Mitral Valve Prolapse

 

Mitral valve prolapse (MVP) may well be the most common problem with the heart valves.  This condition may be present in as many as 5% of the general population.  Women are affected more often than men.

Recall that the mitral valve sits between the left atrium and the left ventricle, the main pumping chamber in the heart.  And remember that the mitral valve closes while the left ventricle contracts, allowing only one pathway for blood to exit the heart–through the aortic valve and into the aorta.

MVP is a problem with the valve closing properly.  The mitral valve consists of 2 leaflets–an anteior (front) and posterior (back) leaflet.  The diagram above shows the normal situation as well as the prolapse situation, where (in this case) one of the leaflets does not close properly.

There are several potential causes, including rheumatic fever, inherited conditions such as Marfan’s syndrome, infection (endocarditis) of the heart and valves, and as a consequence of coronary artery disease and heart attack.  But the most common cause is simply wear and tear, a problem that we call degenerative disease of the valve.

Symptoms may include chest pain, fatigue, and palpitations.  Importantly for athletes, the chest pain is most often unrelated to activity.

Patients with MVP often have a classic sound–a mid- to late systolic click–that can be heard with the stethoscope.  Nonetheless, this condition is most often identified by an echocardiogram that was obtained to sort out the cause of a patient’s symptoms.  The ultrasound pictures show the improper closure of the mitral valve and may show any associated problems such as leaking (regurgitation) of the valve.

We generally think of MVP as a benign condition–that is, one that has few harmful effects other than the symptoms.

Medical treatment with beta-blockers–medications that slow the heart rate and reduce the blood pressure–may alleviate the symptoms.  Current guidelines suggest that individuals with mitral valve prolapse do not need to take antibiotics to prevent infections (endocarditis) of the heart and heart valves.

If regurgitation becomes moderate to severe, because of continued degeneration of the valve over time, surgical repair or replacement of the valve may be necessary.

Recommendations for Athletes

Consensus recommendations for athletes come from the Proceedings of the 36th Bethesda Conference.

Athletes with MVP can participate fully if they don’t have:  a history of syncope (blacking out); repetitive arrhythmias; severe regurgitation of the valve; reduced heart function; a history of stroke or transient ischemic attack (TIA); or a family history of sudden death related to MVP.  Athletes with any of those additional problems should receive further evaluation and should participate only in low-intensity sports.

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Comments

    • says

      I am a professional mtb athlete – with scoliosis and recently found out I have a leaky valve. Otherwise my heart health and health in general is off the charts. Would you agree there’s nkthing I need to worry about with training & racing? Does this put me at a disadvantage in my fitness capacity?

      • Larry Creswell, MD says

        Leaking heart valves make it more inefficient for the heart to do its pumping job. This inefficiency can become more pronounced with higher exertion levels.

        I don’t have enough info from afar to know if there’s reason to “worry” in your particular case. Perhaps the doctor who discovered the heart valve issue could tell you about any implications now and down the road.

  1. Linda says

    I am a 47-year old marathon runner recently diagnosed with MVP (with regurgitation) I have more trouble with the shortness of breath, light headedness, etc. when running 5K’s than longer distances. My cardiologist says I can still run marathons but to not run 5K’s at a high heart rate (I run them all out and nearly faint sometimes). I am not on medication as the doc says I won’t like my reduced heart rate. Any suggestions? I really hate not being able to run hard.

    • Larry Creswell, MD says

      Trust your doctor!….who knows the details of your condition and what best to advise. Certainly, exercising until the point of fainting doesn’t sound healthy.

  2. Chris Perillo says

    I am a 45yo ultra marathon runner who often participates in mountainous races at elevation in distances from 50K to 100mile events. I am curious to know if such taxing endeavors over 12hours at a time put the mitral valve at greater risk of further prolapse/regurgitation from such events. There are times that I have significant symptoms and other events I am asymptomatic. Just wanting to know if I am making the situation worse continuing such events which I love?

  3. Pinky Lim says

    Dear Dr Larry,
    I am a cardiac athlete – since 12 years old. I have mitral valve prolapse syndrome with arrhythmia and scoliosis as a child. I am now a young adult with SVT, PVCs, Bradyarrhythmia. Also had history of pressurized chest pains, dizziness, fainting, breathing difficulty and palpitations. Now I have retired from competitive power sprinting and switched to marathon (5km – 42km). My pediatric & adult congenital cardiologist mentioned that my heart rate & blood pressure are low (±55 bpm; 100/60 mmHg). I am now exercising on 75% intensity. Am I on the correct track?

  4. Sharon says

    Hi Larry

    I am a recovering anorexic who use to run frequently. I have valve regurgitation in 2 of my heart valves.

    I am interested in knowing if I can go back to running. I am weight restored after 7 months in hospital.

  5. Linda says

    Hi. I was diagnosd with mild anterior mitral prolapse. My cardiologist said my prolapse is a normal variant. I’m just a little confused on what he means by this. I have mild regurgitation. Is it true exercising can speed up regurgitation progression? I’ve also heard that severe mitral regurgitation effcects people with posterior prolapse more, like their regurgutation is more likely to progress…

    • Larry Creswell, MD says

      Yes, it is possible for patients with MVP to have worsening of the mitral regurgitation over time.

      And yes, it is true that more patients who require surgery for valve repair/replacement have prolapse of the posterior leaflet than the anterior leaflet.

  6. siti says

    i love running. i had my mitral valve repair on 2010 disember..

    may i know, can i be a marathoner?

    Is that marathon can effect my heart valve?.. im just starting my run. my latest run record is 6-k/ hour without any medical symptoms. i want to be a marathoner.

    did u agree if i trained myself to become a marathoner?

    tq.

    • Larry Creswell, MD says

      I do think it’s possible for athlete patients to take up running–and even complete a marathon–after mitral valve repair, it will be important for you to discuss your plans with your doctor(s) who will be in the best position to know if this will be safe for you specifically. You would want to be sure that there was nothing special about your valve repair that might not be durable….and you would want to be sure your heart and general health were also good.

  7. Mikkele O'Neal says

    Hi. I am a 43 yr. Old female and been diagnosised with mitral valve insufficiency and tricuspid insufficiency. My question is how do I know my lightheadness, fatigue, anxiety, and sometimes pain is not from the valve issue or is it a panicked attack? Also I haven’t been able to exercise as long as I used to. My Dr. Says I can keep doing normal exercise and recheck in 5 yrs. I’m nervous about this diagnosis, but want to be OK to exercise again. Will exercise help it or hurt?
    Thank you.
    Mikkele

    • Larry Creswell, MD says

      Good question. Sometimes heart valve problems and panic attack can both produce similar symptoms. Your doctor will be in the best position to sort that out, after talking with you and listening at the heart.

      For most athletes with only mild insufficiency of the heart valves, exercise can be safe. Best to have a conversation with your doctor about any risks.

  8. Robert Flatland says

    Hi Dr.Cresswell,

    I am 50 years old and have been a distance runner since age 10. I have always had a low resting heart rate ranging from 33-50. I was diagnosed with moderate mitral regurgitation in 2009. I still run but not competitively. After warming up, any breathing difficulty goes away and I can run fine. In the past few months I started having asthma type symptoms during normal daily activities. I can’t seem to get a full breath. I had a stress echo and was told that my heart is responding fine and has not degraded significantly. I also had a breathing test and all seemed fine. I am told that my symptoms might be adult onset asthma, but I just have this feeling that it’s related to the mitral valve. Can you comment my difficulty with getting a full breath while not exercising. Could this be mitral related? Thank you.

    • Larry Creswell, MD says

      From afar, I can’t add much.

      For the other readers, both mitral regurgitation and asthma can cause problems with breathing. Best to visit both cardiologist and pulmonologist to figure out the contribution of each problem and to settle on any treatment needed.

  9. Tiffany says

    Hi Dr. Cresswell

    I have mild MVP, PSVT and last EF that was checked was several years ago, which was 53% (55% 2 years PRIOR to that). Since then I have become more active in participating in triathlons. I do workouts 3-5 days a week ranging from 40 to 90 minutes.

    My PSVT symptoms have been much less frequent after I started becoming more active. Building endurance and increasing my pace is taking me a very long time. I get fatigued and feel like I can’t keep going. I spend most of my workouts in Zone 4 and 5 (based on a max HR of 190). I’m 115 lb without any other co-morbidities. There are other things that could be factored in- diet, heat/humidity (I live in Hawaii), rest, etc. I was wondering if PSVT or MVP has hindered my ability to build endurance.

    Thank you!

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