Exercise and Mitral Valve Prolapse

Symptoms

Many people with MVP live their whole lives without symptoms. Those who do have symptoms may experience heart palpitations, chest pain, fainting, shortness of breath, decreased stamina, or fatigue with periods of weakness. These symptoms should prompt medical attention and evaluation.

Prevalence

Approximately 2% to 4% of the population has MVP to some extent. It seems to run in families, so a genetic component is likely, but this relationship is not clearly understood.

Diagnosis

These patients may be identified by using a stethoscope to listen over the anterior chest wall for certain sounds. Typically, patients with MVP may have a midsystolic click and/or murmur of mitral regurgitation. The diagnosis is usually confirmed by echocardiography to image the mitral valve and look for the abnormal structure and motion of the valve. An electrocardiogram is often done as well to look for evidence of irregular heart rhythms.

Complications

It should be emphasized that MVP is generally not considered to be a life-threatening or a progressive condition in the vast majority of patients. In fact, MVP is considered to be one of the most benign heart conditions that cause murmurs.

The two main concerns for those with MVP are the long-term effects of mitral regurgitation and the potential development of a heart infection called endocarditis. The backflow of blood from the ventricle to the atrium (regurgitation) can lead to enlargement of the cardiac chambers and weakening of the heart muscle. In rare cases, this can potentially lead to heart failure. Only about 5% of those with MVP have a large enough regurgitation to cause any problem.

Endocarditis is a rare but potential occurrence anytime there is an irregular or damaged heart valve. To decrease the risk of this infection, doctors prescribe antibiotics to patients with MVP before any procedure, such as dental work, that is likely to introduce bacteria into the bloodstream.

In general, the greatest risks for unfavorable outcomes with MVP, including severe progressive mitral regurgitation (requiring valve surgery) and endocarditis as well as (less commonly) strokes/emboli, dangerous arrhythmias, and sudden death, appear to be associated with severe, substantial structural abnormality of the mitral valve.

Recommendations for the Athlete

The heart is a muscle, and like any muscle, it gets stronger with exercise. Aerobic exercise strengthens the heart and makes it more efficient and is generally recommended for those with MVP if they do not have significant symptoms. In most cases, MVP is not a barrier to high levels of athletic performance and/or competition.

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