Mitral valve prolapse is a heart disorder where the mitral valve leaflets have extra tissue or become stretched and bulge (or prolapse) into the left atrium. The condition can be asymptomatic in some cases, but if it progresses and the floppy valve no longer closes properly, it can result in damage to the heart muscle, stroke, or even sudden cardiac death.
- Barlow syndrome
- Billowing mitral valve syndrome
- Click-murmur syndrome
- Floppy valve syndrome
- Mitral prolapse
- Myxomatous mitral valve disease

What Are the Symptoms of Mitral Valve Prolapse?
- Chest pain
- Fatigue
- Fast or irregular heartbeat
- Anxiety
- Heart palpitations
- Dizziness or fainting
- Exercise intolerance
- Shortness of breath
- Headaches
- Orthostatic hypotension, which is when your blood pressure drops when you stand up
- Weakness and fatigue
- Shortness of breath with exertion or while lying down
- Edema or swelling in the legs or abdomen
What Causes Mitral Valve Prolapse?
A healthy mitral valve opens to let blood flow from the left atrium to the left ventricle when the heart relaxes and closes tightly to prevent blood from leaking backward as the heart contracts.
What Are the Stages of Mitral Valve Prolapse?
- Stage A: The person is at risk.
- Stage B: The condition is progressive. The person has mild or moderate heart valve disease without heart valve symptoms.
- Stage C: Although there are no heart valve symptoms, the valve disease is severe.
- Stage D: Severe heart valve disease causes symptoms.
What Are the Types of Mitral Valve Prolapse?
Primary
The distinguishing factors of primary mitral valve prolapse include:- Thickening of one or both valve leaflets
- Scarring of leaflet surface
- Thinning or stretching of the tendons of the valve (chordae tendineae)
- Fibrin (a primary component of blood clots) deposits on the valve leaflets
Secondary
The valves are not thickened with secondary mitral valve prolapse. Instead, the secondary type is usually linked to another disease. The prolapse may be caused by damage from decreased blood flow to the muscles and tendons of the valve due to coronary artery disease, changes in the heart muscle, or damage to the valve associated with other conditions.Who Is at Risk of Mitral Valve Prolapse?
- Sex: Mitral valve prolapse is about twice as common in women as in men, but men are more likely to develop severe symptoms.
- Heart attack
- Hypertrophic cardiomyopathy, which is when the left ventricle is larger than normal
- Marfan’s syndrome, a connective tissue disorder
- Polycystic kidney disease
- Pectus excavatum, a congenital abnormality involving the sternum growing inward rather than outward
- Ebstein’s anomaly, which involves an abnormal heart valve
- Ehlers-Danlos syndrome, a connective tissue involving joint hypermobility, skin hyperextensibility, and fragile tissues
- Grave’s disease, a thyroid condition
- Rheumatic heart disease
- Muscular dystrophy
- Scoliosis
How Is Mitral Valve Prolapse Diagnosed?
- Echocardiogram: An echocardiogram is an ultrasound of the heart. It uses sound waves to show detailed images of the heart in motion. It shows how well the mitral valve opens and closes and if there is mitral regurgitation. It can also measure the severity of mitral regurgitation and its effect on the heart muscle. There are two types: a transthoracic echocardiogram (TTE) and a transesophageal echocardiogram (TEE). A TTE is noninvasive and reads images taken with an ultrasound probe on the chest. A TEE is more invasive and involves guiding a flexible tube with an ultrasound probe down the throat and into the esophagus to get a closer look at the heart. A TEE usually requires the patient to be sedated during the procedure. An echocardiogram is the gold standard for diagnosing mitral valve prolapse and monitoring its progression.
- Electrocardiogram (ECG or EKG): An electrocardiogram is a painless test that only lasts a few minutes and measures the heart’s electrical activity. It can determine how fast or slow the heart is beating, detect irregular heart rhythms, and show patterns related to heart disease or problems within the heart chambers.
- Exercise or stress tests: These tests involve riding a stationary bike or walking on a treadmill while monitoring the heart. Exercise and stress tests can help identify symptoms of aortic stenosis during physical activity. If a patient cannot exercise, medications that mimic the effect of exercise on the heart can be administered.
- Chest X-ray: A chest X-ray can show the condition of the heart and lungs. An enlarged heart is a sign of heart valve disease.
- Cardiac MRI scan: A cardiac MRI uses magnetic fields and radio waves to create detailed heart images to determine mitral valve prolapse severity.
- Cardiac catheterization: Although this test isn’t typically used to diagnose mitral valve prolapse, it can help determine severity. It can also be done before mitral valve surgery to ensure the coronary arteries are not blocked. During a cardiac catheterization, a thin, flexible catheter is inserted into an artery at the groin or wrist and advanced into the heart. Dye flows through the catheter as X-ray images of the coronary arteries are taken.
What Are the Possible Complications of Mitral Valve Prolapse?
Mitral Regurgitation
Mitral regurgitation is the most common complication of mitral valve prolapse. According to the Mayo Clinic, men have a higher risk of developing mitral regurgitation with mitral prolapse, as do people with high blood pressure.- Compensated phase: During this phase, the left ventricle gets larger. There are few, if any, symptoms during this phase. As long as the regurgitation is not severe, no surgical intervention is required.
- Transitional phase: The heart muscle begins to weaken as mitral regurgitation progresses, and the left ventricle can no longer compensate. During this phase, the heart’s structure may change, and it may not be able to pump as effectively as more and more blood leaks backward into the ventricle. Symptoms like fatigue, exercise intolerance, and shortness of breath can appear during the transitional phase. This phase is usually when surgical treatment to repair or replace the valve is recommended.
- Decompensated phase: During this phase, the left ventricle continues to enlarge, and the heart function declines as abnormal heart rhythms occur more regularly and pulmonary hypertension, high blood pressure in the arteries from the heart to the lungs, develops. During this phase, heart failure develops, and symptoms get worse. Structural changes to the heart become irreversible if the mitral valve is not repaired or replaced.
Atrial Fibrillation
Atrial fibrillation, a fast and irregular heart rhythm, can occur if mitral valve prolapse leads to mitral regurgitation and the enlargement of the left atrium.Infective Endocarditis
Infective endocarditis is an infection of the inner lining of the heart chambers, and the valves are the most common parts of the heart affected. People with mitral valve prolapse are at higher risk of developing endocarditis because the deformed mitral valve flap can attract bacteria circulating in the bloodstream.Stroke
Although stroke is not a direct complication of mitral valve prolapse, when mitral regurgitation progresses and the left atrium becomes enlarged, the risk of atrial fibrillation increases. People with atrial fibrillation are at high risk for blood clots that can travel from the heart to the brain and cause a stroke.Sudden Cardiac Death
According to physicians at Mount Sinai’s Icahn School of Medicine, mitral valve prolapse with mild to moderate mitral regurgitation can cause ventricular arrhythmias that may lead to sudden cardiac death.What Are the Treatments for Mitral Valve Prolapse?
1. Medications
Medications may be necessary to control symptoms and treat complications. The following are some of the medications typically prescribed:- Beta-blockers: When mitral valve prolapse and regurgitation cause palpitations or atrial fibrillation is present, this class of medication can help control a rapid heartbeat and lower blood pressure. A few examples include metoprolol, carvedilol, and atenolol.
- Diuretics: These medications reduce the level of sodium and water in the bloodstream by removing them in the urine. Diuretics help to lower blood pressure and control symptoms of heart failure related to mitral regurgitation. A few examples include furosemide, bumetanide, and chlorothiazide.
- Anti-arrhythmics: These help control irregular heart rhythms related to mitral valve prolapse and regurgitation, like atrial fibrillation. Examples include amiodarone, digoxin, and metoprolol.
- Blood thinners (anticoagulants): When mitral valve prolapse and regurgitation cause atrial fibrillation, a blood-thinning medication is often prescribed to prevent blood clots that can cause a stroke. A blood-thinning medication is needed for life when the mitral valve is replaced with a mechanical valve. Examples include apixaban, warfarin, and rivaroxaban.
2. Surgery
Mitral valve prolapse usually doesn’t need surgical intervention unless it starts causing symptoms related to mitral regurgitation. Surgical options include repair or replacement of the mitral valve.- There is severe regurgitation
- Regurgitation causes symptoms
- There is left-sided heart failure, and the heart isn’t pumping enough blood
- The heart is enlarged
- Full sternotomy: an incision down the middle of the chest
- Partial sternotomy: an incision into part of the chest
- Right thoracotomy: a smaller incision between two ribs
- Robotic-assisted method: several small incisions between the ribs
Minimally Invasive Repair
The mitral valve clip procedure is a minimally invasive treatment for mitral valve disease. Although the mitral clip doesn’t always eliminate mitral regurgitation, it can significantly reduce symptoms and is a safer procedure for patients considered high-risk for open-heart surgery.In a mitral valve clip procedure, the surgeon makes a small incision in the vein at the groin and guides a thin, flexible tube with the mitral valve clip on the end up to the mitral valve inside the heart. Then, the surgeon attaches the clip to the two places where the valve is defective, also called an “edge-to-edge” repair, to help the valve close more effectively.
Surgical Replacement
Surgical repair of the mitral valve is the preferred treatment for mitral regurgitation. However, if damage to the valve is too extensive, replacement is often necessary. Conditions that can severely damage the mitral valve include endocarditis, heart valve damage from group A streptococcal infections, or extensive damage to the mitral valve support structures like the papillary muscles or chordae.Mitral valve replacement is a complex, open-heart surgery done through a full sternotomy. Similar to mitral valve repair, patients are connected to a cardiopulmonary bypass machine, and the heart is stopped throughout the surgery. The valve can be replaced with a mechanical or a bioprosthetic (tissue) valve.
Mechanical valves are made of carbon and steel, and they have advantages and disadvantages.
Mechanical valves are generally a better choice for younger patients because they are highly durable and can last 20 to 30 years without requiring surgery due to valve degeneration.
A drawback to mechanical valves is that the risk of blood clots is very high, increasing the risk of stroke. People with a mechanical replacement valve need to be on a lifelong regimen of a blood thinner called warfarin, which comes with a higher risk of bleeding and the need for regularly scheduled bloodwork to make sure there isn’t too much or too little of the medication in the bloodstream. Warfarin is also not recommended for pregnant women or those planning to become pregnant because it can harm the fetus. Women of childbearing age who need a new mitral valve can opt for a bioprosthetic valve.
How Does Mindset Affect Mitral Valve Prolapse?
Although mitral valve prolapse doesn’t always cause serious health problems, it can come with symptoms that may lead to anxiety and stress.
Stress and anxiety can increase chronic inflammation and reduce sleep quality, which can increase the risk of heart disease and damage.
Stress and anxiety can also cause people to develop poor lifestyle habits like smoking and drinking alcohol to help them cope. Both smoking and excessive alcohol use can potentially damage the heart.
- Exercising regularly
- Practicing mindfulness
- Maintaining good sleep hygiene
- Avoiding alcohol
- Reducing caffeine intake
- Eating a healthy diet
- Avoiding smoking
What Are the Natural Approaches to Mitral Valve Prolapse?
- Pumpkin seeds
- Chia seeds
- Almonds
- Spinach
- Peanuts
- Black beans
Some medications, like antacids, contain sodium. Ask your health care provider or pharmacist about how much sodium is in your medications. You can also read the labels of over-the-counter medications to find out if they contain sodium.
How Can I Prevent Mitral Valve Prolapse?
- Eat a heart-healthy diet, which includes plenty of fruits and vegetables and lean protein like fish and poultry and restricts sodium, sugar, and processed foods.
- Stay active. A 2022 study suggests that people with mild valvular heart disease can exercise according to standard guidelines. However, people with mitral valve prolapse may be at increased risk of heart arrhythmias and should avoid high-intensity exercise, according to the study. Appropriate activities that avoid excessive strain on the heart include walking, swimming, and yoga.
- Maintain healthy lifestyle habits by not smoking, avoiding alcohol, avoiding stress, and getting enough sleep.
- Brush and floss teeth regularly to prevent bacteria from entering the bloodstream and traveling to the heart, which can cause an infection.
- Ask your doctor if you need to take antibiotics before dental procedures to reduce the risk of a heart infection.
- Schedule regular checkups to monitor mitral valve prolapse to ensure any mitral regurgitation that may be present isn’t progressing.