Mitral valve prolapse

Mitral valve prolapse, also known as Barlow syndrome, is a type of heart valve disease in which the flaps (also called leaflets or cusps) of the mitral valve become enlarged or stretched. These enlarged flaps bulge (prolapse) into the left atrium as the heart contracts with each heartbeat.

The mitral valve controls the flow of blood from the heart’s left atrium to the left ventricle. A prolapsed mitral valve means that the valve’s flaps do not always fit and close properly between each beat of the heart, which may cause the valve to leak blood backward through the valve back to the left atrium. This condition is called mitral valve regurgitation.

Mitral valve prolapse often exists without symptoms. Some people with a prolapsed mitral valve have mild symptoms that develop gradually over time. If noticeable symptoms do develop, they are usually related to the blood leaking (regurgitating) back into the valve.

Symptoms may vary depending on the severity of the prolapse and include:

• Racing heartbeat: you’ll feel an irregular heartbeat, also known as cardiac arrhythmia.
• Dizziness: you’ll feel lightheaded.
• Difficulty breathing: you may have shortness of breath during exercise or when lying down.
• Fatigue: physical exertion may cause you to feel extremely tired.
• Chest pain: you may have discomfort in your chest that is not caused by a heart attack or coronary artery disease.

Check in with your healthcare provider if you are experiencing symptoms related to mitral valve prolapse.

There is not much known about the cause of mitral valve prolapse. It is a lifelong disorder that affects approximately three percent of the population. Women are twice as likely to be diagnosed as men, but the condition can develop at any age. Mitral valve prolapse can run in families as an inherited cardiovascular disease and may be linked to several other conditions, including:

• Marfan syndrome
• Ehlers-Danlos syndrome
• Ebstein anomaly
• Muscular dystrophy
• Graves’ disease
• Scoliosis

Mitral valve prolapse is often noticed during a routine examination with your healthcare provider. Your doctor may hear a click or heart murmur (abnormal sounds during the heartbeat) while examining your heart. The clicking sound comes from stretched valve flaps “snapping” against each other. The murmur is the sound of blood leaking back into your left atrium.

Your doctor will order additional testing such as echocardiography and cardiovascular imaging techniques to diagnose mitral valve prolapse. The diagnostic testing used includes:

• Transthoracic echocardiogram (TTE): as the most common type of echocardiogram, this test uses ultrasound sound wave technology to create images of your heart in its current state.
• Electrocardiogram (ECG or EKG): an electrocardiogram records the heart’s electrical signals using electrodes that are attached to the chest.
• Chest X-ray: a chest radiograph displays a projection of the chest and its contents to help diagnose conditions that may be affecting it.
• Stress test: stress tests are used to assess how your heart works during increasingly difficult physical activity. This test is paired with an electrocardiogram to analyze heart activity.

Many people with a prolapsed mitral valve can live a normal life without disruption from symptoms. However, the mitral valve is the heart valve most prone to degenerative valve disease. There are certain lifestyle choices to avoid when living with mitral valve prolapse to prevent the condition from worsening and possibly needing surgical intervention. Things to avoid include:

• Smoking
• Unhealthy diet and weight
• Sedentary lifestyle (no exercise)
• Not maintaining follow-up care and physical exams with your doctor
• Neglecting management or treatment of other health conditions, especially those that can affect heart health or cause endocarditis

Mitral valve prolapse is usually not a life-threatening condition. Unless the condition is causing mitral regurgitation or symptoms that are disruptive to their quality of life, people with a prolapsed mitral valve can typically proceed without immediate treatment.

Severe mitral regurgitation caused by prolapse may require surgery or symptoms management with medication. If severe mitral valve prolapse and regurgitation are not treated, the heart is forced to work harder to pump normally and compensate for the blood that is leaking from the valve. This extra work can eventually lead to heart failure.

Most people with mitral valve prolapse will not need valve surgery unless it causes severe mitral regurgitation. Whether your mitral valve prolapse is mild or severe, your treatment at Penn may include:

• Regular monitoring: our cardiac team and expert imaging professionals monitor your disease progression during regular appointments. we’ll also educate you about how to prevent infective endocarditis, an infection that causes damage to heart valves.
• Medication: your doctor may prescribe medications that will control your heart rate, drain fluid from your lungs and prevent blood clots to address uncomfortable symptoms like chest pain.
• Surgery: approximately 10 to 15 percent of people with mitral valve prolapse require mitral valve repair and replacement surgery to repair the valve.