Mitral Valve Prolapse - MVP

Understanding this commonly diagnosed problem

Patient explaining chest pain to nurse with clipboard
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Mitral valve prolapse (MVP) is a common cardiac diagnosis. Unfortunately, it is also one of the most commonly misunderstood. So if you have been told you have MVP, it is important for you to understand what it is, what problems it may cause (and not cause), and what you should do about it.

What Is MVP?

MVP is a congenital abnormality that produces an excess of tissue on the mitral valve (the valve that separates the left atrium from the left ventricle).

This excess of tissue allows the mitral valve to become somewhat “floppy.” As a result, when the left ventricle contracts, the mitral valve can partially prolapse back into the left atrium. This prolapse allows some of the blood in the left ventricle to flow backwards (that is, to regurgitate) into the left atrium. 

There is often a genetic predisposition to MVP. If a person has true MVP, it is likely that about 30% of his/her close relatives may also have it.

How Is MVP Diagnosed?

Often, MVP is first suspected when the doctor hears a classic "click-murmur" sound while listening to a person’s heart (the click being caused by the prolapsing of the mitral valve; the murmur by the subsequent regurgitation of blood). The diagnosis is confirmed with an echocardiogram.

In the past, MVP has been grossly over-diagnosed — up to 35% of all individuals tested in some reports were said to have MVP.

However, careful studies have now shown that the actual incidence of “real” MVP is roughly 2% to 3% of the general population. There is evidence that some physicians still greatly over-diagnose this condition.

Why is MVP Significant?

MVP can produce two different types of clinical problems. It can lead to a significant degree of mitral regurgitation; and it can make a person more prone to develop infectious endocarditis (infection of the heart valve).

Significant mitral regurgitation (which is a leakiness of the mitral valve) eventually can lead to enlargement of the cardiac chambers, weakening of the heart muscle, and ultimately, to heart failure. Fortunately, the large majority of people with MVP do not have significant mitral regurgitation — only about 10% of people with MVP will ever develop serious mitral regurgitation over their lifetimes.

While people with MVP do have a somewhat increased risk of developing infectious endocarditis, that risk is still very small. In fact, because endocarditis is so rare, the most recent guidelines from the American Heart Association no longer recommend prophylactic antibiotics for patients with MVP.

What Is the Prognosis With MVP?

The vast majority of patients with MVP can expect to lead completely normal lives, without any symptoms due to their MVP, and without any decrease in life expectancy. In general, the prognosis is closely related to the degree of mitral regurgitation that is present. Most patients with MVP who have minimal mitral regurgitation have an excellent prognosis.

What Other Clinical Problems Have Been Attributed To MVP?

Because MVP is so commonly diagnosed (even when it may not actually be present), it has been associated with a myriad of conditions that probably do not have anything to do with the MVP itself.

Here are the more common conditions that have been associated with MVP, but whose actual relationship to MVP is tenuous at best:

Anxiety, chest pain, palpitations. While it is commonly believed that MVP causes these symptoms, most individuals with MVP do not experience them, and most individuals with anxiety, chest pain and palpitations do not have MVP. A true association with MVP has never been demonstrated.

Stroke or sudden death. It has never been shown that MVP itself causes either stroke or sudden death, or that the incidence of MVP is higher than normal in patients who experience these problems.

While patients with severe mitral regurgitation from any cause have an increased risk of stroke and sudden death, those with mild MVP probably have the same risk as the general population.

The dysautonomia syndromes. The dysautonomia syndromes, which include such things as chronic fatigue syndromevasovagal (or neurocardiogenic) syncopepanic attacksfibromyalgia and irritable bowel syndrome, are often blamed on MVP. (Click here for a review of dysautonomia.) It is not at all clear that people with MVP actually have an increased risk of developing symptoms associated with the dysautonomias (such as palpitations, anxiety, fatigue, aches and pains). But in their desperation to make a diagnosis in patients complaining of such symptoms, and thus ordering every test known to man, doctors have found (naturally) that a proportion of these difficult patients have MVP. Doctors have thus coined the phrase "Mitral Valve Prolapse Syndrome" to explain it. Whether the MVP itself actually has anything whatever to do with these symptoms is very doubtful.

If You Have MVP

If you have been told you have MVP, you should make sure you understand from your physician the degree of mitral regurgitation you have, and that your doctor has outlined a schedule for follow-up. Those with no regurgitation simply need to have a physical examination every five years or so; those with some degree of significant regurgitation ought to have repeat echocardiograms yearly.

If you also have symptoms such as chest pain or palpitations, these symptoms ought to be evaluated as separate issues. If your doctor merely writes these symptoms off as being due to MVP, without ever performing an evaluation, consider seeking another opinion.

If you think you may have one of the dysautonomia syndromes, make sure your doctor is well-versed in managing these conditions. Don't waste time with a doctor who seems too willing to write off your symptoms as "just part of MVP." The dysautonomias are real, honest-to-goodness physiologic disorders, which deserve to be treated and not brushed off.


# Avierinos, JF, Gersh, BJ, Melton LJ 3rd, et al. Natural history of asymptomatic mitral valve prolapse in the community. Circulation 2002; 106:1355.

Kim, S, Kuroda, T, Nishinaga, M, et al. Relation between severity of mitral regurgitation and prognosis of mitral valve prolapse: Echocardiographic follow-up study. Am Heart J 1996; 132:348.

Nishimura RA, Otto CM, Bonow RO, et al. 2014 AHA/ACC guideline 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. J Am Coll Cardiol 2014; 63:e57.

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