Medscape is available in 5 Language Editions – Choose your Edition here.


Mitral Valve Prolapse Clinical Presentation

  • Author: Bhavik V Thakkar, MD; Chief Editor: Richard A Lange, MD, MBA  more...
Updated: Apr 23, 2014


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:

  • Anxiety
  • Panic attacks
  • Arrhythmias
  • Exercise intolerance
  • Palpitations
  • Atypical chest pain
  • Fatigue
  • Orthostasis
  • Syncope or presyncope
  • Neuropsychiatric symptoms

Symptoms related to progression of mitral regurgitation include the following:

  • Fatigue
  • Dyspnea
  • Exercise intolerance
  • Orthopnea
  • 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.

Contributor Information and Disclosures

Bhavik V Thakkar, MD Medical Director, Internal Medicine Hospitalist, AppleCare Medical Group

Bhavik V Thakkar, MD is a member of the following medical societies: American College of Physicians-American Society of Internal Medicine, American Heart Association, American Medical Association, Minnesota Medical Association, American Stroke Association, Society for Vascular Medicine

Disclosure: Nothing to disclose.


Adam E Schussheim, MD Cardiac Specialists, PC

Adam E Schussheim, MD is a member of the following medical societies: American College of Cardiology, American Society of Echocardiography, American Society of Hypertension, American Society of Nuclear Cardiology

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Marschall S Runge, MD, PhD Charles and Anne Sanders Distinguished Professor of Medicine, Chairman, Department of Medicine, Vice Dean for Clinical Affairs, University of North Carolina at Chapel Hill School of Medicine

Marschall S Runge, MD, PhD is a member of the following medical societies: American Physiological Society, American Society for Clinical Investigation, American Society for Investigative Pathology, Association of American Physicians, Texas Medical Association, Southern Society for Clinical Investigation, American Federation for Clinical Research, Association of Professors of Medicine, Association of Professors of Cardiology, American Association for the Advancement of Science, American College of Cardiology, American College of Physicians-American Society of Internal Medicine, American Federation for Medical Research, American Heart Association

Disclosure: Received honoraria from Pfizer for speaking and teaching; Received honoraria from Merck for speaking and teaching; Received consulting fee from Orthoclinica Diagnostica for consulting.

Chief Editor

Richard A Lange, MD, MBA President, Texas Tech University Health Sciences Center, Dean, Paul L Foster School of Medicine

Richard A Lange, MD, MBA is a member of the following medical societies: Alpha Omega Alpha, American College of Cardiology, American Heart Association, Association of Subspecialty Professors

Disclosure: Nothing to disclose.

Additional Contributors

Justin D Pearlman, MD, ME, PhD, FACC, MA Chief, Division of Cardiology, Director of Cardiology Consultative Service, Director of Cardiology Clinic Service, Director of Cardiology Non-Invasive Laboratory, Chair of Institutional Review Board, University of California, Los Angeles, David Geffen School of Medicine

Justin D Pearlman, MD, ME, PhD, FACC, MA is a member of the following medical societies: American College of Cardiology, International Society for Magnetic Resonance in Medicine, American College of Physicians, American Federation for Medical Research, Radiological Society of North America

Disclosure: Nothing to disclose.


Alan D Forker, MD Professor of Medicine, University of Missouri at Kansas City School of Medicine; Director, Outpatient Lipid Diabetes Research, MidAmerica Heart Institute of St Luke's Hospital

Disclosure: Nothing to disclose.

  1. Alpert MA, Mukerji V, Sabeti M, et al. Mitral valve prolapse, panic disorder, and chest pain. Med Clin North Am. 1991 Sep. 75(5):1119-33. [Medline].

  2. Perloff JK, Child JS. Mitral valve prolapse. Evolution and refinement of diagnostic techniques. Circulation. 1989 Sep. 80(3):710-1. [Medline].

  3. Perloff JK, Child JS, Edwards JE. New guidelines for the clinical diagnosis of mitral valve prolapse. Am J Cardiol. 1986 May 1. 57(13):1124-9. [Medline].

  4. Freed LA, Levy D, Levine RA, et al. Prevalence and clinical outcome of mitral-valve prolapse. N Engl J Med. 1999 Jul 1. 341(1):1-7. [Medline]. [Full Text].

  5. Levine RA, Triulzi MO, Harrigan P, Weyman AE. The relationship of mitral annular shape to the diagnosis of mitral valve prolapse. Circulation. 1987 Apr. 75(4):756-67. [Medline].

  6. American College of Cardiology/American Heart Association. ACC/AHA 2006 guidelines for the management of patients with valvular heart disease. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing committee to revise the 1998 guidelines for the Manag. J Am Coll Cardiol. 2006. 48:1-148:[Medline]. [Full Text].

  7. American College of Cardiology/American Heart Association. ACC/AHA guidelines for the management of patients with valvular heart disease. A report of the American College of Cardiology/American Heart Association. Task Force on Practice Guidelines (Committee on Management of Patients with Valvular Heart Disease. J Am Coll Cardiol. 1998 Nov. 32(5):1486-588. [Medline]. [Full Text].

  8. Avierinos JF, Gersh BJ, Melton LJ 3rd, Bailey KR, Shub C, Nishimura RA, et al. Natural history of asymptomatic mitral valve prolapse in the community. Circulation. 2002 Sep 10. 106(11):1355-61. [Medline].

  9. Barnett HJ, Boughner DR, Taylor DW, Cooper PE, Kostuk WJ, Nichol PM. Further evidence relating mitral-valve prolapse to cerebral ischemic events. N Engl J Med. 1980 Jan 17. 302(3):139-44. [Medline].

  10. Bryhn M, Persson S. The prevalence of mitral valve prolapse in healthy men and women in Sweden. An echocardiographic study. Acta Med Scand. 1984. 215(2):157-60. [Medline].

  11. Ciancamerla F, Paglia I, Catuzzo B, Morello M, Mangiardi L. Sudden death in mitral valve prolapse and severe mitral regurgitation. Is chordal rupture an indication to early surgery?. J Cardiovasc Surg (Torino). 2003 Apr. 44(2):283-6. [Medline].

  12. Clemens JD, Horwitz RI, Jaffe CC, Feinstein AR, Stanton BF. A controlled evaluation of the risk of bacterial endocarditis in persons with mitral-valve prolapse. N Engl J Med. 1982 Sep 23. 307(13):776-81. [Medline].

  13. Cohn LH, Couper GS, Aranki SF, Rizzo RJ, Kinchla NM, Collins JJ Jr. Long-term results of mitral valve reconstruction for regurgitation of the myxomatous mitral valve. J Thorac Cardiovasc Surg. 1994 Jan. 107(1):143-50; discussion 150-1. [Medline].

  14. Dajani AS, Taubert KA, Wilson W, et al. Prevention of bacterial endocarditis. Recommendations by the American Heart Association. Circulation. 1997 Jul 1. 96(1):358-66. [Medline].

  15. David TE, Omran A, Armstrong S, Sun Z, Ivanov J. Long-term results of mitral valve repair for myxomatous disease with and without chordal replacement with expanded polytetrafluoroethylene sutures. J Thorac Cardiovasc Surg. 1998 Jun. 115(6):1279-85; discussion 1285-6. [Medline].

  16. Davidsen B, Egeblad H, Pietersen A. Thromboembolism in patients with advanced mitral valve prolapse. J Intern Med. 1989 Dec. 226(6):433-6. [Medline].

  17. Devereux RB. Recent developments in the diagnosis and management of mitral valve prolapse. Curr Opin Cardiol. 1995 Mar. 10(2):107-16. [Medline].

  18. Devereux RB, Hawkins I, Kramer-Fox R, Lutas EM, Hammond IW, Spitzer MC. Complications of mitral valve prolapse. Disproportionate occurrence in men and older patients. Am J Med. 1986 Nov. 81(5):751-8. [Medline].

  19. Devereux RB, Kramer-Fox R, Brown WT, Shear MK, Hartman N, Kligfield P. Relation between clinical features of the mitral prolapse syndrome and echocardiographically documented mitral valve prolapse. J Am Coll Cardiol. 1986 Oct. 8(4):763-72. [Medline].

  20. Devereux RB, Kramer-Fox R, Shear MK, et al. Diagnosis and classification of severity of mitral valve prolapse: methodologic, biologic, and prognostic considerations. Am Heart J. 1987 May. 113(5):1265-80. [Medline].

  21. Devlin WH, Starling MR. Outcome of valvular heart disease with vasodilator therapy. Compr Ther. 1994. 20(10):569-74. [Medline].

  22. Freed LA, Benjamin EJ, Levy D, et al. Mitral valve prolapse in the general population: the benign nature of echocardiographic features in the Framingham Heart Study. J Am Coll Cardiol. 2002 Oct 2. 40(7):1298-304. [Medline].

  23. Gilon D, Buonanno FS, Joffe MM, et al. Lack of evidence of an association between mitral-valve prolapse and stroke in young patients. N Engl J Med. 1999 Jul 1. 341(1):8-13. [Medline].

  24. Glesby MJ, Pyeritz RE. Association of mitral valve prolapse and systemic abnormalities of connective tissue. A phenotypic continuum. JAMA. 1989 Jul 28. 262(4):523-8. [Medline].

  25. Grayburn PA. Vasodilator therapy for chronic aortic and mitral regurgitation. Am J Med Sci. 2000 Sep. 320(3):202-8. [Medline].

  26. Grigioni F, Enriquez-Sarano M, Ling LH, Bailey KR, Seward JB, Tajik AJ. Sudden death in mitral regurgitation due to flail leaflet. J Am Coll Cardiol. 1999 Dec. 34(7):2078-85. [Medline].

  27. Izumo M, Shiota M, Kar S, Gurudevan SV, Tolstrup K, Siegel RJ, et al. Comparison of real-time three-dimensional transesophageal echocardiography to two-dimensional transesophageal echocardiography for quantification of mitral valve prolapse in patients with severe mitral regurgitation. Am J Cardiol. 2013 Feb 15. 111(4):588-94. [Medline].

  28. Kligfield P, Hochreiter C, Kramer H, et al. Complex arrhythmias in mitral regurgitation with and without mitral valve prolapse: contrast to arrhythmias in mitral valve prolapse without mitral regurgitation. Am J Cardiol. 1985 Jun 1. 55(13 Pt 1):1545-9. [Medline].

  29. Kostuk WJ, Boughner DR, Barnett HJ, Silver MD. Strokes: A complication of mitral-leaflet prolapse?. Lancet. 1977 Aug 13. 2(8033):313-6. [Medline].

  30. Kramer HM, Kligfield P, Devereux RB, Savage DD, Kramer-Fox R. Arrhythmias in mitral valve prolapse. Effect of selection bias. Arch Intern Med. 1984 Dec. 144(12):2360-4. [Medline].

  31. Kulan K, Komsuoglu B, Tuncer C, Kulan C. Significance of QT dispersion on ventricular arrhythmias in mitral valve prolapse. Int J Cardiol. 1996 Jun. 54(3):251-7. [Medline].

  32. Levine RA, Handschumacher MD, Sanfilippo AJ, Hagege AA, Harrigan P, Marshall JE. Three-dimensional echocardiographic reconstruction of the mitral valve, with implications for the diagnosis of mitral valve prolapse. Circulation. 1989 Sep. 80(3):589-98. [Medline].

  33. Levine RA, Stathogiannis E, Newell JB, et al. Reconsideration of echocardiographic standards for mitral valve prolapse: lack of association between leaflet displacement isolated to the apical four chamber view and independent echocardiographic evidence of abnormality. J Am Coll Cardiol. 1988 May. 11(5):1010-9. [Medline].

  34. Levy D, Savage D. Prevalence and clinical features of mitral valve prolapse. Am Heart J. 1987 May. 113(5):1281-90. [Medline].

  35. Ling LH, Enriquez-Sarano M, Seward JB, Orszulak TA, Schaff HV, Bailey KR. Early surgery in patients with mitral regurgitation due to flail leaflets: a long-term outcome study. Circulation. 1997 Sep 16. 96(6):1819-25. [Medline].

  36. MacMahon SW, Hickey AJ, Wilcken DE, Wittes JT, Feneley MP, Hickie JB. Risk of infective endocarditis in mitral valve prolapse with and without precordial systolic murmurs. Am J Cardiol. 1987 Jan 1. 59(1):105-8. [Medline].

  37. MacMahon SW, Roberts JK, Kramer-Fox R, et al. Mitral valve prolapse and infective endocarditis. Am Heart J. 1987 May. 113(5):1291-8. [Medline].

  38. Markiewicz W, Stoner J, London E, Hunt SA, Popp RL. Mitral valve prolapse in one hundred presumably healthy young females. Circulation. 1976 Mar. 53(3):464-73. [Medline].

  39. Marks AR, Choong CY, Sanfilippo AJ, et al. Identification of high-risk and low-risk subgroups of patients with mitral-valve prolapse. N Engl J Med. 1989 Apr 20. 320(16):1031-6. [Medline].

  40. Martinez-Rubio A, Schwammenthal Y, Schwammenthal E, Block M, Reinhardt L, Garcia-Alberola A. Patients with valvular heart disease presenting with sustained ventricular tachyarrhythmias or syncope: results of programmed ventricular stimulation and long-term follow-up. Circulation. 1997 Jul 15. 96(2):500-8. [Medline].

  41. Mylonakis E, Calderwood SB. Infective endocarditis in adults. N Engl J Med. 2001 Nov 1. 345(18):1318-30. [Medline].

  42. Nidorf SM, Weyman AE, Hennessey R. The relationship between mitral valve morphology and prognosis in patients with mitral valve prolapse: a prospective echocardiographic study of 568 patients [abstr]. J Am Soc Echocardiogr. 1993. 6:S8.

  43. Nishimura RA, McGoon MD. Perspectives on mitral-valve prolapse. N Engl J Med. 1999 Jul 1. 341(1):48-50. [Medline].

  44. Nishimura RA, McGoon MD, Shub C, Miller FA Jr, Ilstrup DM, Tajik AJ. Echocardiographically documented mitral-valve prolapse. Long-term follow-up of 237 patients. N Engl J Med. 1985 Nov 21. 313(21):1305-9. [Medline].

  45. Olson LJ, Subramanian R, Ackermann DM, Orszulak TA, Edwards WD. Surgical pathology of the mitral valve: a study of 712 cases spanning 21 years. Mayo Clin Proc. 1987 Jan. 62(1):22-34. [Medline].

  46. Orencia AJ, Petty GW, Khandheria BK, Annegers JF, Ballard DJ, Sicks JD. Risk of stroke with mitral valve prolapse in population-based cohort study. Stroke. 1995 Jan. 26(1):7-13. [Medline].

  47. Petty GW, Orencia AJ, Khandheria BK, Whisnant JP. A population-based study of stroke in the setting of mitral valve prolapse: risk factors and infarct subtype classification. Mayo Clin Proc. 1994 Jul. 69(7):632-4. [Medline].

  48. Procacci PM, Savran SV, Schreiter SL, Bryson AL. Prevalence of clinical mitral-valve prolapse in 1169 young women. N Engl J Med. 1976 May 13. 294(20):1086-8. [Medline].

  49. Sandok BA, Giuliani ER. Cerebral ischemic events in patients with mitral valve prolapse. Stroke. 1982 Jul-Aug. 13(4):448-50. [Medline].

  50. Savage DD, Devereux RB, Garrison RJ, et al. Mitral valve prolapse in the general population. 2. Clinical features: the Framingham Study. Am Heart J. 1983 Sep. 106(3):577-81. [Medline].

  51. Savage DD, Garrison RJ, Devereux RB, Castelli WP, Anderson SJ, Levy D. Mitral valve prolapse in the general population. 1. Epidemiologic features: the Framingham Study. Am Heart J. 1983 Sep. 106(3):571-6. [Medline].

  52. Savage DD, Levy D, Garrison RJ, Castelli WP, Kligfield P, Devereux RB. Mitral valve prolapse in the general population. 3. Dysrhythmias: the Framingham Study. Am Heart J. 1983 Sep. 106(3):582-6. [Medline].

  53. Scharf RE, Hennerici M, Bluschke V, Lueck J, Kladetzky RG. Cerebral ischemia in young patients: it is associated with mitral valve prolapse and abnormal platelet activity in vivo?. Stroke. 1982 Jul-Aug. 13(4):454-8. [Medline].

  54. Tieleman RG, Crijns HJ, Wiesfeld AC, Posma J, Hamer HP, Lie KI. Increased dispersion of refractoriness in the absence of QT prolongation in patients with mitral valve prolapse and ventricular arrhythmias. Br Heart J. 1995 Jan. 73(1):37-40. [Medline].

  55. Tse HF, Lau CP, Cheng G. Relation between mitral regurgitation and platelet activation. J Am Coll Cardiol. 1997 Dec. 30(7):1813-8. [Medline].

  56. Ulgen MS, Biyik I, Karadede A, Temamogullari AV, Alan S, Toprak N. Relation between QT dispersion and ventricular arrhythmias in uncomplicated isolated mitral valve prolapse. Jpn Circ J. 1999 Dec. 63(12):929-33. [Medline].

  57. Warth DC, King ME, Cohen JM, Tesoriero VL, Marcus E, Weyman AE. Prevalence of mitral valve prolapse in normal children. J Am Coll Cardiol. 1985 May. 5(5):1173-7. [Medline].

  58. Zipes DP, Libby P, Bonow RO, Braunwald E. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 7th ed. Philadelphia, Pa: Saunders; 2005.

All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.