MITRAL VALVE PROLAPSE

✓ Medically ReviewedDISEASEID: MDBT0163🚨 TRIAGE: ROUTINEICD-10: I34.0

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Definition

CLINICAL DEFINITION

Mitral valve prolapse is a valvular disorder characterised by the systolic displacement of one or both mitral leaflets into the left atrium, typically defined echocardiographically as a superior displacement of ≥2 mm beyond the mitral annular plane in the parasternal long-axis view.

IN PLAIN ENGLISH

Mitral valve prolapse is a condition where the flap between the heart's left chambers bulges backward into the upper chamber when the heart squeezes. It can sometimes cause a heart murmur or leaky valve, but many people have no symptoms at all.

COMMON MISCONCEPTION / WHAT IT DOES NOT MEAN

Mitral Valve Prolapse is NOT synonymous with mitral regurgitation, although the two often coexist; MVP refers to the anatomical displacement of the leaflets, whereas mitral regurgitation is the backward flow of blood.

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Word Breakdown

mitr-

=mitre (from Latin 'mitra', referring to the bicuspid valve's resemblance to a bishop's hat); 'prolapse' derives from Latin 'prolapsus' meaning to slide forward or fall

Literal Meaning: Forward slipping of the mitre-shaped valve

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Abbreviations

MVP=Mitral Valve Prolapse — most common clinical abbreviation

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Synonyms & Variants

Floppy Mitral Valve Syndrome›Barlow's Syndrome›Myxomatous Mitral Valve Disease›

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Category-Specific Context

As a structural valvular disease, mitral valve prolapse exists on a spectrum from an isolated, benign anatomical variant to a progressive myxomatous degeneration causing severe mitral regurgitation and heart failure. It is classified based on echocardiographic leaflet displacement and the presence or absence of regurgitation.

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Clinical Context & Usage

CLINICAL SETTINGS

Cardiology ClinicGeneral Medicine WardEchocardiography LaboratoryEmergency Department

USAGE & DOCUMENTATION NOTES

In clinical documentation, MVP is frequently noted alongside the degree of mitral regurgitation (e.g., 'MVP with moderate MR'). Clinicians often document the presence of a mid-systolic click and late systolic murmur on auscultation. Echocardiography reports specify leaflet thickness (>5 mm indicates classic myxomatous MVP) and the exact segments involved (e.g., posterior leaflet P2 scallop).

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Primary Causes & Pathophysiology

PATHOPHYSIOLOGY

Mitral valve prolapse is primarily caused by myxomatous degeneration of the valve leaflets and chordae tendineae, leading to structural weakening, excess tissue accumulation, and increased elasticity. During ventricular systole, the increased left ventricular pressure forces the weakened, redundant leaflets to bow back across the mitral annulus into the left atrium. This displacement can prevent proper leaflet coaptation, resulting in mitral regurgitation. Over time, the mechanical stress can lead to chordal elongation or rupture, exacerbating the regurgitation and causing left atrial enlargement and left ventricular volume overload.

PRIMARY CAUSES

Primary (Idiopathic) Myxomatous Degeneration

Genetic or sporadic accumulation of dermatan sulfate and structural disruption of the spongiosa layer, leading to thickened, redundant leaflets (classic Barlow's disease).

Connective Tissue Disorders

Systemic collagen and elastin defects in conditions like Marfan syndrome, Ehlers-Danlos syndrome, and Loeys-Dietz syndrome cause secondary myxomatous changes in the mitral apparatus.

Fibroelastic Deficiency

Age-related thinning and rupture of chordae tendineae with normal or thin leaflets, typically seen in older adults (often presenting with flail leaflet rather than classic prolapse).

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Epidemiology

Prevalence:Mitral valve prolapse is one of the most common valvular disorders, affecting approximately 2% to 3% of the general population globally, though historical echocardiographic criteria estimated higher rates.

Age Group:Can be detected at any age, but primary myxomatous MVP is most frequently diagnosed in young to middle-aged adults (20–50 years), while fibroelastic deficiency typically presents in older adults (>60 years).

Sex Predilection:Equal

Geographic Distribution:Globally distributed without specific regional or ethnic predilection.

Red Flags & Triage ★

TRIAGE LEVEL

🚨 ROUTINE

DO NOT MISS — LIFE-THREATENING PRESENTATIONS

Acute severe mitral regurgitation from chordal rupture — presents with sudden dyspnoea and pulmonary oedema; requires urgent echocardiography and surgical evaluation rather than medical management alone.
Infective endocarditis in a patient with known MVP — new fever, embolic phenomena, or changing murmur requires immediate blood cultures and echocardiography to rule out vegetations and valvular destruction.

URGENT EVALUATION TRIGGERS

Sudden onset of severe dyspnoea or orthopnoea (suggesting acute chordal rupture and severe MR)
New-onset atrial fibrillation with rapid ventricular response or haemodynamic instability
Fever with a new or changing murmur, or signs of systemic embolisation (suggesting infective endocarditis)
Syncope or sustained palpitations accompanied by chest pain or pre-syncope (suggesting significant arrhythmia)

Contraindications & Precautions

SPECIAL PRECAUTIONS

Antibiotic Prophylaxis — current guidelines no longer recommend routine endocarditis prophylaxis for isolated MVP
but it is indicated if there is a history of prior endocarditis or prosthetic valve repair/replacement.
Avoidance of extreme isometric strain — patients with severe
uncorrected mitral regurgitation or aortic root dilation (e.g.
Marfan syndrome) should avoid heavy weightlifting to prevent acute chordal rupture or aortic dissection.

Complications

DOWNSTREAM CLINICAL COMPLICATIONS

Severe Mitral Regurgitation — progressive leaflet malcoaptation leading to left ventricular volume overload and heart failure
Infective Endocarditis — abnormal leaflet architecture and regurgitant jets predispose the valve to bacterial colonisation
Chordae Tendineae Rupture — mechanical stress on myxomatous chords can cause sudden flail leaflet and acute severe pulmonary oedema
Arrhythmias and Sudden Cardiac Death — rare but associated with severe myxomatous disease
particularly with complex ventricular ectopy or repolarisation abnormalities

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Confused With (LASA & DDx) ★

LEXICAL (LASA) — SIMILAR NAMES

Mitral Stenosis

Shares the 'mitral valve' anatomical location but involves restricted leaflet opening and diastolic flow obstruction, rather than systolic prolapse.

CLINICAL DIFFERENTIAL DIAGNOSES (DDx)

Hypertrophic Obstructive Cardiomyopathy (HOCM)

Key Distinguishing Feature: Both can present with a systolic murmur, but HOCM murmur increases with Valsalva, whereas MVP murmur typically becomes earlier and longer with Valsalva. Echocardiography shows asymmetric septal hypertrophy and SAM in HOCM.

Papillary Muscle Dysfunction

Key Distinguishing Feature: Causes mitral regurgitation due to ischaemia or infarction rather than primary leaflet myxomatous degeneration; typically seen in older patients with coronary artery disease.

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Clinical Pearls

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The auscultatory hallmark of MVP is a mid-systolic click followed by a late systolic murmur. Maneuvers that decrease left ventricular volume (such as standing or Valsalva) cause the click and murmur to occur earlier in systole, while squatting delays them.

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Echocardiographic criteria for MVP require displacement of the mitral leaflets by ≥2 mm beyond the annular plane in the parasternal long-axis view. Leaflet thickness >5 mm indicates classic myxomatous disease (Barlow's), which carries a higher risk of progression than thin-leaflet prolapse.

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Routine endocarditis prophylaxis is no longer recommended for native valve MVP. Antibiotic prophylaxis is reserved for patients with a history of endocarditis, prosthetic valves, or specific congenital heart conditions.

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Asymptomatic patients with severe primary mitral regurgitation and preserved left ventricular function (LVEF >60%, LVESD <40 mm) should be monitored with serial echocardiography every 6–12 months, as symptoms often develop insidiously.

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Example Usage & SOAP

CLINICAL SENTENCE

"The patient is a 34-year-old female with known myxomatous mitral valve prolapse and moderate mitral regurgitation, currently asymptomatic with preserved left ventricular systolic function on her latest echocardiogram."

IN A SOAP NOTE

S: 45-year-old male with known MVP presents for routine cardiology follow-up. Reports occasional palpitations but no dyspnoea, chest pain, or syncope. O: BP 122/78 mmHg, HR 72 bpm regular. JVP not elevated. Cardiac exam reveals a mid-systolic click and a grade 2/6 late systolic murmur at the apex. Lungs clear. A: Classic mitral valve prolapse with mild-to-moderate mitral regurgitation. Palpitations likely benign premature ventricular contractions, but warrant monitoring. P: Continue current observation. Repeat transthoracic echocardiogram in 12 months. Provide strict return precautions for sudden dyspnoea or worsening palpitations.

DIFFERENTIAL DIAGNOSIS CONTEXT

Differential for a systolic murmur at the apex in a young adult: (1) Mitral Valve Prolapse — characterised by a mid-systolic click and late systolic murmur that changes with dynamic manoeuvres; (2) Hypertrophic Cardiomyopathy — harsh crescendo-decrescendo murmur that increases with Valsalva and is associated with a palpable double apical impulse; (3) Physiological flow murmur — soft, early-to-mid systolic, without clicks, common in high-output states.

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Prognosis

SHORT-TERM OUTCOME

Excellent for asymptomatic patients with mild or no mitral regurgitation; the short-term risk of complications is very low.

LONG-TERM PROGNOSIS

Most patients have a normal life expectancy. However, those with severe mitral regurgitation, reduced left ventricular ejection fraction, or atrial fibrillation face increased long-term risks of heart failure, stroke, and need for valve surgery.

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References & Coding

ICD-10 DIAGNOSTIC CODE

I34.0

LITERATURE CITATIONS & GUIDELINES

[1]Otto CM, Nishimura RA, Bonow RO, et al. 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease. Circulation. 2021;143(5):e72-e227.

[2]Avierinos JF, Gersh BJ, Melton LJ III, et al. Natural history of asymptomatic mitral valve prolapse in the community. Circulation. 2002;106(11):1355-1361.

[3]Nishimura RA, Otto CM, Bonow RO, et al. 2017 AHA/ACC Focused Update of the 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease. J Am Coll Cardiol. 2017;70(2):252-289.

MEDICAL DISCLAIMER — This content is intended for educational purposes and qualified healthcare professionals only. Always refer to current clinical diagnostic criteria, institutional protocols, and official guidelines. Medobo is not responsible for clinical decisions made based on this content.