Mitral Valve Prolapse Differential Diagnoses

Updated: Nov 16, 2016
  • Author: Qurat-ul-ain Jelani, MD; Chief Editor: Richard A Lange, MD, MBA  more...
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DDx

Diagnostic Considerations

Consider all heritable connective tissue disorders mentioned previously, with emphasis on Marfan syndrome because of its increased frequency. The prevalence of mild mitral valve pathology in Marfan syndrome is estimated to be around 75%,  whereas the prevalence of  severe myxomatous mitral valve thickening with prolapse is closer to 25% in these individuals. [38] All causes of mitral regurgitation (MR) should be considered. However, if only a mid-systolic click and/or a mid-to-late systolic murmur is present, the diagnosis is almost always mitral valve prolapse (MVP). If only a late systolic murmur without a click is present, papillary muscle dysfunction secondary to coronary artery disease is a possibility.

Strict diagnostic criteria should be used to prevent the overdiagnoses of MVP that occurred in the 1970s and 1980s. In many patients, MVP was diagnosed on the basis of imprecise echocardiographic criteria, producing undue anxiety, particularly in asymptomatic patients.

In addition, being diagnosed with a heart condition can greatly affect patients' self-perceptions. Care should be taken to explain MVP syndrome in detail so that patients understand that the natural history of MVP is usually benign. The vast majority of patients with MVP should be strongly reassured of their benign prognosis.

Follow up patients with clinically significant MVP. When clinically significant MR develops or progresses, irreversible left ventricular dysfunction may occur in the absence of symptoms. Also, endocarditis can be a subtle illness that makes prompt diagnosis difficult.

Differential Diagnoses