The Essential Guide

Mitral Valve Prolapse: Symptoms, Causes, Treatments, and Natural Approaches

Older men are more likely to experience severe mitral valve prolapse than women, even though it is more common in females. Illustration by Fei Meng
checkCircleIconMedically ReviewedJimmy Almond, M.D.
Updated:

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.

Other names used to describe mitral valve prolapse include the following:
  • Barlow syndrome
  • Billowing mitral valve syndrome
  • Click-murmur syndrome
  • Floppy valve syndrome
  • Mitral prolapse
  • Myxomatous mitral valve disease
Mitral valve prolapse is one of the most common heart valve problems and affects 2 percent to 3 percent of the U.S. population.
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Illustration by The Epoch Times, Shutterstock

What Are the Symptoms of Mitral Valve Prolapse?

Many people with mitral valve prolapse are asymptomatic. Instead of experiencing symptoms, they learn of the condition after a health care provider listens to their heart with a stethoscope and hears a click or a murmur.
When mitral valve prolapse does cause signs and symptoms, they may include:
  • 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
The progression of mitral valve prolapse can cause the valve not to close completely. When this happens, blood leaks backward into the left atrium, a condition called mitral regurgitation. Severe mitral regurgitation can lead to heart failure and more debilitating symptoms, such as the following:
  • 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?

The exact cause of mitral valve prolapse is unknown.

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.

With mitral valve prolapse, the valve is not anatomically correct or has become stretched, and the leaflets of the valve bulge or prolapse into the left atrium. The prolapsed valve may still form a tight closure, but over time, the chords and tendons of the valve can stretch even more, making the valve floppier and leading to mitral regurgitation.

What Are the Stages of Mitral Valve Prolapse?

The stage of mitral valve prolapse depends on many things, including symptoms, severity, the structure of the mitral valve, and how well blood flows through the heart and lungs.
Mitral valve disease is staged into four basic groups:
  • 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?

The two types of mitral valve prolapse are primary and secondary.

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?

Mitral valve prolapse can affect people of all ages, but it is often present at birth and considered hereditary.
The condition is linked to factors such as the following:
  • 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?

Mitral valve prolapse often has no symptoms but is discovered during a routine physical exam as a health care provider listens to the heart with a stethoscope. A clicking sound may be created when the valve’s leaflets snap into place as the heart contracts. Another common sound made by mitral valve prolapse if mitral regurgitation is present is a “whooshing” sound, also known as a murmur, as blood leaks back into the left atrium.
Besides performing a physical exam and collecting a health history, health care providers may perform the following tests to diagnose mitral valve prolapse:
  • 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 valve prolapse can lead to several complications, including mitral regurgitation, atrial fibrillation, infective endocarditis, stroke, and sudden cardiac death.

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.
With mitral regurgitation, blood leaks backward into the left atrium. When this happens, less blood is pumped into the body with each heartbeat. In many cases, regurgitation is minimal and doesn’t create significant symptoms. However, if regurgitation is more significant, the left ventricle has to work much harder to pump enough blood into the body, which causes the heart muscle to change, including increasing the size of the heart’s chambers.
The changes to the heart depend on the amount of regurgitation and take place over several years in the following phases:
  • 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.
Poor dental hygiene can cause endocarditis, so it’s essential for people with mitral valve prolapse to floss and brush their teeth regularly to prevent bacteria from getting into the bloodstream. Health care providers sometimes prescribe antibiotics before dental procedures for people with mitral valve prolapse who are at high risk of infection.

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?

In many cases, mitral valve prolapse doesn’t require treatment. When mitral regurgitation is present along with prolapse but without symptoms, regular checkups are usually recommended to monitor the condition. If mitral regurgitation continues to progress and becomes more severe, medications or surgery may be necessary, even if there are no symptoms.

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.
Health care providers often recommend repairing the valve if:
  • 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
During a mitral valve repair, patients are under anesthesia and hooked up to a cardiopulmonary bypass machine that does the work of the heart and lungs. There are different approaches to accessing the mitral valve, including:
  • 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.

Most people can go home a few hours after the procedure, and it requires little recovery time at home as long as there aren’t any complications.

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.

Bioprosthetic valves are artificial and are made of cow or pig tissue. There is no difference in the durability between the types of biological valves. One of their advantages is that blood-thinning medications aren’t necessary unless there is another medical reason for them. Tissue valves are generally a good choice for older people (60 to 70 years) because they should last their lifetime. However, people under 60 usually require repeat surgery to replace the valve since they generally only last an average of 10 to 15 years.

How Does Mindset Affect Mitral Valve Prolapse?

As mitral valve prolapse is often caused by a birth defect or unavoidable secondary health conditions, mindset doesn’t affect whether or not one develops it. However, it can play a role in how well someone manages their condition.

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.

Specific strategies can help you take control of your anxiety, including the following:
  • 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?

No treatment can reverse mitral valve prolapse, but adhering to a healthy lifestyle can reduce the chance of developing more serious complications like severe mitral regurgitation.
Magnesium is an important mineral in the body that is essential to cardiovascular health. Low magnesium levels in the blood can increase the likelihood of experiencing mitral valve prolapse symptoms, like chest pain, shortness of breath, and palpitations.
According to an article in U.S. Pharmacist Magazine, patients with symptomatic mitral valve prolapse may experience improvement by supplementing with 200 to 800 milligrams of magnesium daily. Although magnesium is generally considered safe, people with heart or kidney problems should supplement with caution.
Magnesium is also present in many foods, including:
  • Pumpkin seeds
  • Chia seeds
  • Almonds
  • Spinach
  • Peanuts
  • Black beans
Sodium, another important mineral in the body, is vital to heart health. Too much can lead to high blood pressure, which could increase stress on the left ventricle and increase mitral regurgitation.
The American Heart Association recommends limiting sodium to less than 1,500 milligrams per day for adults with high blood pressure. While some foods naturally contain sodium, most of the sodium in the modern diet comes from processed and packaged foods. Make a habit of reading food labels to know the sodium content.

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.

Coenzyme Q10 (CoQ10) is another dietary supplement that can reduce inflammation and protect the heart. It’s also been shown to improve the left ventricle function in people with mitral valve prolapse. CoQ10 is found naturally in meat, fish, and nuts, but according to the Mayo Clinic, dietary sources don’t significantly increase CoQ10 levels in the body, and adding a dietary supplement may be necessary.
It’s important to note that CoQ10 is generally safe with few side effects. However, it can interact with warfarin by making it less effective, increasing the risk of blood clots.

How Can I Prevent Mitral Valve Prolapse?

Generally, it’s impossible to prevent mitral valve prolapse, but there are steps to avoid the complications it may cause. Consider the following:
  • 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.
Allison DeMajistre
Author
Allison DeMajistre, BSN, RN, CCRN is a freelance medical writer for The Epoch Times. She is a registered nurse who previously worked in critical care. She specializes in cardiology-related topics.
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