MITRAL VALVE PROLAPSE - Symptoms, Causes and Treatment

Also called Floppy valve syndrome or Barlow syndrome. During the phase of systole , when the left ventricular will generate tremendous amount of pressure that will cause blood to rush into aorta, there will be a lot of pressure on the mitral valve leaflets. The bicuspid mitral valve however able to retain its position because of chordae tendineae and papillary muscles. 

In mitral valve prolapse because of the defective coaptation of the valve leaflet, there is upward bulging of the valve that cause undue stress on chordae tendineae and papillary muscles, which cause ischaemia of sub adjacent myocardium.

Due to undue stress occurring on the chordae tendineae, auscultatory finding created is called mid systolic clicks 

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Mid systolic click

Due to extra tension generated on the chordae tendineae during excessive bulging up of mitral valve.

Incase there is snapping of chordae tendineae, there will be incompetent valve. Left ventricular will be decompressing into left atria,mitral regurgitation will occur. During the phase of ventricular systole, a particular amount of blood will leaks into lumen of left atrium. This would result in structural damage in the left atria, and possibility of left ventricular failure and pulmonary edema will occur.

 The patient blood will back up into the pulmonary circulation and will develop features like orthopnae and paroxysmal nocturnal dyspnea

In Western population Mitral valve prolapse is the number one cause of the development of the mitral regurgitation 

Why Mitral valve prolapse is in the first place?

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Mitral Valve Prolapse Causes 

Idiopathic

• Genetic
• Defect of type 3 collagen
• Connective tissue disorders like Marfan syndrome, Osteogenesis imperfecta
• Ehler Danlos syndrome
• Autosomal Dominant polycystic kidney disease
• Straight back syndrome
• Ostiun secundum ASD

Clinical Presentation

Asymtomatic (most common) in the beginning, but as the disease will progress, it will cause palpitations, syncopal attacks, orthopnoea, paroxysmal nocturnal dyspnoea

Which rhythms occur in this patient?

Premature ventricular contractions

There is also a possibility of broad complex ventricular tachycardia

Even PSVT (Paroxysmal Supraventricular Tachycardia)

Because of this condition , there is leakage of blood from LV to LA that cause structural damage to LA, on the long run can trigger atrial fibrillation

Examination Findings

• Mid systolic click
• Late systolic murmur

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Impact of squatting and standing on the duration of the murmur

On squatting the murmur will become shorter and on standing it will become relatively longer

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Investigation of choice

Echocardiography- posterior leaflets are affected more than the anterior leaflets. If the posterior leaflets is defective,  jet of blood moves anteriorly, murmur radiates to the base of the heart. If the anterior leaflets is defective, jet of blood moves posteriorly, murmur radiated to axilla/ back.

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Mitral Valve Prolapse Treatment 

1. Beta blockers to control the heart rate
2. Prophylaxis for infective endocarditis is mandatory 
3. Mitral valve repair to prevent mitral regurgitation

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