Mitral valve prolapse is a heart condition where the valve between two chambers on the left side of the heart doesn’t close as smoothly as it should, causing one of its flaps to bulge backward like a parachute. While this sounds alarming, the vast majority of people with this condition live completely normal lives without knowing they have it. In fact, doctors often discover it by chance during a routine checkup when listening to the heart.

Understanding How Common This Condition Is

Mitral valve prolapse affects a significant portion of the general population, though estimates vary depending on the study. According to research, approximately 2 to 3 percent of people worldwide have this condition, which translates to roughly 7 to 8 million individuals in the United States alone and more than 16 million people globally.^[1][2][4] This makes it one of the most common forms of heart valve disease that healthcare providers encounter in their practice.

The condition does not affect all groups equally. Women are more likely to be diagnosed with mitral valve prolapse than men, though interestingly, men who have the condition face a higher risk of developing severe mitral regurgitation, which means blood leaking backward through the valve.^[2][7] The condition can occur at any age, and some people are born with it. As people get older, the risk of mitral valve prolapse may increase because aging naturally affects the valve’s structure and function over time.^[7]

What Causes the Valve to Behave This Way

The underlying problem in mitral valve prolapse is a weakness in the valve’s tissue, a process doctors call myxomatous degeneration. This term describes changes that make the valve leaflets—the flaps that open and close—too stretchy or floppy. Think of it like a door hinge that has become loose over time and no longer fits snugly in its frame.^[2]

In many cases, the exact reason why this tissue weakness develops remains unclear. However, genetics plays an important role. The condition often runs in families, meaning it can be passed down from parents to their children. Researchers have identified several genes that appear to be linked to mitral valve prolapse, including genes with names like FLNA, DCHS1, DZIP1, and PLD1.^[2] When the condition is inherited, it typically follows an autosomal dominant pattern, which means a person needs to inherit only one copy of the altered gene from one parent to develop the condition.

Some people develop mitral valve prolapse as part of a broader health issue. Certain connective tissue disorders—conditions that affect the proteins giving structure and support to skin, bones, blood vessels, and organs—can cause the valve tissue to become abnormally stretchy. These disorders include Marfan syndrome, a genetic condition affecting connective tissue throughout the body; Ehlers-Danlos syndrome, which causes very flexible joints and fragile skin; and Loeys-Dietz syndrome, another connective tissue disorder.^[2][4] Other health conditions that may increase the risk include rheumatic heart disease, which can develop after a strep throat infection damages the heart valves; Graves’ disease, a thyroid condition; and scoliosis, an abnormal curvature of the spine.^[2][7]

Groups at Higher Risk

While mitral valve prolapse can develop in anyone, certain factors increase the likelihood of having the condition. People with a family history of the condition face higher odds because of the genetic component. Those born with connective tissue disorders carry significant risk, as these conditions directly affect the valve’s structural integrity.^[2]

Individuals who had rheumatic fever as children may develop mitral valve prolapse later in life because this illness can permanently damage heart valves. People with Graves’ disease, a condition where the thyroid gland is overactive, also face elevated risk. Those with certain bone structure abnormalities, such as scoliosis or a chest deformity called pectus excavatum (where the breastbone appears sunken), show higher rates of the condition as well.^[2][4]

Age is another consideration. While people can be born with mitral valve prolapse, the risk increases as the valve experiences wear and tear over decades. Women develop the condition more frequently than men, though researchers don’t fully understand why this gender difference exists. However, among those who have mitral valve prolapse, men are more likely to experience progression to severe leaking of the valve, which may require surgical intervention.^[2]

Recognizing the Symptoms

The overwhelming majority of people with mitral valve prolapse experience no symptoms whatsoever. Many individuals live their entire lives without realizing they have the condition because it causes no noticeable problems. The valve continues to function well enough that blood flows properly through the heart, and daily activities proceed without difficulty.^[1][2]

However, some people do develop symptoms, and these can vary widely from one person to another. When symptoms appear, they often develop gradually rather than suddenly. One common symptom is heart palpitations, which people describe as feeling like their heart is racing, fluttering, skipping beats, or pounding harder than usual. These sensations can be unsettling, even though they may not indicate serious danger.^[1][2]

Chest pain or discomfort is another possible symptom, though it differs from the crushing chest pain associated with heart attacks. Instead, people might feel sharp, brief pains or a general achiness in the chest area. Shortness of breath can occur, especially during physical exertion like climbing stairs, walking uphill, or exercising. Some individuals notice they become tired more easily than before, lacking their usual energy for daily tasks.^[1][2]

Dizziness or lightheadedness may happen occasionally, and some people report experiencing severe headaches called migraines. A smaller number might develop a persistent cough or notice swelling in their ankles and legs if the condition progresses to affect other parts of the heart.^[1][7]

Steps to Prevent Complications

Since mitral valve prolapse is often inherited or develops due to other medical conditions, there is no guaranteed way to prevent the condition itself from occurring. However, people can take important steps to prevent complications and maintain heart health once they know they have the condition.^[7]

Maintaining a heart-healthy lifestyle forms the foundation of prevention. This means eating a balanced diet rich in fruits, vegetables, whole grains, and lean proteins while limiting foods high in saturated fats, salt, and added sugars. Such dietary choices help prevent high blood pressure and high cholesterol, which can worsen valve leaking if it occurs.^[17]

Staying physically active strengthens the heart and improves overall cardiovascular health. For most people with mitral valve prolapse, there are no exercise restrictions, and regular physical activity is encouraged. Activities like walking, swimming, or cycling for about two and a half hours per week can make a significant difference in heart health.^[17]

Not smoking is crucial because tobacco use damages blood vessels and worsens heart conditions. If someone smokes, quitting represents one of the most important steps they can take for their heart. Limiting alcohol consumption also helps, as excessive drinking can contribute to heart rhythm problems and high blood pressure.^[17]

Managing other health conditions properly prevents them from complicating mitral valve prolapse. This includes keeping blood pressure under good control, managing diabetes if present, and treating high cholesterol according to medical advice. Getting vaccinated against COVID-19, influenza, and pneumonia helps prevent infections that could strain the heart.^[7][17]

People who have had a heart valve replaced may need to take antibiotics before dental procedures to prevent a serious infection called endocarditis, which affects the heart’s lining and valves. However, antibiotics are no longer routinely recommended for most people with mitral valve prolapse alone.^[7]

Regular medical checkups allow doctors to monitor the valve’s condition over time and detect any changes early. Those with minimal disease and thin valve leaflets might only need checkups every three to five years, while those with thickened leaflets may require annual monitoring.^[11]

How the Condition Changes Normal Heart Function

To understand mitral valve prolapse, it helps to picture how the heart normally works. The heart has four chambers: two upper chambers called atria and two lower chambers called ventricles. Between these chambers are one-way valves that control blood flow, ensuring blood moves in the correct direction and doesn’t flow backward.^[7]

The mitral valve sits between the left atrium (the upper left chamber) and the left ventricle (the lower left chamber). This valve has two flaps, or leaflets, that function like a gate. When the left atrium fills with oxygen-rich blood from the lungs, the mitral valve opens, allowing blood to flow down into the left ventricle. Then, when the left ventricle contracts to pump blood out to the body, the mitral valve should snap shut tightly, preventing any blood from leaking back up into the left atrium.^[7]

The valve leaflets are connected to the heart muscle by cord-like structures called chordae tendineae, which work somewhat like the strings on a parachute. These cords keep the leaflets in position and prevent them from flipping inside out during the heart’s pumping action. In mitral valve prolapse, these cords may be too long, or in more severe cases, some of them may break. Additionally, the leaflets themselves are too floppy or thick.^[2]

When the left ventricle contracts in someone with mitral valve prolapse, instead of the leaflets meeting neatly to seal shut, one or both leaflets bulge backward into the left atrium. Picture a parachute where some strings have broken—that section of the parachute would billow out more than the rest. This bulging creates an imperfect seal, and in some cases, blood can leak backward through the gap.^[1]

When blood leaks backward, this is called regurgitation. In mild cases, only a small amount of blood leaks back, and the heart compensates easily without causing any problems. The person feels completely normal, and their body receives adequate blood supply. However, if the regurgitation becomes moderate or severe, several changes occur in the heart over time.^[2]

The left atrium receives extra blood—both the normal amount coming from the lungs and the abnormal amount leaking back from the left ventricle. This additional volume causes the left atrium to stretch and enlarge over time. When the atrium becomes enlarged, it may trigger an abnormal heart rhythm called atrial fibrillation, where the upper chambers quiver rapidly instead of beating regularly. This irregular rhythm can make symptoms worse and increases the risk of blood clots forming in the heart, which could lead to a stroke.^[2]

The left ventricle must work harder because not all of its blood reaches the body—some leaks back with each beat. Over time, this extra workload can cause the left ventricle to enlarge and potentially weaken, a condition called heart failure. When the heart muscle weakens, it cannot pump blood effectively, leading to fluid buildup in the lungs and body. This explains why some people with severe regurgitation develop shortness of breath, especially when lying flat, and swelling in their legs and ankles.^[2]

The increased pressure from blood backing up into the left atrium also affects the lungs. The left atrium connects to blood vessels in the lungs, and when pressure builds up, fluid can be pushed into the lung tissue, making breathing difficult. This is why people with significant valve leaking may feel short of breath during physical activity or even at rest in severe cases.^[14]

In rare instances, the abnormal valve structure and blood flow patterns can irritate the heart’s electrical system, leading to potentially dangerous irregular heart rhythms originating from the ventricles. These ventricular arrhythmias can, in extremely rare cases, lead to sudden cardiac death, though this complication is uncommon.^[2]

Another potential complication is infective endocarditis, an infection of the heart valve. Bacteria can sometimes attach to the abnormal valve tissue, especially if blood is flowing turbulently due to leaking. Once bacteria establish themselves, they form infected growths that damage the valve further and can spread infection throughout the body.^[2]

The good news is that these serious complications occur in only a small percentage of people with mitral valve prolapse. Most individuals experience either no regurgitation or very mild leaking that never progresses. Their hearts adapt to the minor abnormality without developing symptoms or requiring treatment. Only about 4 percent of people with mitral valve prolapse develop significant mitral regurgitation that requires medical intervention.^[4]