Mitral valve prolapse

To diagnose mitral valve prolapse, your health care provider will usually do a physical exam and listen to your heart with a stethoscope.

If you have mitral valve prolapse, a clicking sound may be heard through the stethoscope. If blood is leaking backward through the mitral valve, a whooshing sound (heart murmur) also may be heard.

Tests

Tests that may done to help confirm mitral valve prolapse and evaluate the heart include:

• Echocardiogram. An echocardiogram uses sounds waves to create images of the heart in motion. A standard echocardiogram, also called a transthoracic echocardiogram (TTE), can confirm a diagnosis of mitral valve prolapse and determine its severity.

  Sometimes, a transesophageal echocardiogram (TEE) may be done to get more-detailed images of the mitral valve. In this type of echocardiogram, a small transducer attached to the end of a tube is inserted down the tube leading from the mouth to the stomach (esophagus).

• Chest X-ray. A chest X-ray shows the condition of the heart and lungs. It can help show if the heart is enlarged.
• Electrocardiogram (ECG or EKG). This quick and painless test measures the electrical activity of the heart. An ECG can detect irregular heart rhythms (arrhythmias) related to mitral valve disease.
• Exercise or stress tests. These tests often involve walking on a treadmill or riding a stationary bike while the heart is monitored with ECG. Exercise tests help reveal how the heart responds to physical activity and whether mitral valve prolapse symptoms occur during exercise. If you're unable to exercise, you might be given medications that mimic the effect of exercise on the heart.
• Cardiac catheterization. This test isn't often used to diagnose mitral valve prolapse, but it can be helpful if other tests haven't diagnosed the condition. A health care provider threads a thin tube (catheter) through a blood vessel in the arm or groin to an artery in the heart and injects dye through the catheter. This makes the arteries in the heart chambers show up more clearly on an X-ray.

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

If you have mitral valve regurgitation but don't have symptoms, your health care provider may recommend regular checkups to monitor your condition.

If you have severe mitral valve regurgitation, medications or surgery may be needed even if you don't have symptoms.

Medications

Medications may be needed to treat irregular heartbeats or other complications of mitral valve prolapse. Medications include:

• Beta blockers. These drugs relax blood vessels and slow the heartbeat, which reduces blood pressure.
• Water pills (diuretics). These medicines help remove salt (sodium) and water through your urine, reducing blood pressure.
• Heart rhythm drugs (antiarrhythmics). Medications may be used to help control irregular heart rhythms.
• Blood thinners (anticoagulants). If mitral valve disease is causing an irregular heartbeat called atrial fibrillation, your health care provider may recommend blood-thinning drugs to prevent blood clots. Atrial fibrillation increases the risk of blood clots and strokes. If you had mitral valve replacement with a mechanical valve, blood thinners are needed for life.
• Antibiotics. The American Heart Association says antibiotics aren't usually necessary for someone with mitral valve prolapse. But if you've had mitral valve replacement, your care provider may recommend taking antibiotics before dental procedures to prevent a heart infection called infective endocarditis.

Surgery and other procedures

Most people with mitral valve prolapse don't need surgery. But surgery may be recommended if mitral prolapse causes severe mitral valve regurgitation, whether or not you have symptoms.

Surgery for a diseased or damaged mitral valve includes mitral valve repair or mitral valve replacement. Mitral valve repair is preferred because it saves the existing valve.

Valve repair and replacement may be done using open-heart surgery or minimally invasive surgery. Minimally invasive surgery involves smaller incisions and may have less blood loss and a quicker recovery time.

During mitral valve repair surgery, the surgeon might remove excess tissue from the prolapsed valve so the flaps can close tightly. The surgeon may also replace the cords that support the valve. Other repairs may also be done.

If mitral valve repair isn't possible, the valve may be replaced. During mitral valve replacement surgery, a surgeon removes the mitral valve and replaces it with a mechanical valve or a valve made from cow, pig or human heart tissue (biological tissue valve).

Sometimes, a heart catheter procedure is done to place a replacement valve into a biological tissue valve that no longer works well. This is called a valve-in-valve procedure.

If you have mitral valve prolapse, you'll have regular follow-up appointments with your health care provider to monitor your condition.

It's also important to take steps to keep your heart healthy.

• Eat a heart-healthy diet. Eat a variety of fruits and vegetables. Choose low-fat or fat-free dairy products, poultry, fish, and whole grains. Avoid saturated and trans fat, and excess salt and sugar.
• Maintain a healthy weight. If you are overweight or have obesity, your health care provider might recommend that you lose weight.
• Get regular physical activity. Most people with mitral valve prolapse are able to do daily activities and exercise without restrictions. Aim to include about 30 minutes of physical activity, such as brisk walks, into your daily fitness routine. If mitral valve prolapse causes severe regurgitation, your provider may recommend certain exercise limitations.
• Manage stress. Getting more exercise, connecting with others and practicing mindfulness are some ways to reduce stress.
• Avoid tobacco. If you smoke, quit. Ask your health care provider about resources to help you quit smoking.

Here's some information to help you get ready for your appointment.

What you can do

• Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance.
• Write down your symptoms, including any that may seem unrelated to mitral valve prolapse, and when they began.
• Write down key personal information, including a family history of heart disease, heart defects, genetic disorders, strokes, high blood pressure or diabetes, and any major stresses or recent life changes.
• Make a list of all medications, vitamins or supplements you take, including doses.
• Take a family member or friend along, if possible. Someone who accompanies you can help you remember the information you're given.
• Be prepared to discuss your diet and exercise habits. If you don't already follow a diet or exercise routine, be ready to talk to your health care provider about any challenges you might face in getting started.
• Write down questions to ask your provider.

For mitral valve prolapse, some basic questions to ask your health care provider include:

• What is likely causing my symptoms or condition?
• What are other possible causes?
• What tests do I need?
• Do I need treatment? What kind?
• What are the alternatives to the primary approach that you're suggesting?
• I have other health conditions. How can I best manage them together?
• Are there any restrictions that I need to follow?
• Should I see a specialist?
• If I need surgery, which surgeon do you recommend for mitral valve repair?
• Is there a generic alternative to the medicine you're prescribing for me?
• Are there any brochures or other printed material that I can take home with me? What websites do you recommend visiting?

Don't hesitate to ask any questions you have.

What to expect from your doctor

Your health care provider is likely to ask you questions, such as:

• Do you always have symptoms or do they come and go?
• How severe are your symptoms?
• What makes the symptoms better?
• What makes the symptoms worse?