Mitral Valve Prolapse

Aka: Mitral Valve Prolapse, MVP

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II. Epidemiology

  1. Incidence: 2.4%

III. Pathophysiology

  1. Redundant valve tissue with elongated chordae tendineae

IV. Symptoms

  1. Chest Pain (occurs in 50% of those with MVP)
    1. Prolonged, sharp and non-exertional
    2. May mimic Angina
  2. Vague associated symptoms
    1. Palpitations
    2. Weakness
  3. Red Flags for problems associated with MVP
    1. Exertional Syncope
    2. Family History of Sudden Cardiac Death
    3. Arrhythmia with Exercise
    4. Marked Mitral Regurgitation

V. Signs

  1. Midsystolic click
    1. Results from sudden tensing of mitral valve
    2. Occurs as leaflets prolapse into left atrium
  2. Systolic Murmur
    1. Late systolic or holosystolic murmur
    2. Murmur prolonged with Valsalva
    3. Murmur decreased with squatting
  3. Timing of click and murmur
    1. Decreased end-diastolic volume (Standing)
      1. Click and murmur start just after S1 Heart Sound
    2. Increased end-diastolic volume (Squatting)
      1. Click and murmur start closer to S2 Heart Sound

VI. Diagnosis

  1. Electrocardiogram often abnormal
    1. Inverted T Waves in leads II, III, and AVF
  2. Holter Monitor
    1. Variety of Dysrhythmias
  3. Echocardiogram
    1. Mitral Valve Prolapse is a common echo finding
    2. New criteria based on three dimensional valve shape

VII. Management

  1. Reassurance
    1. Low Incidence of serious complications
  2. Symptomatic treatment
    1. Indications
      1. Chest Pain
      2. Palpitations
      3. Anxiety
    2. Medications
      1. Beta Blockers
  3. General measures
    1. Alcohol cessation
    2. Tobacco Cessation
    3. Caffeine cessation
  4. SBE Prophylaxis
    1. Indicated only if Mitral Regurgitation present

VIII. References

  1. Kondos (1998) CMEA Medicine Review Lecture, San Diego
  2. Assi (1998) Postgrad Med 104(6):99-110 [PubMed]
  3. Bonow (1998) Circulation 98:1949-84 [PubMed]
  4. Carabello (1997) N Engl J Med 337(1):32-41 [PubMed]
  5. Joy (1996) Physician and Sportsmed 24(7):78-86
  6. Shipton (2001) Am Fam Physician 63(11):2201-8 [PubMed]

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