Approach Considerations

Consultation by a cardiologist is recommended to confirm the diagnosis of mitral valve prolapse (MVP), to exclude other possible disorders from the diagnosis (eg, hypertrophic cardiomyopathy, atrial septal defect) and to further evaluate symptoms (eg, palpitations).

Echocardiography may not be necessary for diagnosis in many cases because dynamic auscultation may be more reliable.

Cognitive behavioral therapy and breathing retraining may diminish functional cardiac symptoms (eg, chest pain, dyspnea, dizziness).

Follow-up care by a cardiothoracic surgeon is recommended for patients with hemodynamically significant mitral regurgitation (MR). Surgical repair or replacement of the mitral valve is indicated for patients with exertional dyspnea, an ejection fraction below 50%, and a left ventricular end-systolic dimension approaching 45 mm.

Prevention

Blood pressure control may diminish the risk of progression to mitral regurgitation.

Exercise; biofeedback; meditation; and avoidance of smoking, alcohol, caffeine, and stimulants may prevent symptoms.

Prehospital Care

The prehospital treatment of patients with chest pain, dyspnea, palpitations, a neurologic deficit, or syncope should include cardiac monitoring, supplemental oxygen, and intravenous catheter placement.

Emergency Department Care

Patients with symptoms of chest pain, dyspnea, palpitations, a neurologic deficit, or syncope should be placed on oxygen, put in a supine or Fowler position, and monitored with the following:

Pulse oximetry
Cardiac monitoring
Frequent vital signs, including one set of orthostatic vital signs when possible

Anxious patients should be reassured regarding their status, and many may benefit from psychosocial intervention.

Patients with stroke, risk of sudden death, unstable ventricular dysrhythmias, severe symptomatic mitral regurgitation (MR), or bacterial endocarditis may require inpatient management.

Consultations

Consult a cardiologist in cases of diagnostic uncertainty, ventricular dysrhythmia, or risk of sudden death as well as when symptoms of severe MR are present.

Consider consulting a cardiothoracic surgeon in patients with significant exertional dyspnea and congestive heart failure that is related to MR.

Medication

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