What is it?

The heart is composed of four chambers (two atria and two ventricles), which are separated by valves that allow the blood to flow from the atria to the ventricles. The mitral valve is located on the left side. Mitral valve prolapse (MVP) occurs when the leaflets of the mitral valve bulge into the left atrium when the heart contracts. This is usually a result of an abnormal size or damage of the mitral valve tissue. MVP is very common, with recent studies suggesting that it is present in nearly 3 percent of the population.

Symptoms

Often patients with mitral valve prolapse do not have any symptoms, if present symptoms may include:

• Palpitations (feeling your heart racing)
• Chest discomfort
• Fatigue
• Dizziness or lightheadedness
• Shortness of breath with exercising or when lying flat
• Anxiety

The severity of the symptoms does not necessarily correlate with the severity of the mitral valve prolapse. Many times, people with severe symptoms have very mild prolapse when further testing is done, for which treatment may not be required.

Sports Medicine Evaluation / Treatment

Athletes with the above symptoms should seek further evaluation by a physician. The Sports Medicine physician will perform a thorough history and physical examination, focusing on past medical history, family history of cardiac disease or other conditions, and listening to your heart. When listening to the heart, the physician may hear a click and a murmur. These are sounds that are associated with the abnormal motion of the valve.

The physician may also order further testing to evaluate the severity of the mitral valve prolapse. An ultrasound of the heart (echocardiography) is the most useful test to look at structure and movement of the heart. This test is not painful, it involves gel and the ultrasound transducer on a bare chest. Aside from information about the heart valves, an echocardiogram also provides information on blood flow through the heart.

An EKG (electrocardiogram) is another test that may be performed by the physician. This is another non-painful exam involving stickers on the chest and extremities to look at electrical conduction through the heart. An EKG assesses for irregularities of the heart rhythm and how fast the heart is beating.

Most people with mitral valve prolapse do not experience any problems and treatment is usually not needed. Common complications, if present, include:

• Mitral regurgitation is a backflow of blood in the heart, specifically into the upper left chamber. Most patients with MVP usually have only trace or mild mitral regurgitation. Patients with severe mitral regurgitation, can often benefit from surgery to repair or replace the mitral valve.
• Infective endocarditis (infection of the valve tissue) is another possible complication of MVP but is rare overall. Endocarditis prophylaxis with antibiotics is no longer recommended for patients undergoing routine dental procedures.
• Irregular heart rhythms (arrhythmias) are also associated with MVP and are usually bothersome, but not life-threatening.

Prevention

People with Mitral Valve Prolapse are usually born with it. Therefore, it cannot be prevented.

Return to Play

Athletes with mitral valve prolapse, who do not experience any severe symptoms can participate in all competitive sports. Severe symptoms and findings include fainting due to abnormal heart rhythm, sustained fast heart rate (>100bpm), severe mitral regurgitation, prior embolic event and history of family members with sudden cardiac death. Athletes with any of these symptoms or findings should only engage in low intensity competitive sports, such as golf, bowling or riflery.

Athletes with MVP and no mitral regurgitation can be evaluated by a Cardiologist who will determine frequency of follow up and testing. People with moderate to severe mitral regurgitation should be evaluated at least annually by a Cardiologist. Any development of new symptoms should prompt for further investigation by a physician.

AMSSM Member Authors
George N. Liras, DO, and Ioannis N. Liras, MD

References
1. Freed LA, Levy D, Levine RA, et al. Prevalence and clinical outcome of mitral-valve prolapse. N Engl J Med. 1999;341(1):1-7. doi:10.1056/NEJM199907013410101
2. Chaitanya Madamanchi, MD , FACC; Eugene H. Chung, MD, FACC. Mitral Valve Prolapse and Mitral Valve Regurgitation in Athletes. American College of Cardiology (AAC.org). Published Feb 21 2017. Available at: https://www.acc.org/latest-in-cardiology/articles/2017/02/20/08/06/mv-prolapse-and-mvregurgitation-in-athletes
3. Heidenreich PA, Bear J, Browner W, Foster E. The clinical impact of echocardiography on antibiotic prophylaxis use in patients with suspected mitral valve prolapse. Am J Med 1997; 102:337.
4. Devereux RB, Kramer-Fox R, Kligfield P. Mitral valve prolapse: causes, clinical manifestations, and management. Ann Intern Med 1989; 111:305.