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Mitral valve prolapse overview

Updated: October 29, 2017

Mitral valve prolapse also known as mitral click murmur syndrome is abnormal protrusion/bulging (prolapse) of the mitral valve leaflets into the left atrium during systole. It commonly presents as a mid to late systolic (mitral) click and murmur (see below).

Causes

Generally unknown. However, it may be caused by a genetically determined disorder of collagen tissue leading to myxomatous degeneration of the mitral valve leaflets.

Clinical suspicion

Usually asymptomatic discovered by chance. Mainly affects young females and may present with chest pain (not related to effort and not relieved by nitrates) or with palpitations.

Diagnosis

Auscultation (apex): mid-systolic click, and in the case of incompetence, a mid to late systolic murmur that increases with standing or Valsalva's maneuver.

Echocardiography: mitral valve leaflets protruding ≥2 mm above the annular plane during systole. Thickening of the mitral leaflets. Mitral regurge may be present.

Complications

Rare complications include infective endocarditis, arrhythmias, progressive mitrial regurge, cerebral emboli (see below).

Treatment

Asymptomatic patients should be offered assurance and routine follow up for complications (see below)

Symptomatic patients with palpitations may benefit from avoidance of stimulants (e.g. nicotine, coffee). Some patients with palpitations or chest pain may benefit from beta blockers which may relieve the stretch on the mitral valve leaflets during systole by decreasing cardiac contractility and rate.

Routine follow up with cardiac examination and echo every 3 to 5 years to detect complications which are very rare (<1% per year) and include:

  • Mitral regurgitation which may require surgical repair
  • Infective endocarditis. Only patients with previous endocarditis should be offered prophylactic antibiotics especially during dental manipulations otherwise the majority of patients with MVP do not require prophylaxis [1].
  • Rupture chordae tendineae
  • Embolic complications such as TIAs or stroke
  • Benign supraventricular cardiac arrhythmias

References

1. Wilson W, Taubert KA, Gewitz M, et al. Prevention of infective endocarditis: A guideline from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group. Circulation. 2007;116:1736–54.


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