Mitral Valve Prolapse Clinical Presentation
- Author: Bhavik V Thakkar, MD; Chief Editor: Richard A Lange, MD, MBA more...
Mitral valve prolapse (MVP) is often diagnosed from the physical examination, when the classic auscultatory finding of a mid-to-late systolic click and/or murmur is appreciated. Alternatively, it may be incidentally diagnosed during routine echocardiography or discovered when complications of MVP manifest.
Most patients are asymptomatic. Symptomatic patients with MVP are separated into 3 categories: (1) those with symptoms related to autonomic dysfunction; (2) those with symptoms related to the progression of mitral regurgitation; and (3) those with symptoms that occur as a result of an associated complication (ie, stroke, endocarditis, or arrhythmia).
Symptoms related to autonomic dysfunction are usually associated with genetically inherited MVP and include the following:
- Panic attacks
- Exercise intolerance
- Atypical chest pain
- Syncope or presyncope
- Neuropsychiatric symptoms
Symptoms related to progression of mitral regurgitation include the following:
- Exercise intolerance
- Paroxysmal nocturnal dyspnea (PND)
- Progressive signs of congestive heart failure (CHF)
The ECG usually is normal, but can show nonspecific ST-segment and T wave abnormalities especially in leads II, III, aVF.
MVP is also commonly seen in patients with inheritable connective tissue disorders.
Clinical characteristics are typically benign in young women, whereas men older than 50 years tend to have serious consequence of mitral regurgitation.
Common general physical features associated with MVP include the following:
- Asthenic body habitus
- Low body weight or body mass index (BMI)
- Straight-back syndrome
- Scoliosis or kyphosis
- Pectus excavatum
- Hypermobility of the joints
- Arm span greater than height (which may be indicative of Marfan syndrome)
The classic auscultatory finding is a mid-to-late systolic click, which is present due to the leaflets prolapsing into the left atrium resulting in tensing of the mitral valve apparatus. It may or may not be followed by a high-pitched, mid-to-late systolic murmur at the cardiac apex.
The midsystolic click can vary in intensity and timing, primarily depending on left ventricular volume.
End-diastolic volume can be reduced by performing a Valsalva maneuver or by having the patient stand. These maneuvers result in an early click, which is close to the first heart sound, and a prolonged murmur. In the supine position, especially with the legs raised for increased venous return, left ventricular diastolic volume is increased, resulting in a click later in systole and a shortened murmur.
Patients with MVP most frequently have symptoms of autonomic dysfunction, including easy fatigability, dizziness, and atypical chest pain. This pain is perhaps related to papillary muscle strain (ie, excessive pulling on the left ventricular wall with prolapsed leaflets in the left atrium).
MVP usually occurs as an isolated entity. As previously mentioned, it also commonly occurs with heritable disorders of connective tissue. MVP has also been described in association with a secundum atrial septal defect.
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