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Mitral Valve Prolapse (Barlow Syndrome)

Mitral Valve Prolapse Syndrome

What is mitral valve prolapse? — Mitral valve prolapse is a condition in which one of the valves in the heart (figure 1), called the mitral valve, doesn't close normally (figure 2). The mitral valve is between the left atrium and left ventricle. The mitral valve is made up of 2 flaps. In mitral valve prolapse, one or both flaps billow or bulge into the left atrium.
When the heart valves work normally, they keep blood flowing in only one direction. The mitral valve normally keeps blood flowing from the left atrium to the left ventricle (figure 1).
When the mitral valve flaps don't close correctly, blood can leak backward in the wrong direction. When blood leaks backward from the left ventricle to the left atrium, doctors call it "mitral regurgitation." Some patients with mitral valve prolapse have mitral regurgitation.
What causes mitral valve prolapse? — Mitral valve prolapse can happen on its own or it can happen with other medical conditions. For example, "connective-tissue diseases," which are diseases that affect certain tissues in the body, can cause mitral valve prolapse.
What are the symptoms of mitral valve prolapse? — Many people with mitral valve prolapse have no symptoms. Their doctor or nurse will find out they have it during an exam. The doctor or nurse will hear a "click" when he or she listens to the heart with a stethoscope. He or she might also hear a heart murmur. A murmur is an abnormal sound that often sounds like an extra "whoosh" or "swish" in the heartbeat.
Some people with mitral valve prolapse have symptoms such as chest pain, feeling their heart beating fast or hard, fainting, or feeling dizzy. Even though these symptoms sometimes happen in people with mitral valve prolapse, these symptoms might not be caused by the mitral valve prolapse.
Mitral valve prolapse can be mild or severe. It sometimes also leads to serious problems. These can include:
Mitral regurgitation – This usually causes no symptoms until it is severe. Severe mitral regurgitation can cause trouble breathing and tiredness.
Infective endocarditis, which is when a heart valve gets infected – This usually causes fever, chills, and tiredness.
Heart rhythm problems – Sometimes, this makes people feel as if their heart is beating fast or hard. Rarely, a heart rhythm problem can cause sudden death, which is when the heart suddenly stops beating.
Is there a test for mitral valve prolapse? — Yes. The test used most often to check for mitral valve prolapse is an echocardiogram (also called an "echo"). This test uses sound waves to create a picture of the heart as it beats. It shows the size of the heart chambers, how well the heart is pumping, and how well the heart valves are working (figure 3).
How is mitral valve prolapse treated? — Treatment depends on how severe the mitral valve prolapse is and whether it is causing problems.
People with mild mitral valve prolapse and mild mitral regurgitation usually do not need any treatment. But their doctor will follow their condition to see if it worsens and needs treatment later on.
People with severe mitral regurgitation might need surgery. During surgery, the doctor will fix or replace the mitral valve. Some people who can't have surgery can instead have a procedure to reduce the leak. During this procedure, a doctor inserts a tube called a catheter into a blood vessel in the arm or leg. Then the doctor advances the catheter up to the heart and attaches a clip to the valve leaflets.
Other treatments some people with mitral valve prolapse might have include:
Medicines that lower blood pressure
Medicines that treat heart rhythm problems
Medicines that help prevent blood clots – These medicines might be used if people also have a heart rhythm problem called "atrial fibrillation."
Do I need to take antibiotics before I go to the dentist? — No. In the past, doctors recommended that people with mitral valve prolapse take "preventive" antibiotics before going to the dentist or having certain medical or dental procedures. But now, people with mitral valve prolapse do not need antibiotics at those times. You only need preventive antibiotics if you have certain heart conditions, like if you had a valve infection (called "infective endocarditis") in the past.
What if I want to get pregnant? — If you want to get pregnant, talk with your doctor before you start trying. He or she will discuss the problems that might happen during your pregnancy. He or she might also need to change your medicines to ones that are safer to take during pregnancy.
All topics are updated as new evidence becomes available and our peer review process is complete.
This topic retrieved from UpToDate on: Mar 30, 2020.
Topic 83799 Version 5.0
Release: 28.2.2 - C28.105
© 2020 UpToDate, Inc. and/or its affiliates. All rights reserved.

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