💓 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.

🩺 Case 1 — Incidental Finding

A 25-year-old woman attends for a routine health check. She is asymptomatic, but auscultation reveals a mid-systolic click with a late systolic murmur at the apex. Echocardiography confirms mitral valve prolapse with trivial mitral regurgitation. Management: 🩺 No treatment required if asymptomatic and no significant regurgitation. Reassurance and periodic echo follow-up. Avoid: ❌ Unnecessary antibiotics for endocarditis prophylaxis (not recommended). Avoid excessive stimulants (caffeine) if palpitations are a problem.

🩺 Case 2 — Symptomatic with Palpitations

A 32-year-old man presents with intermittent palpitations, atypical chest pain, and light-headedness. Exam shows a mid-systolic click and late systolic murmur. Echo demonstrates MVP with moderate mitral regurgitation. Management: 💊 Beta-blockers for palpitations, monitor for progression of MR. Anticoagulation if atrial fibrillation develops. Surgical repair if severe MR with symptoms or LV dysfunction. Avoid: ❌ Ignoring arrhythmia risk; avoid delaying surgical referral if severe regurgitation develops.

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Mitral Valve prolapse 💔