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Symptoms of mitral valve prolapse
Last reviewed: 07.07.2025
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Most patients have no symptoms of mitral valve prolapse and are asymptomatic. In the presence of complaints, the clinical picture of uncomplicated mitral valve prolapse is determined by symptoms of dysfunction of the autonomic nervous system, accompanying syndromes of connective tissue dysplasia, cardialgia, palpitations, increased fatigue, weakness, orthostatic hypotension, syncopal and pre-syncopal conditions, a feeling of "insufficiency of inspiration", "panic attacks", neuropsychological syndromes (depression, mood instability, anxiety, etc.).
[ Common Symptoms of Mitral Valve Prolapse
Among the numerous symptoms of mitral valve prolapse, mitral regurgitation occupies a special place, since it determines the severity of the disease. In most cases, the severity of mitral regurgitation is insignificant or moderate, but 8-10% of men and 4-5% of women with MVP develop severe pathology. It is believed that the degree and rate of progression of mitral regurgitation are more pronounced with prolapse of the posterior mitral valve leaflet. The incidence of severe mitral regurgitation increases with age, regardless of gender. The first symptoms of congestive heart failure occur on average 15-16 years after the onset of mitral regurgitation in patients with leaflet prolapse >10 mm and severe regurgitation.
Rupture of the altered tendinous chordae may result in acute mitral regurgitation with the formation of acute left ventricular failure. The auscultatory picture is determined by the appearance of an intense holosystolic murmur (may be accompanied by a "chord squeak"). Due to the eccentric location of the regurgitant jet, deflected by the unattached segment of the leaflet, when the chordae of the posterior leaflet rupture, the systolic murmur is transmitted to the aortic zone and to the vessels of the neck, and when the anterior leaflet ruptures, to the axillary region and to the back. Rupture of the chordae is more often detected in patients with prolapse of the posterior leaflet of the mitral valve.
Symptoms of complications of mitral valve prolapse
In the development of complications of mitral valve prolapse, myxomatous degeneration of the cusps is of significant importance. Thickening of the cusp >5 mm is a predictor of the development of complications such as sudden death, rhythm disturbances, infective endocarditis, and thromboembolism in the vessels of the brain.
Characteristic clinical symptoms of complicated mitral valve prolapse are paroxysmal rhythm disturbances. The most common are supraventricular and ventricular extrasystoles, paroxysmal supraventricular tachyarrhythmias, unstable and stable ventricular tachycardias. Factors contributing to the development of rhythm disturbances include excessive tension of the valves, chordae tendineae and papillary muscles during prolapse; dilation of the left atrium and/or left ventricle; fibrous changes in the papillary muscles, myocardium of the left atrium and left ventricle; dysplasia of the coronary artery supplying the atrioventricular (AV) node, prolongation of the QT interval, the presence of AV shunt tracts. An imbalance in the autonomic nervous system with a predominance of sympathicotonia plays a major role in the origin of arrhythmias in young people, which contributes to the occurrence of electrical instability of the myocardium.
Patients with MVP may develop thromboembolic complications with damage to the vessels of the brain and retina. Possible pathophysiological factors causing their development include disruption of the integrity of the endocardium in the areas of myxomatous transformation with the formation of parietal thrombi and subsequent embolization, as well as paroxysmal supraventricular tachyarrhythmias.
One of the complications of mitral valve prolapse is infective endocarditis. Its development is facilitated by mitral regurgitation and the presence of thickened myxomatous altered cusps in bacteremia.
One of the serious but rare complications of mitral valve prolapse is sudden death of arrhythmic origin, which occurs in 2% of cases, with an annual mortality rate of 0.5-1%. The European Society of Cardiology Guidelines for the Prevention of Sudden Death (2001) list the following as risk factors for sudden cardiac death of arrhythmic origin in mitral valve prolapse:
- history of episodes of cardiac arrest or ventricular tachycardia;
- myxomatous changes and redundancy of the mitral valve leaflets;
- sudden cardiac death of arrhythmic origin in family history;
- prolongation of the QT interval or changes in its dispersion;
- frequent and high-grade ventricular extrasystoles;
- severe mitral regurgitation.
Clinical observation
Patient S., 23, complained of aching pain in the heart area, not related to physical exertion, lasting up to 1 hour, relieved by taking sedatives, palpitations, increased fatigue, arthralgia in the knee joints, occurring in the afternoon, subsiding during the day. The above complaints have bothered her since she was 20 years old. She is being observed on an outpatient basis with a diagnosis of "neurocirculatory asthenia".
On physical examination: asthenic build, height 171 cm, weight 55 kg.
In a standing position, a curvature of the spine in the frontal plane is noticeable - type C deformation with a right-sided arc in the thoracic region. Adams test is positive. "Funnel-shaped" chest. The skin is of normal color. The thickness of the skin fold above the outer ends of the clavicles is 4 cm. Joint hypermobility according to Beighton is 5 points. In the lungs - vesicular breathing, no wheezing, Heart sounds are sonorous, the rhythm is regular. A systolic click and a short soft late systolic murmur without irradiation are heard above the apex. HR is 72 per minute, BP is 110/70 mm Hg, The abdomen is soft, painless, The liver and spleen are not enlarged. Stool and urination are normal. There are no peripheral edemas.
Clinical blood test: hemoglobin - 128 g/l, leukocytes - 4.0x 10 9 /l, formula unchanged, ESR - 12 mm/m; clinical urine test - no pathology. In the immunological blood test: CRP - negative, ASL-O - 1:200. rheumatoid factor - negative.
Electrocardiography shows vertical position of the cardiac axis, sinus rhythm, isolated atrial extrasystoles, incomplete right bundle branch block. Heart rate is 78 beats per minute.
Holter 24-hour monitoring: during the observation period, 54 atrial extrasystoles and 10 ventricular extrasystoles were recorded; no changes in the QRS complex were found.
According to echocardiography: prolapse of the posterior leaflet of the mitral valve into the cavity of the left atrium - 7 mm, leaflet thickness - 6 mm, mitral regurgitation I.
Considering the presence of phenotypic markers of STD, a genetic study was conducted, during which differentiated STD syndrome was not confirmed.
Clinical diagnosis
Hypermobility syndrome: joint hypermobility (Beighton score - 5), arthralgia of the knee joints, FI 0; funnel chest; C-shaped right-sided thoracic scoliosis; hyperextensibility of the skin; symptoms of grade II mitral valve prolapse (myxomatous degeneration - grade II), complicated by mild mitral regurgitation. NC 0, FC 0.