Mitral valve prolapse is a deformity of one or both mitral valve leaflets and usually produces no symptoms. This condition occurs in up to 2.5% of the general population and twice as frequently in women as in men. The cause may be an inherited connective tissue disorder but, in many cases, the cause is unknown.

In mitral valve prolapse, a portion of one or both mitral valve leaflets balloons back into the atrium during systole. Rarely, ballooning stretches the leaflet to the point that the valve does not remain closed during systole. Blood then regurgitates from the left ventricle back into the left atrium. About 15% of patients who develop murmurs eventually experience heart enlargement, atrial fibrillation, pulmonary hypertension, or heart failure.

The syndrome may produce no symptoms or, rarely, it progresses and can result in sudden death.

• Patients may experience shortness of breath (not correlated with activity), lightheadedness, dizziness, syncope, palpitations, chest pain, and anxiety.
• Fatigue may be present regardless of the person's activity level and amount of rest or sleep.

• An extra heart sound, referred to as a mitral (systolic) click, is an early sign that a valve leaflet is ballooning into the left atrium.
• A mitral regurgitation murmur may be heard if the valve opens during systole and blood flows back into the left atrium.
• If mitral regurgitation exists, a patient may experience signs and symptoms of heart failure.
• Echocardiography is used to diagnose and monitor progression of mitral valve prolapse.

Medical management is directed at controlling symptoms.

• Advise dietary restrictions, the elimination of alcohol and caffeine, and cessation of tobacco products use.
• Antiarrhythmic medications may be prescribed.
• Prophylactic antibiotics are not recommended prior to dental or invasive procedures.
• Chest pain unresponsive to nitrates may respond to calcium channel blockers or beta-blockers.
• Heart failure from this cause is treated as it would be for any other case of heart failure.
• Patients with severe mitral regurgitation and symptomatic heart failure may require mitral valve repair or replacement.
• Women diagnosed with mitral valve prolapse without mitral regurgitation or other complications may complete pregnancies with vaginal deliveries.

• Educate patient about the diagnosis and the possibility that the condition is hereditary.
• Instruct the patient regarding how to minimize risk for infective endocarditis, practicing good oral hygiene, obtaining routine dental care, avoiding body piercing and body branding, and not using toothpicks or other sharp objects in the oral cavity.
• Explain the need to inform the health care provider about any symptoms that may develop.
• Instruct patient to avoid alcohol and caffeine, and encourage patient to read over-the-counter product labels to avoid products with alcohol, caffeine, ephedrine, and epinephrine, which may stimulate dysrhythmias.
• Explore possible diet, activity, sleep, and other lifestyle factors that may correlate with symptoms.
• Discuss treatment of dysrhythmias, chest pain, heart failure, or other complications of mitral valve prolapse. See Acute Coronary Syndrome and Myocardial Infarction in Section A, and Heart Failure in Section H.

For more information, see Chapter 28 in Hinkle, J. L., & Cheever, K. H. (2018). Brunner and Suddarth's textbook of medical-surgical nursing (14th ed.). Philadelphia, PA: Lippincott Williams & Wilkins.