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Mitral Valve Prolapse - MVP

Understanding this commonly diagnosed problem

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Updated November 13, 2011

Written or reviewed by a board-certified physician. See About.com's Medical Review Board.

Mitral valve prolapse (MVP) is one of the most common cardiac diagnoses. 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 occurs when a congenital abnormality in the mitral valve allows it to flop (i.e., to prolapse) back into the left atrium as the left ventricle contracts, thus allowing a certain amount of backflow of blood (i.e. regurgitation) from the ventricle to the atrium. In general, the problem in MVP is an excess of tissue on the mitral valve, making it "floppy." Often, MVP is first suspected when the doctor hears a classic "click-murmur" sound while listening to your heart (the click being caused by the prolapsing of the mitral valve; the murmur by the subsequent regurgitation of blood). The diagnosis is confirmed with an echocardiogram.

In the past, MVP has been grossly over-diagnosed - up to 35% of patients in some reports were said to have MVP. However, careful studies have now shown that the actual incidence is roughly 2% to 3% of the general population. It seems likely, however, that many physicians still greatly over-diagnose this condition.

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

Why is MVP Significant?

Two clinical problems are caused directly by MVP: significant mitral regurgitation, and infectious endocarditis(i.e., infection of the mitral valve).

Mitral regurgitation can lead to enlargement of the cardiac chambers, weakening of the heart muscle, and ultimately, to heart failure. Fortunately, MVP usually does NOT cause significant mitral regurgitation; about 90% of patients with true MVP will NEVER develop significant mitral regurgitation over their lifetimes.

The risk of developing infectious endocarditis increases any time a leaky valve is present within the heart. Fortunately, endocarditis associated with MVP is quite rare. 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 longevity. 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 common, it has been associated with a myriad of conditions that probably do not have anything to do with the MVP itself. Here are the more common conditions that have been associated with MVP, but whose actual relationship to MVP is tenuous at best:

Anxiety, chest pain, palpitations. 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.

The dysautonomia syndromes: chronic fatigue syndrome, vasovagal (or neurocardiogenic) syncope, panic attacks, fibromyalgia. (Click here for a review of dysautonomia.) It is not at all clear that patients with MVP actually have an increased risk of developing symptoms associated with the dysautonomias (palpitations, anxiety, fatigue, aches and pains). But in their desperation to make a diagnosis in patients complaining of such symptoms, and thus by 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 whatever to do with these symptoms is very doubtful.

If You Have MVP

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. Those with no regurgitation simply need to have a physical examination every five years or so; those with some degree of significant regurgitation ought to have repeat echocardiograms yearly.

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 an 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 deserve to be treated and not brushed off.

Sources

# Avierinos, JF, Gersh, BJ, Melton LJ 3rd, et al. Natural history of asymptomatic mitral valve prolapse in the community. Circulation 2002; 106:1355.

Kim, S, Kuroda, T, Nishinaga, M, et al. Relation between severity of mitral regurgitation and prognosis of mitral valve prolapse: Echocardiographic follow-up study. Am Heart J 1996; 132:348.

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