Q&A: Concerning Mitral Valve Prolapse

Mitral valve prolapse (MVP) is a common cause of mitral regurgitation (MR). Although most patients with MVP have mild, trivial, or no MR, MVP is the most common cause of surgical MR in developed countries. Other potential complications include infective endocarditis and arrhythmias. The diagnosis of MVP is suspected on physical examination and confirmed by echocardiography.

This article is for Medical Students & Professionals

This is a Question & Answer revision article designed for medical students and professionals preparing for the PLAB, MRCP or USMLE examinations. They are based on actual questions from these examinations. You may find the Heart & Blood Vessel articles more useful, or one of our many articles on Diseases & Conditions, Medical Syndromes, Health & Wellness or Home Remedies.

In this article:
Classification of mitral valve prolapse
MCQ: clinical scenario
MCQ: answer
MCQ: explanation

Classification of mitral valve prolapse

The diagnosis of mitral valve prolapse (MVP) was previously based upon a combination of clinical exam findings and echocardiographic criteria; the current definition relies on imaging alone. The current imaging definition of MVP is billowing of any portion of the mitral leaflets ≥2 mm above the annular plane in a long axis view (parasternal or apical three-chamber).

There are multiple ways of classifying MVP, underscoring the heterogeneity of this disorder:

• Etiologically, MVP is classified as primary (degenerative disease in the absence of identifiable connective tissue disease, sporadic, or familial) versus secondary MVP (associated with an identifiable disorder such as Marfan syndrome).
• Clinically, MVP can be classified as syndromic when extra-cardiac manifestations are present (eg, pectus excavatum) versus non-syndromic, isolated MVP.
• MVP is also classified by severity of the abnormal movement of the valve. The leaflets are described as billowing when the tips of leaflets remain in the left ventricle (LV) versus flail when the tip(s) of one (or both) leaflets prolapses into the left atrium (LA).
• Morphologically, MVP is classified as classic (also known as Barlow’s syndrome with markedly and diffusely thickened leaflets [≥5 mm] with bileaflet prolapse) versus non-classic (with limited or absent thickening [thickness <5mm] and segmental prolapse).
• Doppler echocardiography can also distinguish MVP without mitral regurgitation (MR) from MVP with MR.

MCQ: clinical scenario

A 26 year old female experiences chest pain. She also complains of palpitations. An ECHO is done and shows that she has mitral valve prolapse. Her physical findings are classic for mitral valve prolapse.

Which of the following is associated with mitral valve prolapse:

a) large v wave in the jugular pulse
b) diastolic rumbling murmur
c) increased pulse pressure
d) large a wave in the jugular pulse
e) mid systolic click with a systolic murmur

MCQ: answer

The correct answer is E

MCQ: explanation

A mid systolic click with a systolic murmur is heard with mitral valve prolapse. Mitral valve prolapse is also called 'click murmur syndrome'.

A large v wave in the jugular pulse (choice a) is seen with tricuspid insufficiency. A diastolic rumbling murmur (choice b) is heard with mitral stenosis, not with mitral valve prolapse. The pulse pressure is the difference between systolic and diastolic pressure. An increased pulse pressure (choice c) is seen with aortic regurgitation. A large a wave in the jugular pulse (choice d) is seen with tricuspid stenosis.

Reference(s)
1). UpToDate: Definition and diagnosis of mitral valve prolapse. Available online: https://www.uptodate.com/contents/definition-and-diagnosis-of-mitral-valve-prolapse