Mitral Valve Prolapse

Mitral valve prolapse is a common heart condition that affects millions of people worldwide, yet many don’t even know they have it. While most cases are harmless and require no treatment, understanding this condition can help you manage your heart health and know when to seek medical attention.

Table of contents

• What Is Mitral Valve Prolapse?
• Other Names for This Condition
• Affected Parts of the Heart
• How Common Is This Condition?
• What Causes Mitral Valve Prolapse?
• Who Is More Likely to Develop This Condition?
• Signs and Symptoms
• Possible Complications
• How Doctors Diagnose Mitral Valve Prolapse
• Treatment Options
• Living With Mitral Valve Prolapse

What Is Mitral Valve Prolapse?

Mitral valve prolapse is a type of heart valve disease that affects the valve between the left heart chambers^[1]. To understand this condition, it helps to know how your heart works.

Your heart has four chambers and four valves. These valves act like one-way gates that control blood flow through your heart^[7]. The mitral valve (the valve affected in this condition) sits between the upper left chamber called the left atrium and the lower left chamber called the left ventricle^[2].

The mitral valve has two tissue flaps called leaflets that open and close with each heartbeat. These leaflets open to let blood flow from the left atrium into the left ventricle. Then they close tightly to prevent blood from flowing backward^[7].

In mitral valve prolapse, the leaflets of the mitral valve are floppy and bulge backward into the left atrium like a parachute when the heart squeezes^[1]. The leaflets and the strings that hold them in place (called chordae tendineae) become too stretchy^[2]. Think of it like a parachute with broken or overstretched strings—when it fills with air, parts of it don’t hold properly^[14].

Sometimes this bulging causes blood to leak backward through the valve from the left ventricle into the left atrium. This backward flow is called mitral regurgitation^[1]. However, most people with mitral valve prolapse don’t have any backflow, and the condition doesn’t cause health problems^[7].

Other Names for This Condition

Barlow syndrome, Billowing mitral valve syndrome, Click-murmur syndrome, Floppy valve syndrome, Mitral prolapse, Myxomatous mitral valve disease, Systolic click-murmur syndrome, Floppy mitral valve syndrome, Billowing mitral leaflets

Affected Parts of the Heart

• Mitral valve
• Left atrium
• Left ventricle
• Chordae tendineae
• Valve leaflets

How Common Is This Condition?

Mitral valve prolapse is a common heart condition. It affects about 2% to 3% of the general population^[2]. In the United States, approximately 7 to 8 million people have this condition, and more than 16 million people worldwide are affected^[4].

The condition can affect people of all ages. Many people are born with it, and it often runs in families^[7]. Mitral valve prolapse is more common in females, but males are more likely to develop severe mitral valve regurgitation (the leaking of blood backward)^[2].

What Causes Mitral Valve Prolapse?

The main cause of mitral valve prolapse is weakness in the valve tissue, a condition called myxomatous degeneration^[2]. This weakness makes the valve tissue abnormally thick or floppy, preventing it from closing tightly.

It’s not always clear what causes this tissue weakness. In many cases, the condition is genetic, meaning families may pass it down to their children through their genes^[2]. Researchers have linked mitral valve prolapse with several specific genes, including FLNA, DCHS1, DZIP1 and PLD1^[2].

Mitral valve prolapse can occur as an isolated condition (called primary mitral valve prolapse) or as part of other health conditions (called secondary mitral valve prolapse)^[4]. The most common cause is weakness in the tissue of the valve, which is genetic^[5].

Some connective tissue disorders may cause the valve tissue weakness. Connective tissue is material in your body that supports and connects different structures. These disorders include Marfan syndrome, Ehlers-Danlos syndrome, and Loeys-Dietz syndrome^[2]. Other conditions associated with mitral valve prolapse include osteogenesis imperfecta, pseudoxanthoma elasticum, and aneurysms-osteoarthritis syndrome^[4].

Who Is More Likely to Develop This Condition?

Anyone can have mitral valve prolapse, but certain factors increase the risk^[7]. You may be more likely to develop this condition if you:

• Are older. The risk increases as aging affects the valve^[7].
• Had rheumatic fever, a disease that can develop after a strep throat infection and cause damage to the heart valves^[7]. Rheumatic heart disease may also increase the risk^[2].
• Were born with a connective tissue disorder, such as Marfan syndrome or Ehlers-Danlos syndrome^[7].
• Have Graves’ disease, a type of thyroid condition^[7].
• Have scoliosis (a side-to-side curve of the spine) or other problems with the bones of your body^[7].
• Have some types of muscular dystrophy^[7].
• Have polycystic kidney disease or pectus excavatum^[4].

Most people who have mitral valve prolapse were born with it. The condition tends to run in families, though researchers don’t know the exact cause^[7].

Signs and Symptoms

Many people with mitral valve prolapse don’t have any symptoms at all. They feel fine, and the condition doesn’t cause them any problems^[7]. In fact, most people don’t even know they have it^[2]. The condition is often discovered during a routine physical examination when a doctor hears an unusual sound while listening to the heart with a stethoscope^[1].

When symptoms do occur, they can vary widely from one person to another. Symptoms may develop gradually^[1]. Common symptoms of mitral valve prolapse include:

• Heart palpitations. These can feel like bursts of rapid heartbeat, skipping beats, or an awareness of your heartbeat^[2]. You might feel that your heart is fluttering or beating too hard or too fast^[7].
• Shortness of breath. You may feel like you can’t get enough air, especially during exercise or when lying flat^[1]. This can happen when you exert yourself^[2].
• Chest pain^[2].
• Dizziness or lightheadedness^[1].
• Fatigue. You may feel tired and weak all over^[5]. Because some blood flows backward, you may feel tired and lack energy, thinking you’re just getting older. You might need to rest more than usual^[14].
• A cough^[7].
• Anxiety^[7].
• Migraines (severe headaches)^[7].

It’s important to know that people who have symptoms of mitral valve prolapse might not have a severe form of the condition. Symptoms and severity don’t always go hand-in-hand^[2]. Still, if you experience any of these symptoms, it’s important to tell a healthcare provider about them.

If blood is leaking backward into the upper chamber (left atrium), it also goes into the lungs. This can cause pressure to build in the lungs, causing congestion. Lung congestion may cause you to feel short of breath when doing physical activities, such as walking up or down stairs or hills, carrying groceries or doing laundry^[14].

When the pressure in the lungs becomes high, it may cause a different heart valve called the tricuspid valve to leak. If this happens, you may have swelling in your ankles and legs^[14].

Possible Complications

Usually, mitral valve prolapse isn’t life-threatening and doesn’t require treatment or lifestyle changes^[1]. However, in rare cases, the condition can cause other problems.

The main complication of mitral valve prolapse is mitral regurgitation. This means blood leaks the wrong way through your valve from your left ventricle into your left atrium^[2]. Mitral valve prolapse is one of the most common causes of mitral regurgitation^[2]. If the leak is severe enough, you may need surgery or a procedure to help your valve work as it should.

Mitral valve prolapse can be associated with significant mitral valve regurgitation (4%), bacterial endocarditis, congestive heart failure, and even sudden death^[4]. However, these complications are rare. In rare cases, mitral valve prolapse may present with sudden cardiac death, endocarditis, or a stroke^[4].

People who have mitral valve prolapse and regurgitation are at risk for complications, including^[2]:

• Heart failure. This is a condition where the heart can’t push enough blood out to the body^[7].
• Infective endocarditis. This is an infection in the lining of the heart and heart valves^[7].
• Atrial fibrillation. This is a type of abnormal heart rhythm (arrhythmia)^[2]. If the left atrium becomes enlarged, it may trigger this irregular heart rhythm, which can make your mitral valve symptoms worse. If you develop atrial fibrillation, you can develop a blood clot because your atria are not squeezing as they should. If the blood clot breaks off, it can cause a stroke or another serious health event^[14].
• Ventricular arrhythmias, which can lead to sudden cardiac death^[2].
• Stroke^[2].

When patients come to surgery for severe mitral valve prolapse, about 4 in 10 have developed atrial fibrillation, and about 1 or 2 in 10 have developed a tricuspid valve with a severe leak^[14].

How Doctors Diagnose Mitral Valve Prolapse

Healthcare providers often find mitral valve prolapse during routine health check-ups^[7]. If you have mitral valve prolapse, your provider may hear a clicking sound when listening to your heart with a stethoscope^[7]. This clicking sound is an abnormal heart sound caused by the malfunction of the mitral valve^[20].

If blood flows backward through the valve, your heart may also make a whooshing sound called a heart murmur^[7]. A heart murmur is an abnormal heart sound caused by turbulent blood flow^[20].

To confirm the diagnosis of mitral valve prolapse, your health care provider will usually do a physical exam and listen to your heart^[8]. You may also need certain heart tests:

Echocardiogram (also called an echo). This is the most useful test for diagnosing mitral valve prolapse^[7]. An echocardiogram is a painless test that uses sound waves to create images of the heart in motion^[8]. It can help determine the severity of the prolapse and whether blood is leaking backward through the valve^[20]. A standard echocardiogram, also called a transthoracic echocardiogram (TTE), can confirm a diagnosis of mitral valve prolapse and determine its severity. Sometimes, a transesophageal echocardiogram (TEE) may be done to get more-detailed images of the mitral valve. In this type of echocardiogram, a small device attached to the end of a tube is inserted down the tube leading from the mouth to the stomach^[8].

Chest X-ray. A chest X-ray shows the condition of the heart and lungs. It can help show if the heart is enlarged^[8].

Electrocardiogram (ECG or EKG). This quick and painless test measures the electrical activity of the heart. An ECG can detect irregular heart rhythms (arrhythmias) related to mitral valve disease^[8].

Exercise or stress tests. These tests often involve walking on a treadmill or riding a stationary bike while the heart is monitored with ECG. Exercise tests help reveal how the heart responds to physical activity and whether mitral valve prolapse symptoms occur during exercise. If you’re unable to exercise, you might be given medications that mimic the effect of exercise on the heart^[8]. If it is unclear whether or not you are experiencing symptoms with the degree of blood leaking backward, a treadmill stress test for exercise tolerance can be performed to demonstrate that you can walk vigorously without symptoms^[11].

Cardiac catheterization. This test isn’t often used to diagnose mitral valve prolapse, but it can be helpful if other tests haven’t diagnosed the condition^[8].

If you have symptoms such as chest pain, dizziness or palpitations, further tests may be needed to determine the cause^[20]. An ambulatory 24-hour Holter monitor may be useful for detecting irregular heart rhythms^[11].

Treatment Options

Most people don’t need any treatment for mitral valve prolapse^[7]. As long as mitral valve prolapse is not causing any symptoms, no treatment is needed^[20]. Many people can lead normal, healthy lives with proper management and care^[4].

If you have symptoms with little or no backflow, you may only need medicine to relieve your discomfort^[7]. Medical therapy has a limited role in patients with mitral valve prolapse because the underlying process is a degenerative valve that requires intervention^[11].

People with evidence of mild mitral valve disease should be reassured of their benign prognosis. They should undergo initial echocardiography for risk assessment. If no clinically significant blood leaking and thin leaflets are observed, clinical examinations and echocardiographic studies can be scheduled every 3-5 years. If echocardiography demonstrates leaflet thickening, which is considered a high-risk feature, these patients should be followed with annual echocardiograms^[11].

Treatment options include:

Medications. If you have symptoms, your doctor may prescribe:

• Beta-blockers, such as propranolol, metoprolol or atenolol, to treat symptoms like chest pain or palpitations^[20]. A trial of beta-blockers for symptom relief can be recommended in patients with palpitations or other symptoms^[11]. If your heart beats too fast, your doctor may give you a beta-blocker to slow it and ease your symptoms^[5].
• Medicines to help your heart work better^[7].
• In some cases, medication may be prescribed to manage symptoms such as palpitations, chest pain, or high blood pressure^[4].

Medical management should be focused on treating any related high blood pressure and/or heart failure with guideline-directed medical therapy, especially in patients with reduced heart pumping function^[11].

Surgery. If the amount of backflow is significant, you may need treatment to prevent other heart problems from developing^[7]. Some people may need medications or surgery, especially if the prolapse causes severe regurgitation^[1]. If mitral valve prolapse turns into severe mitral regurgitation, the defective mitral valve may need to be repaired or replaced^[20].

Heart surgery to repair or replace a very abnormal mitral valve with backflow may be needed. The goal of surgery is to improve your symptoms and reduce your risk of developing heart failure. When possible, valve repair is generally preferred^[7]. This can be done with open-heart surgery. A newer option is to repair the faulty valve from inside the heart using a small tube called a catheter equipped with a device to anchor the mitral valve’s leaflets in place^[20].

People with moderate-to-severe blood leaking and heart chamber enlargement, especially those with atrial fibrillation and/or pulmonary hypertension, should undergo surgery before heart function deteriorates^[11]. Early referral to cardiothoracic surgery in a center experienced with mitral valve interventions is recommended^[11].

Doctors once recommended that people with mitral valve prolapse take antibiotics before having dental work and other procedures. New guidelines from the American Heart Association say that antibiotics are no longer recommended for people with mitral valve prolapse^[20]. However, if you have had a heart valve replaced, your provider may have you take antibiotics before a dental procedure to prevent a heart valve infection^[18].

Living With Mitral Valve Prolapse

While there is no cure for mitral valve prolapse, most people with the condition can lead normal lives with proper management^[4]. With proper treatment and lifestyle modifications, individuals with mitral valve prolapse can continue to enjoy a good quality of life^[21].

Regular follow-up care. It’s important for individuals with mitral valve prolapse to have regular check-ups with a cardiologist to monitor their heart health and assess for any changes in symptoms or valve function^[4]. Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor if you are having problems^[17].

Lifestyle modifications. Adopting a heart-healthy lifestyle can help manage mitral valve prolapse and reduce the risk of complications^[4]. This includes:

• Eating a balanced diet. Eat heart-healthy foods that are low in saturated fats, cholesterol, and sodium, and rich in fruits, vegetables, and whole grains^[4]. These foods include vegetables, fruits, nuts, beans, lean meat, fish, and whole grains. Limit sodium, alcohol, and sugar^[17].
• Regular exercise. Engaging in regular physical activity can help strengthen the heart and improve overall cardiovascular health^[4]. People with minimal mitral valve disease should be encouraged to pursue a normal, unrestricted lifestyle, including vigorous exercise^[11]. Be active. If you have not been active before, talk with your doctor before starting an exercise program. Try for 2½ hours of activity a week. Walking is a good choice. You also may want to do other activities, such as running, swimming, cycling, or playing tennis or team sports^[17]. Your doctors do not want you to lose muscle mass and become weak. Listen to your body and try to keep up your physical activity. Even mild to moderate exercise such as walking, biking and swimming can help. A routine exercise program will also help you notice a change in symptoms such as feeling short of breath sooner than if you were inactive^[18].
• Not smoking. Avoiding tobacco is important^[4]. If you need help quitting, talk to your doctor about stop-smoking programs and medicines^[17]. Abstinence from stimulants such as caffeine, alcohol, and cigarettes is also recommended^[11].
• Limiting excessive alcohol consumption^[4].
• Staying at a healthy weight. Lose weight if you need to^[17].
• Managing other health problems, such as diabetes, high blood pressure, and high cholesterol^[17]. Keeping your blood pressure under good control is especially important to slow the progression of mild or moderate mitral regurgitation^[18].
• Getting vaccinated. Get vaccinated against COVID-19, influenza (flu), and pneumonia^[17]. Preventing infection is important^[18].

Monitoring for complications. Individuals with mitral valve prolapse should be aware of potential complications and seek prompt medical attention if symptoms develop^[4]. See your cardiology team if your symptoms change^[18].

Specific tips for managing symptoms:

• Take all your medication as prescribed—especially the diuretics (water pills). Diuretics can be a nuisance because they cause you to urinate more often, but the fluid is better out than in^[18].
• Keep tabs on weight changes. Weigh yourself at the same time every morning after you go to the bathroom and before you eat breakfast, then write it down. If you notice a weight gain of 2-3 pounds overnight or 5 pounds in a week, call your doctor. He or she may want to adjust the dosage of your water pill^[18].
• Watch your salt intake. Because of your leaky mitral valve, you are prone to retain too much fluid. Salt, or sodium, acts like a sponge, and water is trapped inside your body. While it’s a good idea to avoid the salt shaker, processed and restaurant foods are the main source of sodium in our diets^[18].

When to seek help. Call your doctor or seek immediate medical care if you have new or increased shortness of breath^[17]. Watch closely for changes in your health, and be sure to contact your doctor if you are not getting better as expected.

Emotional well-being. Living with a chronic condition like mitral valve prolapse can sometimes take a toll on mental health. It’s normal to experience feelings of anxiety, stress, or fear about the condition and its potential complications. Seeking support from loved ones, joining support groups, or talking to a mental health professional can be helpful in coping with these emotions^[4].