RELATED STORIES • Video: Echocardiogram • Echocardiogram: Sound imaging of the heart • Mitral valve stenosis • Mitral valve regurgitation HEART & BLOOD Cardiovascular System • Aortic aneurysm • High blood pressure (hypertension) • High blood cholesterol • Thrombophlebitis • Rheumatic fever • Varicose veins • Heart arrhythmias • Atrial fibrillation • Endocarditis • Aortic valve stenosis • Aortic valve regurgitation • Mitral valve stenosis • Mitral valve regurgitation • Pulmonary hypertension • Raynaud's disease • Long QT syndrome • Mitral valve prolapse • Pericarditis • Cardiomyopathy • Myocarditis • Arteriosclerosis / Atherosclerosis • Peripheral arterial disease (PAD) • Low blood pressure (hypotension) • Aortic dissection • Lymphedema • Pulmonary valve stenosis • Ventricular septal defect (VSD) • Tetralogy of Fallot • Coarctation of the aorta • Atrial septal defect (ASD) • Patent ductus arteriosus (PDA) • Left ventricular hypertrophy • Bundle branch block • Heart murmurs • Patent foramen ovale • Transposition of the great arteries • Hypoplastic left heart syndrome • Sudden cardiac arrest • Prehypertension • Tricuspid atresia • Ebstein's anomaly • Buerger's disease

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Mitral valve prolapse (MVP) is a disorder that affects one of your heart's valves — the mitral valve. It occurs when the valve doesn't close correctly, allowing backward leaking of blood in your heart.

Mitral valve prolapse affects slightly more than 2 percent of the adult population in the United States. Men and women appear to develop MVP in similar numbers.

In most people, MVP is harmless and doesn't require any changes in lifestyle. It also doesn't shorten your life expectancy. In some people with MVP, however, the progression of the disease requires treatment.

Although MVP is a lifetime disorder, many people with this condition never have signs and symptoms. When diagnosed, people may be surprised to learn that they have a heart abnormality because of the absence of signs and symptoms.

When signs and symptoms do occur with MVP, they can vary widely from one person to another. They tend to be mild, develop gradually and may include:

• A racing or irregular heartbeat (arrhythmia)
• Dizziness, lightheadedness
• Difficulty breathing or shortness of breath, often when lying flat or after physical exertion
• Fatigue
• Chest pain that's not associated with a heart attack or coronary artery disease

When your heart is working properly, the mitral valve opens and closes to regulate the movement of blood between your heart's upper left chamber (left atrium, or holding chamber) and the lower left chamber (left ventricle, or pumping chamber). But in some people, their mitral valve malfunctions, bulging (prolapsing) like a parachute into their left atrium each time the heart pumps or contracts. The bulging may keep the valve from closing tightly. As a result, rather than all of the blood flowing normally in one direction, some blood may leak back into the atrium.

Another name for mitral valve prolapse is click-murmur syndrome. When a doctor listens to your heart using a stethoscope, he or she may hear a clicking sound as the valve's leaflets billow out, as well as a murmur resulting from blood flowing back into the atrium. Doctors also use other names to describe MVP, including:

• Barlow's syndrome
• Floppy valve syndrome
• Ballooning mitral valve syndrome

There may be a hereditary component to MVP in some people, and the condition frequently runs in families. People with Marfan syndrome as well as those with connective tissue disorders tend to have an increased susceptibility to MVP.

If you have MVP, the flaps of your mitral valve may be oversized or thickened. Women who develop MVP are often thin and have curvature of the spine (scoliosis) or minor skeletal abnormalities of the chest wall. Some also may have a hole in the walls separating the upper heart chambers, a condition called atrial septal defect.

If you develop what may appear to be the signs or symptoms of MVP, contact your doctor. If you've already been diagnosed with this disorder, see your doctor if your symptoms worsen.

Most frequently, doctors diagnose mitral valve prolapse during young adulthood. Your doctor is most likely to detect MVP during a routine examination of your heart using a stethoscope. If MVP is present, he or she may hear abnormal sounds, such as a characteristic clicking noise that suggests MVP. This clicking sound typically occurs midway through the beating portion of each heartbeat cycle, followed by a murmur or whooshing noise. The clicking sound is made by the flapping of the mitral valve's leaflets, and the murmur is associated with the backward flow of blood into the atrium.

To confirm the diagnosis, you may undergo an echocardiogram, which is a noninvasive, ultrasound (sonar) evaluation of your heart. This test uses high-frequency sound waves to create a picture of your heart and its structures, including the mitral valve itself and the flow of blood through it. The amount of leakage (regurgitation) can be measured.

In some cases, you may need to undergo additional tests to provide more details about your heart's valves and help in the diagnosis, including ruling out other conditions of the heart. These tests may include:

• Chest X-ray. With an X-ray of your chest, your doctor can study the size and shape of your heart, which may point to a problem such as a malfunctioning valve.
• Electrocardiogram (ECG). In this test, patches with wires (electrodes) are attached to your skin to measure the electrical impulses produced by your heart. Impulses are recorded as waves displayed on a monitor or printed on paper. Among other data, an ECG gives information about your heart rhythm.
• Transesophageal echocardiogram. This type of echocardiogram allows an even closer look at the mitral valve. The esophagus, the tube that runs from your throat to your stomach, lies close to your heart. In a traditional echocardiogram, a wand-like device (transducer), which produces the sound waves necessary to create the image of your beating heart, is moved across your chest. In a transesophageal echocardiogram, a small transducer attached to the end of a tube is inserted down your esophagus. Because your esophagus lies close to your heart, having the transducer there provides a clear picture of the mitral valve and blood flow through it.
• Doppler ultrasound. By measuring the changes in pitch (frequency) of ultrasound waves bouncing off the red blood cells moving through your heart or blood vessels, this type of ultrasound provides information about the speed and direction of blood flow. This is particularly useful in assessing your heart valve function. A computer tracks blood flow through your heart. It then presents this information as part of a two-dimensional image, using colors to represent the direction and speed of blood flow.
• Cardiac catheterization. In this procedure, your doctor threads a thin tube (catheter) through a blood vessel in your arm or groin into your heart. The catheter is used to deliver dye into the heart chambers and the blood vessels of your heart. The dye, appearing on X-ray images as it moves through your heart, gives your doctor detailed information about your heart and heart valves, including blood flow and leakage. Some catheters used in cardiac catheterization have miniature devices (sensors) at the tips that can measure pressure within heart chambers, such as in the left ventricle.

Once you've received a diagnosis of MVP, your doctor may suggest testing for your first-degree relatives — parents, siblings and children —to determine if they also have this condition.

Although most people with MVP never have problems, complications can occur. Complications tend to occur in middle-aged or older adults. They may include:

• Mitral valve regurgitation. The most common problem is mitral valve regurgitation (mitral insufficiency) — a condition in which the valve is particularly leaky and allows excessive blood back into the left atrium. If the regurgitation is severe, surgery may be recommended to repair or even replace the valve in order to prevent the development of complications, such as congestive heart failure. This regurgitation of blood also increases the likelihood of acquiring an infection called bacterial endocarditis, which can affect the mitral valve or the heart's lining. Because of the risk of developing bacterial endocarditis, antibiotics are given to people with MVP who have also been diagnosed with significant mitral valve regurgitation around the time of dental procedures and certain types of surgery.
• Rhythm problems. Irregular heart rhythms can occur in people with MVP. These most commonly occur in the upper chambers of the heart and while they may be bothersome, they are not usually life-threatening. Doctors have reported cases of sudden cardiac death associated with MVP; however, such fatalities are extremely rare and are not necessarily related to the valve problem. When fatalities do occur, these sudden deaths appear to result from an arrhythmia. People with severe mitral regurgitation, or severe deformity of their mitral valve, are most susceptible to serious rhythm problems.

Most people with mitral valve prolapse, particularly people without any symptoms of MVP, don't require treatment.

If you develop symptoms, your doctor might prescribe certain medications to treat MVP-related chest pain or heart rhythm abnormalities. For example, doctors sometimes recommend drugs called beta blockers for irregular heartbeats, fast heartbeats or chest discomfort. Never stop taking these medications or change their dose without your doctor's approval.

Keeping others informed
Make sure your dentist or dental hygienist knows that you have mitral valve prolapse if you need to undergo dental work likely to cause gum bleeding, including routine cleaning. Also, tell your surgeon about your MVP before operations such as tonsillectomies, gallbladder surgery or prostate surgery. You may need to take a course of antibiotics before the treatment or surgery in order to reduce the risks of an infection. The prophylactic use of antibiotics destroys most of the bacteria that enter and travel through your bloodstream, thus preventing an infection of the heart valve. Amoxicillin is one of the most commonly prescribed medications for this use, but if you're allergic to the penicillin family of drugs, your doctor can choose other antibiotics instead, such as clindamycin, clarithromycin or azithromycin.

Precautions during pregnancy
If you're pregnant and have MVP, your chances of a successful, uncomplicated pregnancy are good. Even so, doctors sometimes recommend antibiotics during childbirth if there's a risk of an infection that could affect the mitral valve.

If you don't have MVP-associated signs or symptoms, and thus aren't receiving any treatment for this disorder, your doctor may still advise being rechecked every three to five years to monitor whether the condition has progressed to frank mitral regurgitation.

You can't prevent mitral valve prolapse. However, you can lower your chances of developing the complications associated with it — particularly bacterial infections that may occur during surgery or dental treatments — by letting your doctor or dentist know that you have MVP. When appropriate, you'll receive prophylactic antibiotics before any procedures. If you develop any signs and symptoms of a bacterial infection — including fever, chills or headaches — or if you develop shortness of breath, contact your doctor.

Most people with MVP lead normal, productive and symptom-free lives. Doctors generally won't recommend any restrictions on your lifestyle or any limitations on your personal exercise or dietary program.