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Mitral Valve Prolapse

A Message from the Heart to the Heart

Prepared by:
Dr.Ramy Khalil .MBBCH, University of Australia

Reviewed and edited by :
Dr. Abdulwahab Arrazaghi
(Specialist of Internal Medicine and Cardiovascular Diseases)
University of Toronto, Canada

Mitral Valve Prolapse

1. What is the mitral valve ?
The heart consists of 4 chambers, 2 atriums and 2 ventricles as illustrated in figure one. The chambers are separated by 4 valves that allow for the movement of blood throughout the different chambers. The mitral valve is the valve that separates the left atrium from the left ventricle. The mitral valve has 2 flaps that attach it to the walls of the ventricles by the chordae tendinea (like strings). When the heart contracts blood moves from the left atrium to the left ventricle via the mitral valve. The valve then shuts and blood moves to the rest of the body before returning back to the heart.

Description: http://upload.wikimedia.org/wikipedia/commons/thumb/e/e5/Diagram_of_the_human_heart_%28cropped%29.svg/230px-Diagram_of_the_human_heart_%28cropped%29.svg.png

2. What is mitral valve prolapse ?
When there is a problem with any aspect of the valve (e.g valve too large, chordae tendinane too long) the result is uneven closure of the valve and prolapsing/bulging backwards into the left atrium (like a parachute). This results in a small amount of blood leaking backwards to the atrium.

3. What causes mitral valve prolapse ?
In most cases there are no clear known factors that cause it. As we age calcium may deposit on the valve or extra tissue may form. This is may attribute to the prolapsing of the valve. Individuals with connective tissue disease (e.gMarfan's syndrome, Ehlers Danlos syndrome) are at a greater risk of developing mitral valve prolapse.

4. What are the symptoms of mitral valve prolapse ?
60% of individuals with mitral valve prolapse have no symptoms. Situations that cause stress to the heart may result in symptoms. Situations of stress include child birth, viral/bacterial illness, job/emotional distress etc. Symptoms include:

  • Chest pain, anxiety
  • Fatigue
  • Palpitations (fast irregular heart beats felt as pounding/fluttering in the chest)
  • Dizziness/light headedness
  • Shortness of breath

5. How is it diagnosed ?
Echocardiography (ultrasound of the heart) is the best way to diagnose this condition. It allows for 2D and 3D visualisation of the heart to be viewed. The valve is assessed for thickness and displacement. Clinically it may produce a clicking sound which may be heard with the use of a stethoscope.

6. How is it treated?What is the outcome of this condition?
Mitral valve is a common structural abnormality. It is thought to affect 2-3% of the general population. It is more common in women and is diagnosed around the age of 20 to 40 years. For most people this disease is not life threatening and requires no lifestyle modification or treatment.

At the discretion of the caring physician symptomatic individuals may benefit from medications. These include medications that slow down the heart rate (e.g beta blockesr) and blood thinners (e.g aspirin and warfarin).

If the prolapse leads to severemitral valve regurgitation (backwards flow of blood to the left atrium) it may require surgical repair as it can have an association with sudden death, stroke and heart failure.