Many patients with mitral valve prolapse are entirely asymptomatic. However, this is such a common disease that it is found in association with many other cardiac disorders. Therefore, patients may present with symptoms attributable to other cardiac disorders and have mitral valve prolapse seen as an incidental diagnosis.
Patients with “classic mitral valve prolapse syndrome” often present with chest pain. The chest pain may not be due to cardiac ischemia, because it is not brought on by exertion and occurs at rest. The pain is often fleeting, sharp, or stabbing in nature. Often the chest pain syndrome is due to anxiety, and the patients are found to have mitral valve prolapse when an echocardiogram is performed.
Outline the proper management for patients with mitral valve prolapse.
Asymptomatic patients need no definitive therapy performed. They should undergo routine follow-up on a regular basis, every 6 months to 1 year. Physical examination should assess the mitral regurgitation murmur for worsening.
In older patients, there is a tendency for chordae tendineae to rupture and mitral regurgitation to become much worse. Since the valve is abnormal, these patients are also at risk for endocarditis. Therefore, they should be given antibiotic prophylaxis for any dental or urinary tract procedure which will result in bacteremia.
In patients with palpitations, a beta blocker is often a useful medication, although this should not be instituted until the arrhythmia has been assessed thoroughly with Holter monitoring or other available means, i.e., stress exercise testing.