the valve slips out of its regular position during the blood flow process creating a gap between the two flaps.

Mitral Valve Prolapse is caused by a variety of factors, chiefly:

• Any heart valve abnormality that is inherent or congenital, such as pectus excavatum
• Injury to the heart valve, trauma - high blood pressure that damages the heart
• Rheumatic heart condition, infection of the heart (endocarditis), and heart failure
• Advancing age is a significant factor that causes a deterioration of the mitral valves
• Some of the associated conditions that cause a widening of the heart valves include connective tissue disorders (Marfan syndrome and Ehlers-Danlos syndrome), Ebstein’s anomaly, scoliosis, adult polycystic kidney disease, and Graves’ disease

What are the Signs and Symptoms of Mitral Valve Prolapse?

Mild Mitral Valve Prolapse can present itself without any symptoms for a long period. There is also a possibility that it might suddenly develop into a life-threatening situation. The signs and symptoms are usually noted when regurgitation of blood occurs (backward flow into the heart).

The signs and symptoms include:

• Unusual chest pain that is not caused by a heart condition
• Feeling of intense fear or feeling panicky
• Irregular heartbeat patterns, heart palpitations, arrhythmia (a click-murmur sound can be heard on using a stethoscope)
• Feeling of dizziness; feeling giddy or lightheaded
• Coughing due to breathing trouble, or shortness of breath, or rapid breathing - the symptoms occurring quite unexpectedly without much exertion or while sleeping
• Fatigue while exercising, or sometimes while in bed during the night

How is Mitral Valve Prolapse Diagnosed?

Early detection and treatment of the condition may not be essential, unless Mitral Valve Prolapse has the potential to lead to serious complications, progressing from a mild case to a severe one. A physical evaluation of the individual’s heart and body condition is undertaken once the physician suspects the disorder.

The basic sequence of diagnosis is:

• Evaluation of personal and family history for heart-related conditions
• Listening to the heartbeat, using a stethoscope, to detect any unusual sound (blood leakage through the valve, abnormal beats or sounds, heart murmur)
• Testing pulse rates and blood pressure values (typically, these values are within the normal range)

A cardiologist may then plan the type of tests that are required. Sometimes, various exercises are used to measure the heart’s response to physical activities. Other diagnostic tools include:

• A chest X-ray may reveal a swollen left ventricle. The size and shape of the heart can be also studied
• Echocardiogram, CT scan of the heart, Doppler’s study of blood flow of heart, and MRI scan of the heart are a few common imaging studies used
• A catheter may be inserted into the left ventricle of the heart to study or diagnose the condition, if the heart function does not appear encouraging
• Differential diagnosis may have to be considered, especially when other heart complications are present

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Mitral Valve Prolapse?

Complications due to mild Mitral Valve Prolapse are generally uncommon. But, if an individual is older and/or the MVP is severe, then certain serious complications could develop that include:

• Mitral valve regurgitation - when there is backflow of blood into the left atrium
• Endocarditis - a kind of heart infection caused by inflammation of the heart walls or inner linings
• Arrhythmias – the heart beats irregularly, which can be fatal at times
• Infrequently, blood clots may develop, which can travel to other vital organs such as the brain or lungs. This is called an arterial embolism

How is Mitral Valve Prolapse Treated?

Treatment of Mitral Valve Prolapse is based on the condition of the heart, the overall health condition of the individual, and the signs and symptoms presented (whether they are mild, moderate or severe). The treatment measures are:

• Mild forms of MVP do not require any management, but this is age-dependent
• If the case presents mild symptoms of mitral regurgitation; then, regular and periodic evaluation of the condition (using an echocardiogram) is prescribed. In such cases, being vigilant is important
• Medications to treat the symptoms include beta blockers (for irregular heartbeats), aspirin and anticoagulants (to prevent blood clot risks)
• Individuals, who are moderately affected are also administered medications, such as ACE inhibitors/beta-blockers, anticoagulants to prevent blood clots, drugs to control arrhythmias, and diuretics (substances that increase the rate of fluid flow from the body, also called water pills), in order to keep the medical condition under check and also to control the build-up of any fluid
• Surgical procedures, to either repair or replace the heart valves, are normally resorted to, when the symptoms and heart function do not appear too encouraging
• Surgery is also advocated to prevent mitral valve regurgitation from progressively worsening and creating life-threatening situations
• Avoidance of stressful situations and physical activities, keeping the blood pressure under control are particularly important
• Having a low-sodium diet is recommended and so is periodic and regular visits to your cardiologist or healthcare provider
• Pregnant women with Mitral Valve Prolapse may be administered antibiotics (after birth of the child) to prevent any MVP-associated infection risk

How can Mitral Valve Prolapse be Prevented?

Mitral Valve Prolapse may not be prevented; however, some of the risk factors that lead to the condition may be controlled and further, MVP prevented from causing any serious complications.

• Individuals with the condition have to always maintain their blood pressure in control and within acceptable levels, to prevent any valve regurgitation
• Germs in the bloodstream, due to poor oral hygiene, are a leading cause of endocarditis - a heart condition that causes damage to the heart valves. Hence, keeping the gums and teeth in good hygienic condition is essential
• Rheumatic heart condition is said to cause mitral regurgitation. Thus, taking care of your sore throat or bacterial throat infection, is one way to ensure that rheumatic fever does not develop
• Avoid smoking completely
• Follow a healthy diet for the heart
• Maintain a healthy body weight, avoid obesity
• Treat conditions that are causal factors for Mitral Valve Prolapse promptly and take the prescribed medications regularly

What is the Prognosis of Mitral Valve Prolapse? (Outcomes/Resolutions)

• Mild forms of Mitral Valve Prolapse are asymptomatic and it may not be noticed. This condition remains benign in most individuals and they can lead a normal life
• For cases that cause severe mitral regurgitation (which is a high-mortality component), surgical intervention is recommended. This can help rectify the defect, if no additional complications develop
• Under severe circumstances, if the treatment is delayed or is not provided, then it may be fatal for individuals with a heart failure, or those suffering from other heart conditions

Additional and Relevant Useful Information for Mitral Valve Prolapse:

• A healthy lifestyle improves the quality of heart life. Light exercising (walking, swimming, as recommended by the physician), periodic health check-ups (both with a cardiologist and a dentist), keeping blood pressure under control, using less salt in the diet, are all good and beneficial practices
• If MVP is present along with central nervous system functional issues, then it leads to a condition termed as Mitral Valve Prolapse Syndrome (MVPS)

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