Mitral valve prolapse
Mitral valve prolapse is systolic displacement of one or both mitral leaflets into the left atrium, usually from myxomatous degeneration, marked by a mid-systolic click and a late systolic murmur. Most cases are benign, but it is the leading cause of primary mitral regurgitation and a small subset carry arrhythmic risk. Management is reassurance for benign disease, beta-blockers for symptoms, and mitral valve repair for severe regurgitation.
- Topic reviewThe full article, organized the way the exam asks it.
- ABIM-format MCQsVignettes with an explanation for every wrong answer.
- Key factsThe numbers and thresholds worth memorizing, up front.
- AI tutorMedBrain answers the question you're stuck on.
What this article covers
- Overview
Definition: mitral valve prolapse is systolic billowing of one or both mitral leaflets more than 2 mm above the annular plane into the left atrium, usually from myxomatous degeneration.
- Epidemiology
Common, the leading cause of primary mitral regurgitation requiring surgery.
- Risk factors
Myxomatous degeneration and familial predisposition.
- Pathophysiology
Myxomatous leaflets and elongated chordae: redundant tissue allows systolic prolapse into the atrium.
- Clinical features
Usually asymptomatic. A mid-systolic click followed by a late systolic murmur at the apex, with the click moving earlier on standing or Valsalva.
- Differential diagnosis
Mitral regurgitation of other cause: holosystolic rather than late systolic (Mitral regurgitation).
- Diagnosis
Establish with echocardiography showing systolic leaflet displacement above the annular plane: the diagnostic basis is transthoracic echocardiography demonstrating prolapse of one or both leaflets…
- Management
First-line, reassure and observe most patients: benign prolapse without significant regurgitation needs only explanation and periodic follow-up.
- Complications
Progressive severe mitral regurgitation and chordal rupture.
- Prognosis
Benign in the majority. Higher morbidity in those who develop severe mitral regurgitation.
- Prevention
Surveillance echocardiography every 1 to 3 years depending on regurgitation severity to detect progression.
Read the whole article
Subscribing to Internal Medicine opens every article, the full question bank and MedBrain, on the web, iPhone and Android.
Related articles
- Mitral regurgitation
Mitral regurgitation is systolic backflow from the left ventricle into the left atrium, classified as primary (valve disease) or secondary (ventricular or annular disease). Chronic disease causes volume overload with an apical holosystolic murmur, while acute severe regurgitation causes pulmonary edema; severe primary disease is treated with valve repair or replacement.
- Marfan syndrome
Marfan syndrome is an autosomal dominant connective tissue disorder from FBN1 (fibrillin-1) mutations, with skeletal, ocular, and cardiovascular features. The cardiovascular risk drives prognosis: aortic root dilation predisposing to dissection and rupture, managed with beta-blockers or ARBs, activity restriction, surveillance imaging, and prophylactic aortic surgery.
- Supraventricular tachycardia
Supraventricular tachycardia is any tachyarrhythmia arising at or above the AV node, usually a regular narrow-complex tachycardia. Acute management of a stable regular narrow-complex SVT is vagal maneuvers then adenosine; unstable patients receive synchronized cardioversion, and definitive therapy is catheter ablation.
- Hypertrophic cardiomyopathy
Hypertrophic cardiomyopathy is an autosomal dominant sarcomere disease causing unexplained left ventricular hypertrophy, often with dynamic left ventricular outflow tract obstruction, and is a leading cause of sudden cardiac death in young people. Diagnosis is by echocardiography or cardiac MRI showing unexplained hypertrophy, and management includes negative inotropes, obstruction relief, and ICD placement for high sudden-death risk.
- Aortic stenosis
Aortic stenosis is obstruction to left ventricular outflow from a narrowed aortic valve, most often calcific degeneration in older adults or a bicentric bicuspid valve earlier in life. Symptoms of angina, syncope, or heart failure mark a poor prognosis, and severe symptomatic disease is treated with valve replacement (surgical or transcatheter).