Mitral valve prolapse (MVP) is a common heart valve condition where the mitral valve does not close smoothly. It affects about 2% to 3% of the general population. While MVP is often considered benign and many individuals experience no symptoms, its course can vary. For some, the condition may change or progress with age, potentially leading to increased severity of symptoms or complications.
Understanding Mitral Valve Prolapse
The mitral valve, also known as the bicuspid valve, is located on the left side of the heart, between the left atrium and the left ventricle. Its role is to ensure oxygen-rich blood flows from the left atrium into the left ventricle and to prevent blood from flowing backward into the left atrium when the heart contracts. The valve consists of two flaps, or leaflets, which open and close with each heartbeat.
In mitral valve prolapse, one or both of these valve leaflets bulge backward into the left atrium during the heart’s contraction. This bulging can prevent the valve from closing tightly, potentially allowing some blood to leak backward, a condition called mitral regurgitation. The underlying cause often involves weakness in the valve tissue, known as myxomatous degeneration, where the leaflets become abnormally stretchy. While the cause is often unknown, it can be linked to genetic factors or connective tissue disorders like Marfan syndrome. Many individuals with MVP are asymptomatic, but some may experience symptoms such as chest pain, palpitations, dizziness, fatigue, or shortness of breath.
Progression and Age-Related Changes
Mitral valve prolapse can progress over time, and these changes are often linked to aging. As individuals age, the valve leaflets can thicken or become more redundant due to ongoing myxomatous degeneration. This structural change can contribute to an increase in the degree of valve prolapse and the severity of mitral regurgitation.
MVP can progress through increased mitral regurgitation. Over time, continuous stress on the valve can lead to elongation and weakening of the chordae tendineae, small cord-like structures that support the valve leaflets. In some cases, a chord can even rupture, causing a sudden and significant worsening of the regurgitation. Factors influencing this progression include the initial severity of regurgitation, the presence of specific valve abnormalities such as significant leaflet thickening, and age at diagnosis. Progression is not universal; many people with MVP remain stable throughout their lives, while others experience slow or, less commonly, rapid worsening.
Potential Complications
If mitral valve prolapse worsens, particularly if it leads to significant mitral regurgitation, several complications can arise. One concern is the development of heart failure. When the mitral valve leaks substantially, the heart must work harder to pump blood effectively, which can lead to enlargement of the left atrium and/or left ventricle. Over time, this increased workload can cause symptoms of heart failure, such as severe fatigue, swelling, and shortness of breath.
Arrhythmias are another potential complication associated with MVP. Conditions like atrial fibrillation can become more prevalent as the condition progresses, especially with left atrial enlargement due to significant regurgitation. Although rare, infective endocarditis, a bacterial infection on the heart valve, is a concern for those with more severe forms of MVP or pre-existing valve damage. Additionally, a very rare risk of stroke exists, possibly due to clot formation, especially with associated atrial fibrillation or abnormal valve surface changes.
Monitoring and Management
Regular monitoring is important for individuals diagnosed with mitral valve prolapse, especially given its potential for progression. This typically involves regular check-ups with a cardiologist, including physical examinations and echocardiograms. Echocardiograms, which use sound waves to create images of the heart, help assess valve function and detect any changes in the severity of prolapse or regurgitation. The frequency of these check-ups depends on the condition’s severity; those with mild MVP and no significant regurgitation might be monitored every 3 to 5 years, while those with moderate to severe regurgitation may need annual or more frequent evaluations.
Lifestyle modifications also play a role in managing MVP and supporting overall heart health. Maintaining a healthy weight, engaging in regular exercise, managing blood pressure, and avoiding stimulants like excessive caffeine or nicotine (if they trigger symptoms) are recommended. Medications might be prescribed to manage specific symptoms, such as beta-blockers for palpitations. If mitral regurgitation becomes severe, or if the heart shows signs of damage like enlargement, surgical intervention may be considered. Valve repair, often preferred over valve replacement, is typically reserved for symptomatic individuals or those with evidence of heart strain, even if asymptomatic.