Diagnosis

Doctors may diagnose mitral valve prolapse at any age. Your doctor is most likely to diagnose mitral valve prolapse while listening to your heart with a stethoscope during a physical examination.

If you have mitral valve prolapse, your doctor may hear a clicking sound, which is common with this condition. Your doctor may detect a heart murmur, which would be due to mitral regurgitation if it is present.

Other tests that may be used to evaluate your heart may include:

  • Echocardiogram. An echocardiogram is usually done to confirm the diagnosis and determine the severity of your condition. An echocardiogram is a noninvasive ultrasound evaluation of your heart.

    This test uses high-frequency sound waves to create images of your heart. It helps doctors see the flow of blood through your mitral valve and measure the amount of blood leakage (regurgitation).

    You may have a transesophageal echocardiogram. In this test, your doctor inserts a flexible tube with a small device (transducer) attached into your throat and down into your esophagus — the tube that connects the back of your mouth to your stomach. From there, the transducer can be positioned to obtain more-detailed images of your heart.

  • Chest X-ray. A chest X-ray shows a picture of your heart, lungs and blood vessels and can help your doctor make a diagnosis. It can help show if your heart is enlarged.
  • Electrocardiogram (ECG). In this noninvasive test, a technician will place probes on your chest that record the electrical impulses that make your heart beat.

    An ECG records these electrical signals and can help your doctor detect irregularities in your heart's rhythm and structure, including mitral valve prolapse.

  • Stress test. Your doctor may order a stress test to see if mitral valve regurgitation limits your ability to exercise. In a stress test, you exercise or take certain medications to increase your heart rate and make your heart work harder.

    You may also have a stress test if your doctor is trying to determine if you have another condition such as coronary artery disease.

  • Coronary angiogram. This type of cardiac catheterization uses X-ray imaging to see your heart's blood vessels. It isn't generally used to diagnose mitral valve prolapse, but may reveal the condition when you're being testing for another suspected diagnosis.

    In some cases, your doctor may recommend a coronary angiogram and cardiac catheterization to gather more information about the severity of your condition.

    In a cardiac catheterization procedure, doctors insert a catheter in an artery in your groin (femoral artery) or in your wrist (radial artery). The catheter is then threaded through your blood vessels to your heart.

Treatment

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 doctor may suggest you return regularly for follow-up examinations to monitor your condition, depending on the severity of your condition.

However, if you have symptoms and if a significant amount of blood is leaking through the mitral valve, your doctor may recommend medications or surgery, depending on the severity of your condition.

Medications

If you develop symptoms, your doctor might prescribe certain medications to treat mitral valve prolapse-related chest pain, heart rhythm abnormalities or other complications. Some medications you might be prescribed include:

  • Beta blockers. These drugs help prevent irregular heartbeats by making your heart beat more slowly and with less force, which reduces your blood pressure. Beta blockers also help blood vessels relax and open up to improve blood flow.
  • Diuretics. Your doctor may prescribe water pills (diuretics) to drain fluid from your lungs.
  • Heart rhythm medications. Your doctor may prescribe an antiarrhythmic medication, such as flecainide (Tambocor), amiodarone (Cordarone, Pacerone), and propafenone (Rythmol, Rythmol SR). Antiarrhythmics help control your heart rhythm by normalizing electrical signals in heart tissue.
  • Aspirin. If you have mitral valve prolapse and a history of strokes, your doctor might prescribe aspirin to reduce the risk of blood clots.
  • Prescription anticoagulants (blood thinners). These medications — such as warfarin (Coumadin), heparin, dabigatran (Pradaxa), rivaroxaban (Xarelto), apixaban (Eliquis) and edoxaban (Savaysa) — prevent your blood from clotting if you have had irregular heart rhythms, such as atrial fibrillation.

    If you have atrial fibrillation, a history of heart failure or a history of strokes, your doctor may suggest these drugs. They can have dangerous side effects, however, and must be taken exactly as prescribed.

Surgery

Though most people with mitral valve prolapse don't need surgery, your doctor may suggest surgical treatment if you have severe mitral valve regurgitation with or without symptoms.

Severe mitral valve regurgitation can eventually cause heart failure, preventing your heart from effectively pumping blood. If regurgitation goes on too long, your heart may be too weak for surgery.

If your doctor suggests surgery, he or she may suggest repairing or replacing the mitral valve. Valve repair and replacement may be performed 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 than open surgery.

  • Valve repair. Mitral valve repair is a surgery that preserves your own valve. For most people with mitral valve prolapse, this is the preferred surgical treatment to correct the condition.

    Your mitral valve consists of two triangular-shaped flaps of tissue called leaflets. The leaflets of the mitral valve connect to the heart muscle through a ring called the annulus.

    The surgeon can modify the original valve (valvuloplasty) to eliminate backward blood flow. Surgeons can also repair the valve by reconnecting valve leaflets or by removing excess valve tissue so that the leaflets can close tightly.

    Sometimes repairing the valve includes tightening or replacing the annulus. This is called an annuloplasty. It is important to ensure that your surgeon is experienced in performing mitral valve repair.

  • Valve replacement. Your surgeon may perform a valve replacement if valve repair isn't possible. In valve replacement surgery, the damaged mitral valve is replaced by an artificial (prosthetic) valve. Artificial valves are mechanical or tissue valves.

    Mechanical valves may last a long time. However, if you have a mechanical valve, you must use an anticoagulant medication, such as warfarin (Coumadin), for the rest of your life to prevent blood clots from forming on the valve. If a blood clot forms on the valve and breaks free, it could travel to your brain and cause a stroke.

    Tissue valves are made from animal tissue such as a pig or cow valve. These kinds of valves are called bioprostheses. They may wear out over time and need replacement. However, an advantage of the tissue valve is that you don't have to use long-term anticoagulant medication.

Antibiotics seldom recommended

Doctors used to recommend that some people with mitral valve prolapse take antibiotics before certain dental or medical procedures to prevent endocarditis but not anymore.

According to the American Heart Association, antibiotics are no longer necessary in most cases for someone with mitral valve regurgitation or mitral valve prolapse.

Still, if you've been told to take antibiotics before any procedures in the past, check with your doctor whether that's still necessary.

Potential future treatments

Researchers are studying new techniques to repair or replace a valve using a tube (catheter) inserted in a blood vessel in your groin and guided to your heart.

Lifestyle and home remedies

Most people with mitral valve prolapse lead normal, productive and symptom-free lives.

Doctors generally won't recommend restrictions on your lifestyle or any limitations on your personal exercise or dietary program. However, ask your doctor if he or she recommends any changes to your lifestyle. If you have severe mitral valve regurgitation, your doctor may recommend certain exercise limitations.

Your doctor may recommend regular follow-up visits to evaluate your condition.

Preparing for your appointment

Because appointments can be brief, and because there's often a lot to discuss, it's a good idea to be prepared for your appointment. Here's some information to help you get ready for your appointment and know what to expect from your doctor.

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 any symptoms you're experiencing, including any that may seem unrelated to mitral valve prolapse.
  • Write down key personal information, including a family history of heart disease, heart defects, genetic disorders, stroke, high blood pressure or diabetes, and any major stresses or recent life changes.
  • Make a list of all medications, vitamins or supplements that you're taking.
  • Take a family member or friend along, if possible. Sometimes it can be difficult to remember all the information provided to you during an appointment. Someone who accompanies you may remember something that you missed or forgot.
  • 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 doctor about any challenges you might face in getting started.
  • Write down questions to ask your doctor.

Your time with your doctor is limited, so preparing a list of questions will help you make the most of your time together. List your questions from most important to least important in case time runs out. For mitral valve prolapse, some basic questions to ask your doctor include:

  • What is likely causing my symptoms or condition?
  • What are other possible causes for my symptoms or condition?
  • What kinds of tests will 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?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment at any time that you don't understand something.

What to expect from your doctor

Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:

  • When did you first begin experiencing symptoms?
  • Have your symptoms been continuous or occasional?
  • How severe are your symptoms?
  • What, if anything, seems to improve your symptoms?
  • What, if anything, appears to worsen your symptoms?