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.
can scoliosis cause mvp??
There is an association between scoliosis and MVP. Both may be due to some problem with the body’s connective tissues.
Scoliosis probably doesn’t CAUSE mitral valve prolapse.
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?
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.
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.
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.
Thanks for your response. Sounds like I have to slow down a bit and just enjoy being able to run.
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?
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?
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.
Depends on the degree of regurgitation and any other heart problems. Best to ask your doctor.
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…
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.
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.
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.
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
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.
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.
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.
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!
Offhand I can’t think of how those conditions would limit one’s ability to build endurance.
Hello I’m 23 ,years old and I have mitral valve prolapse I little bit worry about this because this problem is heart I feel short of breath at all the time I don’t know what to do with this I feel like this for 1 and half years and I steel don’t like it I will want to ask you I’m not on any medication if is something to help me with the breathing please any advice thank you
Sometimes mitral valve prolapse is associated with regurgitation….and that may cause shortness of breath. Perhaps ask your doctor(s) about reasons for shortness of breath in your particular circumstance.
I am devastated that since my mitral valve repair 2 years ago I can no longer run as fast as I used to (13:00 pace vs. 9:00 pace). I’ve tried intervals, tempo workouts, hill training, etc. but can not seem to improve. Came down with bronchitis 3 months post surgery and childhood asthma recurred also after surgery. Ready to give up long distance running which used to be a significant part of my life. Are there any other options? Surgeon told me I’d be running faster after surgery. Anemia has been ruled out. All echocardiograms have been unremarkable since surgery. Otherwise healthy 55 y.o. Male.
From a distance, I’m not sure what to make of your situation.
Most often, athletes can return safely to operation after successful mitral valve repair….and, to the extent that valve leakage improved, I’d think that exercise would be easier.
I am in the exact same boat. Mitral valve repair, 2 1/2 years ago and my pace is exactly the same as the original poster. I, too, was told that I’d run faster.
A theory was presented to me that the artificial ring added to the mitral valve is designed to bring the leaflets closer together to allow them to seal properly. The ring is slightly smaller, thus allowing less blood to move through.
Thoughts?
Thanks for sharing your experience, Duncan.
Most patients who get mitral valve repair do so because of leakage, or regurgitation, of the valve. After repair, more blood will go in the correct direction than before the operation.
I would think that, for most patients, a mitral annuloplasty ring that reduces the orifice area of the valve would not have a significant impact on the maximum amount of blood that can cross the valve at maximal exertion.
Hi what a great blog I only wish I found this four years ago I am a 46-year-old very athletic personal trainer and Nutrition coach. I had my mitral valve repaired four years ago . I was diagnosed with mitral valve prolapse and it progressed enough to where I had to have the valve repaired. Although I am still very athletic I also struggle with the things that I used to be able to do before I feel my endurance is nowhere where it used to be prior to the surgery. This sometimes leaves me very frustrated and I was wondering if other people have had the same situation and as I read through this I see yes….. I just don’t understand why ? The valve was leaking you have it repaired so you would think that your athletic ability will be better yet it’s not! Open heart surgery 46 was very Trumatic and I am thankful to be able to do everything that I can yet sometimes I am left very frustrated. Other than that perfectly healthy no other issues. Any thoughts ? Thanks
Most athletes with mitral regurgitation who have valve repair/replacement will be noticeably better after operation.
If not….worth discussion with your doctors about why not.
I am a cardiologist & runner. If you are still SOBOE after a MV repair & it looks okay on resting echo get your cardiologist to do an exercise stress echo looking for dynamic LVOT ostruction….its a not uncommon is post repair….the cardiologist will know what it is
Can a child with mvp run ??
Ordinarily, athletes with MVP–and no other problems–can participate fully in their sports.
Sir i have mild mvp with MR
My Resting heart rate is low 45bpm to 50bpm
But when i walk run its goes fast
I use to play cricket alot
So is it slow by mvp or being in sports running plz reply
I would think that MVP does not cause a slow heart rate.
Thanks sir Thank you so much
Hello sir I have mild AML prolapse and trivial MR and first degree Av block should its a problem to worry and it better to exercise and running in this condition either it make scenario more worst
You should ask your doctor(s) about what forms of exercise may be safe for you. They will be most familiar with all of your details.
Many athletes with mild mitral valve prolapse, trivial mitral regurgitation, or first degree heart block can participate safely in their sports.
HI .IM Dana,22..I have been recently diagnosed with mitral valve prolapse.For over 1 year and a half i used to take aprazolam and drank coffee everyday until the day i left both and ended up with tachycardia at the hospital one day.Then i found out about MVP.I havent had any symptoms until the last 5 days.My heart rate is out of whack.90 and i can feel the beats on my back really strong.(i can also feel them on my feet)I must admit,i have been exercising regularly but now that i do,i cant do like i used to.Does this mean my MVP has progressed?Im scared.
The good thing about MVP is that it’s severity can easily be measured with an echocardiogram. Perhaps you could ask your doctor about that test.
I am 3 years post MV Repair through OHS. I fell over this morning while running and went down on my left side. My left side of my chest has been sore since, would this be bruising, I guess the OHS means I will have a weak chest wall? Also, someone commented and said she were advised not to runas it will wear the repair out quicker, is this right? I was never told this.
For patients who have open heart surgery with an incision through the breast bone (sternum), that bone heals after the operation just like any other broken bone. It usually gets most of its strength back within the first few weeks. Sadly, though, there are some patients whose breast bone does not heal properly afterwards….and some of those even require another operation to try to set things right.
We usually use the term “chest wall” to refer to the ribs and the muscles of the chest. Those are not usually affected by open heart surgery, but rib fracture(s) do sometimes occur.
I have a bicuspid aortic valve(no leak and no aortic stenosis) and I also have a thickened mitral valve (no regurgitation). My resting pulse is 55-60bpm. I keep myself fit by cycling and going to gym classes however I notice that my heart rate goes up to 180 when I exert myself. My average heart rate is about 150 bpm on a relaxed bike run. Is it okay to push my heart rate up and what rate should be my upper limit? I’m 51 years old and of normal weight. Is it ok to lift heavy weights at the gym?
Your doctor(s) will be in the best position to comment on your heart rate during exercise. S/he will be most familiar with all of your specifics.
Ordinarily, when there is no heart disease other than bicuspid valve, we don’t worry about maximal heart rate during exercise.
Patients with bicuspid aortic valve sometimes also have disease of the nearby aorta, which may enlarge over time (or form an aneurysm, as we say). There is concern that activities such as weight lifting may place additional strain on the nearby aorta and cause it to enlarge. This is an area where you should have conversation with your doctor(s) to settle on which activities may be safe for you. One factor which may be relevant is the size (diameter) of the aorta near the heart.