Understanding mitral valve prolapse (MVP).

In asymptomatic or symptomatic patients with an audible click and late systolic murmur, mitral valve prolapse can be assumed to be present, the pathologic-anatomical substrate of which is characterized by myxomatous changes in the mitral valve leaflets and collagen degeneration of the chordae tendineae. The conclusion that all persons with a systolic click have a diseased mitral valve and are at risk of complications is probably excessive. In the presence of an unequivocally-audible click and/or late systolic murmur, an echocardiogram for confirmation of the diagnosis is not necessary. If the auscultatory findings are uncertain, an M-mode recording and, because of its high sensitivity and specificity, a two-dimensional display from the parasternal long-axis view should be obtained. From the apical four-chamber view, false-positive findings may be incurred. A small percentage of patients with mitral valve prolapse have complaints which can be assumed attributable to disturbances in the neuroendocrine system (Tables 1 and 3). To what extent a relationship actually exists between autonomic dysfunction and mitral valve prolapse and whether or not this is coincidental, remains unclear. Treatment of the symptoms with anxiolytic drugs or beta-adrenergic receptor blocking agents is only indicated for disabling complaints if reassurance and psychological support are ineffective. Complaints of chest pain are atypical for angina pectoris. Supraventricular and ventricular arrhythmias may be observed (Table 3), the initial step in the management of which is to advise avoidance of irritants such as coffee, tobacco and emotional stress. Medical treatment is only indicated for hemodynamically-meaningful arrhythmias and in those patients in whom an increased risk of sudden death is present.(ABSTRACT TRUNCATED AT 250 WORDS)