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12: MITRAL VALVE PROLAPSE

Natalie V. Wessel, DO, MPH; Eric Shamus, PhD, DPT, PT, CSCS

CONDITION/DISORDER SYNONYMS

  • Barlow syndrome

  • Floppy mitral valve

  • Mitral-click murmur syndrome

  • Systolic-click murmur syndrome

ICD-9-CM CODE

  • 424.0 Mitral valve disorders

ICD-10-CM CODE

  • I34.1 Nonrheumatic mitral (valve) prolapse

PREFERRED PRACTICE PATTERN

  • 6D: Impaired Aerobic Capacity/Endurance Associated With Cardiovascular Pump Dysfunction or Failure1

PATIENT PRESENTATION

A 38-year-old woman presents with palpitations, anxiety, and dizziness. She states that nothing in particular has been causing her stress lately, but she feels her “heart racing.” Vitals are: Pulse: 84, Respirations: 18, Blood Pressure: 110/70, and SpO2% of 99%. On examination, there is an audible non-ejection click and a faint, late systolic murmur. On the musculoskeletal examination, there is a narrow anteroposterior chest diameter and a mild scoliosis. On echocardiogram, there is a 2.5-mm displacement of the mitral valve leaflet.

KEY FEATURES

Description

  • Abnormally thickened mitral valve that becomes displaced into left atrium during systolic contraction

  • Classic and nonclassic

    • Nonclassic carries low risk of complications

    • Complications of classic mitral valve prolapse (MVP) include mitral valve regurgitation, endocarditis, congestive heart failure, cardiac arrest

FIGURE 12-1

Mitral valve prolapse in an asymptomatic 8-year-old child. The cardiac echo demonstrated a mitral prolapse without regurgitation. Both the phonogram and spectrogram show a systolic mitral click and a diastolic S3 prominent during inspiration. (From Pahlm O, Wagner GS. Multimodal Cardiovascular Imaging: Principles and Clinical Applications. www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

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Essentials of Diagnosis

  • Stethoscope for auscultation systolic click in the mitral position, possible late systolic murmur

  • EKG/ECG2

  • Echocardiography

  • Exercise stress test

General Considerations

  • Education on disease management reduces hospitalization.

  • Patients with significant prolapse may show signs and symptoms of congestive heart failure.

  • Strenuous activity should be limited for symptomatic mitral prolapse.

  • Can lead to sudden cardiac death, arrhythmias, embolic events, and coronary disease.

  • Patients can develop bacterial endocarditis.

  • Mild-to-moderate prolapse generally does not cause symptoms.

Demographics

  • Prevalent in 2% of thin female adolescents3

  • Equal incidence of classic and nonclassic

  • Equal incidence between genders and age groups

  • More common in patients with underlying genetic disease

CLINICAL FINDINGS

SIGNS AND SYMPTOMS

  • Murmur accentuated with standing, hand-grip maneuver, Valsalva maneuver, and diminished with squatting

  • Cardiovascular collapse or shock

  • Angina pectoris4

  • Syncope4

  • Congestive heart failure4

  • Dyspnea on exertion

  • Shortness of breath4

  • Anginal chest pain that increases with exercise

  • Orthopnea4

  • Fatigue, weakness4

  • Fainting, dizziness with activity

  • Palpitations

  • Palpable heaves/thrills over precordium

  • Arrhythmias, particularly atrial fibrillation

  • Endocarditis

Functional Implications

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