Makindo Medical Notes

💓 Mitral Valve Prolapse (MVP), also called "floppy mitral valve", is usually benign. However, it may rarely lead to complications such as mitral regurgitation, endocarditis, stroke, or arrhythmias — hence appropriate monitoring is important.

📖 About / Characteristics

• Also called “floppy mitral valve”.
• Most patients have a benign course ✅.
• In a minority, there is risk of stroke 🧠 or sudden cardiac death ⚡.
• Often an incidental finding on echocardiography.

🧬 Aetiology

• Autosomal dominant inheritance described in some families.
• Myxomatous degeneration of valve leaflets → redundant, prolapsing valve (e.g. in Marfan syndrome 🧑‍🦱, fibrillin mutations).
• Elevated plasma catecholamines sometimes observed.

🩺 Clinical Presentation

• 🎧 Classic finding: mid-systolic click → followed by a mid-to-late systolic murmur (“click–murmur complex”).
• Atypical chest pain, palpitations due to arrhythmias.
• Most are asymptomatic.

⚠️ Complications

• Mitral regurgitation (most common complication).
• Arrhythmias (AF, ventricular ectopics).
• Endocarditis (rare).
• Stroke / embolic events (very rare).
• Sudden cardiac death (extremely rare).

🔗 Associations

• Connective tissue disorders: Marfan’s, Ehlers-Danlos, Osteogenesis imperfecta, Pseudoxanthoma elasticum.
• Skeletal features: Pectus excavatum, scoliosis.
• Other cardiac conditions: HOCM, ASD, Ebstein anomaly, WPW syndrome.
• Other associations: False-positive exercise stress tests (esp. in women), Rheumatic fever, Von Willebrand’s disease.

🔎 Investigations

• Bloods: FBC, U&E, LFTs — usually normal (done to exclude other pathology).
• ECG: May show arrhythmias, non-specific ST/T changes.
• Holter monitor: To detect intermittent arrhythmias if palpitations.
• CXR: Often normal; may show cardiomegaly in advanced MR.
• Echocardiography (gold standard): Diagnostic — shows leaflet prolapse ± MR. Beware early echo “overdiagnosis”.

💊 Management

• Reassurance: Most patients require no treatment, just follow-up ✅.
• Beta-blockers: For palpitations, arrhythmias, or atypical chest pain.
• Aspirin / Warfarin: Consider if embolic events or AF present.
• Endocarditis prophylaxis: Not routinely indicated; only if prosthetic valve, prior endocarditis, or very high-risk lesions (per updated NICE/ESC guidance).
• Surgery: Reserved for severe symptomatic MR or LV dysfunction → mitral valve repair preferred over replacement.

📉 Prognosis

• Generally excellent — most patients live a normal life expectancy.
• Monitor with periodic echocardiography if MR present.
• Complications (stroke, arrhythmias, SCD) are very rare but important to recognise early.

📚 References

• ESC: Mitral Valve Prolapse
• Basso C et al. Arrhythmic Mitral Valve Prolapse and Sudden Cardiac Death, Circulation 2015.