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- Severe pain, weakness or tingling in your leg(s).
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- Unexplained fever, nausea or vomiting.
- A history of cancer or unexplained weight loss.
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Mitral Valve Prolapse
Overview
You have 4 heart valves located within the 4 chambers of your heart. Normal valves open and close tightly with each heartbeat. The mitral valve allows blood to flow in only one direction, from your upper left atrium to the lower left ventricle.
Mitral valve prolapse happens when the leaflets, or flaps, of the valve do not close tightly and become floppy. Most of the time, there are no symptoms. In some cases, there is a backflow of blood from the left ventricle upward into the left atrium (mitral regurgitation), which can cause symptoms.
A physical exam and echocardiogram can usually diagnose your heart valve problem. Most of the time, no treatment is needed. Medication and lifestyle changes may sometimes be needed to help manage your condition. If you start to have symptoms of mitral regurgitation with the prolapse, you will probably need heart surgery to either repair or replace the valve.
Your treatment will be supported by a team of doctors, which may include a cardiologist and heart surgeon.
Symptoms
Most people with mitral valve prolapse will have no symptoms, and no treatment is needed. Other people will develop symptoms if there is mitral regurgitation. The common symptoms are:
- Shortness of breath, especially with activity
- A heartbeat that is uneven (fast, slow, or skipping)
- Dizziness
- Chest pain
Rarely, the valves can become infected (endocarditis) or cause blood clots to be formed, which could cause a stroke.
Causes
Mitral valve prolapse is usually caused by a congenital condition that is present at birth. It can occur if you had polycystic kidney disease or Marfan syndrome.
Diagnosis
A test as simple as an echocardiogram may be used to diagnose your heart valve problem. Other tests can also help us diagnose your condition:
- Physical exam. We listen for a clicking sound or a heart murmur. However, a heart murmur does not necessarily mean that you have an abnormal valve. Most murmurs are found in people with normal valves.
- Electrocardiogram (ECG/EKG). We will check your heart rate, heart rhythm, and the size of the heart chambers.
- Chest X-ray. We are looking to see whether you have an enlarged heart or if your valve is calcified or stiffened.
- Echocardiogram. We use sound waves to examine how your heart works while it beats. The test shows the size and shape of your heart valves and heart muscle, how well your heart pumps blood, and any stiffness or leakage of your valves.
- Cardiac catheterization. We check the function of your heart valves and measure any leakage through the valves. For this test, we thread a small catheter into one of your blood vessels and into your heart.
- Transesophageal echocardiogram (TEE). We get a better picture of the heart by using this test. We will place a wand in a special tube down your throat and into your food pipe (esophagus).
- Exercise stress test. We have you exercise on a treadmill or bicycle while we monitor your heart, blood pressure, and symptoms.
- Stress echocardiogram. We will be able to see if the heart valve problem is affecting the ability of your heart to work hard. This test is performed before and after you exercise, usually on a treadmill.
- Cardiac MRI. We can determine the type of surgery you may need by using a powerful magnet to make images of your heart.
Treatments
There are a variety of treatments available for mitral valve prolapse, depending on the symptoms you are having and how severely the valve function is affected.
Lifestyle changes
Making and maintaining changes in your daily habits may sometimes be enough to control mild symptoms. We recommend that you cut back on caffeine, avoid tobacco, practice stress reduction, and get aerobic exercise on most days. You may be instructed to avoid competitive sports if you have symptoms with your mitral valve prolapse.
Medications
Medications may be necessary to control your symptoms and improve blood flow through the heart:
- Diuretics get rid of excess water.
- Beta blockers help to slow the heart rate, control palpitations, and improve blood flow.
- ACE inhibitors lower the blood pressure and relax and widen the blood vessels to help the heart beat more easily.
- Calcium channel blockers and vasodilators allow the blood to flow more easily.
- Digoxin may be helpful for shortness of breath and controlling an irregular heart rate.
- Blood thinners and/or aspirin are used to prevent and treat blood clots.
Over time, we will keep an eye on your symptoms and the results of certain tests, to decide when to recommend valve repair or replacement.
- Surgery will typically be recommended if you begin to have heart symptoms.
- An echocardiogram may be done periodically if you begin to have symptoms to watch for changes to the valve.
- A treadmill exercise test might be done to find out if you are unable to exercise as easily or if you become more short of breath.
Surgery
Surgery to repair or replace the valve may be needed in some cases of severe mitral regurgitation. Although valve repair is usually preferred with mitral valve prolapse, if the valve is replaced, the choice of valve to be used will be determined by you and your surgeon and will depend on your age, your willingness to take blood thinners for the rest of your life, and the size of your valve. There are 2 types of valves used:
- Mechanical metal valves last longer but require the lifelong use of blood thinners.
- Bioprosthetic valves made from human, cow, or pig tissues do not last as long as mechanical valves but do not require the use of blood thinners.
Prevention
There are several ways that you can lower your risk for mitral valve prolapse.
Treat strep throat promptly. Call or e-mail us if you think you may have strep throat symptoms, such as a red and painful throat, fever, or white spots on your tonsils. Also, please follow our directions and take all of your antibiotics if we prescribe them.
Practice good dental hygiene. Brush and floss your teeth every day and have your teeth cleaned at the dentist's office regularly. The more you prevent bacteria from building up on your teeth and gums, the safer you will be from infection to your heart valves.
Use antibiotics. Before certain dental procedures or surgeries, antibiotics may be recommended to you if you are at risk for endocarditis and have:
- An artificial heart valve
- Certain congenital (present at birth) heart defects
- A history of infective endocarditis
- Valve problems after a heart transplant
Control your cholesterol and risks for heart disease:
- If you use tobacco, quit.
- Exercise regularly.
- Take medicines to lower your cholesterol if necessary.
- Eat a heart-healthy, low-fat diet.
- Control your blood pressure.
- Maintain your ideal weight if possible.
- Control your blood sugar if you have diabetes.
Additional References:
- External Link to Heart Valve Surgery
- External Link to Marfan Syndrome
- External Link to Polycystic Kidney Diseases - Health Encyclopedia
- PDF Link to Bacterial Endocarditis: The Disease, Treatment, and Prevention
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- Mitral Valve Repair or Replacement (Emmi) Mitral Valve Repair or Replacement (Emmi)
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This information is not intended to diagnose health problems or to take the place of specific medical advice or care you receive from your physician or other health care professional. If you have persistent health problems, or if you have additional questions, please consult with your doctor. If you have questions or need more information about your medication, please speak to your pharmacist. Kaiser Permanente does not endorse the medications or products mentioned. Any trade names listed are for easy identification only.