What are the symptoms of Mitral Valve Prolapse (MVP)?

Symptoms of Mitral Valve Prolapse (MVP)

The most common symptoms of Mitral Valve Prolapse include palpitations, atypical chest pain, dyspnea, fatigue, and neuropsychiatric complaints such as anxiety and panic attacks, though many patients may be asymptomatic. 1

Common Symptoms

• Palpitations - Often reported even when continuous ambulatory ECG recordings show no arrhythmias 1
• Atypical chest pain - Rarely resembles classic angina pectoris 1
• Dyspnea and fatigue - May occur despite normal exercise tolerance on objective testing 1
• Neuropsychiatric complaints - Including anxiety, panic attacks, and similar syndromes 1
• Orthostatic symptoms - Dizziness, postural hypotension, and tachycardia may occur 2

Physical Findings

• Midsystolic click - A high-pitched sound of short duration that may vary in intensity and timing 1
• Late systolic murmur - Usually medium to high-pitched and loudest at the cardiac apex 1
• Dynamic auscultation changes - The timing of clicks and murmurs varies with changes in left ventricular volume 1
• No auscultatory findings - MVP can be present without classic findings, and clicks may be intermittent 1

Neurological Symptoms

• Transient cerebral ischemic episodes - Occur with increased incidence in MVP patients 1
• Visual disturbances - Reports of amaurosis fugax, homonymous field loss, and retinal artery occlusion have been described 1
• Syncope or presyncope - May occur in some patients 3

Autonomic and Neuroendocrine Symptoms

• Orthostatic phenomena - Related to autonomic dysfunction and hyperadrenergic states 2, 3
• Poor exercise tolerance - May be related to neuroendocrine abnormalities rather than valve dysfunction alone 3
• Symptoms related to baroreceptor abnormalities - Including abnormal regulation of blood pressure 2

Symptom Patterns

MVP patients typically fall into two categories:

1. Patients with symptoms directly related to progressive mitral regurgitation 4, 3
2. Patients with symptoms that cannot be explained by the degree of mitral regurgitation alone (MVP syndrome) 4, 3

Clinical Relevance of Symptoms

• Approximately 40% of patients are referred due to complications of MVP 5
• About 37% of cases are discovered incidentally 5
• Nearly 24% of patients are referred due to neurotic symptoms 5
• The prevalence of panic disorder is higher in MVP patients, with approximately 45% of panic disorder patients having MVP 1

Management Considerations

• Beta blockers may help patients with palpitations, mild tachyarrhythmias, chest pain, anxiety, or fatigue 1
• Cessation of stimulants (caffeine, alcohol, cigarettes) may control symptoms in many cases 1
• Volume expansion through increased fluid and salt intake may help with orthostatic symptoms 1
• Reassurance is a major part of management for patients with mild symptoms 1

It's important to note that while many patients experience these symptoms, MVP is often benign in most cases, though complications can occur, particularly in older men with mitral regurgitation 6.