Mitral Valve Prolapse – Diagnosis and Treatment
Diagnosis
Doctors often find mitral valve prolapse (MVP) during a routine checkup. They may hear a clicking sound or a murmur when listening to the heart with a stethoscope.
This sound comes from the mitral valve flapping backward into the upper heart chamber.
To confirm MVP and check how the valve is working, doctors may order the following tests:
- Echocardiogram (Echo): This is the main test for MVP. It uses sound waves to create pictures of the heart and shows if the valve flaps bulge into the upper chamber. It also shows if any blood is leaking backward (regurgitation).
- Electrocardiogram (ECG): Checks for changes in the heart’s rhythm or signs of strain on the heart.
- Chest X-ray: May be used to look at the heart’s size or check for fluid in the lungs if regurgitation is severe.
- Stress Test or Exercise Test: Shows how well the heart works during activity and helps doctors assess symptoms like shortness of breath or fatigue.
- Cardiac MRI: In special cases, this test gives a detailed view of the heart and valves to measure the severity of the problem.
MVP may not cause any symptoms or health problems, but doctors will monitor for changes over time. People with moderate or severe regurgitation may need follow-up visits and repeat imaging to check heart function.
Treatment
Medicine Options
People with mitral valve prolapse (MVP) who have little or no symptoms usually do not need medicines. When treatment is needed, doctors choose medicines based on the symptoms or problems the person has.
Medications help manage heart rhythm irregularities, high blood pressure, or complications like atrial fibrillation or heart failure.
Common medications for MVP include:
| Medication Type | Purpose |
|---|---|
| Beta blockers | Slows the heartbeat and relaxes blood vessels. |
| Diuretics (water pills) | Removes extra salt and fluid from the body. |
| Antiarrhythmics | Helps control irregular heartbeats. |
| Blood thinners (anticoagulants) | Lowers risk of blood clots and stroke. |
| Antibiotics | Prevents endocarditis in certain situations. |
- Beta blockers slow the heartbeat and lower blood pressure. These medicines help with symptoms like palpitations or dizziness from arrhythmias.
- Diuretics reduce fluid buildup in people with heart failure symptoms.
- Antiarrhythmic drugs help people with serious irregular heart rhythms maintain a normal heartbeat.
- Blood thinners prevent blood clots and lower the risk of stroke in patients with atrial fibrillation. If someone has an artificial (mechanical) mitral valve, they must take blood thinners for life.
- Antibiotics are not necessary for most people with MVP. However, doctors may prescribe antibiotics before dental visits or certain medical procedures for those with a valve replacement to prevent a heart infection called infective endocarditis.
Doctors recommend regular checkups to watch for changes in heart function. Care providers also use tests like echocardiograms, electrocardiograms (ECG), or stress tests to check valve function, regurgitation, and heart rhythm.
Valve Surgery and Minimally Invasive Procedures
Most people with mitral valve prolapse do not need surgery, especially if they have no symptoms or only mild regurgitation.
If the mitral valve becomes very leaky (severe regurgitation), surgeons might need to fix or replace the valve.
Surgical procedures include:
- Mitral Valve Repair: Surgeons usually prefer this because it saves a person’s own heart valve. They may cut away floppy parts (flail leaflet), fix or replace cords (chordae tendineae), or reshape parts of the valve.
- Mitral Valve Replacement: If surgeons cannot repair the valve, they remove and replace it. Replacement valves may be mechanical (lasting a long time but needing lifetime blood thinners), or made from tissue (biologic valves from cow, pig, or human heart).
Surgeons use both open-heart and minimally invasive techniques. Minimally invasive surgery uses smaller cuts, which can lead to less blood loss and a faster recovery.
People with MVP might also undergo a valve-in-valve procedure if a biological tissue valve wears out over time. Doctors use a heart catheter to put a new valve inside the old one, avoiding open surgery.
Heart care teams use imaging with echocardiography, a cardiac MRI, and other tests to help decide when to operate and to check for problems like heart failure or arrhythmias.
Regular monitoring helps catch any worsening symptoms, including shortness of breath, fatigue, or dizziness.
Lifestyle and Monitoring
Most people with MVP can live normal, active lives. Regular cardiac evaluations (echocardiograms, ECGs) help monitor valve function.
Healthy habits like maintaining a healthy weight, limiting caffeine, and avoiding stimulants may reduce symptoms like palpitations. People with MVP should inform their doctor about any new or worsening symptoms such as shortness of breath, fatigue, or chest pain.
