Mitral Valve Prolapse

Definition

Mitral valve prolapse (MVP) is a condition in which the mitral valve, the valve that separates the left atrium and left
ventricle of the heart, does not close tightly. This can cause blood to leak backward into the left atrium, a condition
called mitral valve regurgitation. MVP is a common condition, affecting about 2-3% of the population. It is often
harmless and does not require treatment. However, in some cases, MVP can lead to complications, such as heart failure
or stroke. MVP is typically caused by a weakness in the mitral valve leaflets. This weakness can be caused by a number of
factors, including genetics, aging, and certain medical conditions, such as Marfan syndrome and rheumatic fever. The
symptoms of MVP can vary depending on the severity of the condition. Some people with MVP have no symptoms at all.
Others may experience symptoms such as palpitations, chest pain, shortness of breath, and fatigue.

Mitral valve prolapse (MVP) is a prevalent heart condition characterized by the bulging or prolapse of one or both mitral
valve leaflets into the left atrium during the heart's contraction. This protrusion can lead to mitral valve regurgitation
(MR), a condition where blood leaks backward through the valve, potentially affecting heart function. MVP affects
approximately 2-3% of the population in the United States, translating to an estimated 7-8 million individuals.

MVP is a relatively common condition in the Philippines, with an estimated prevalence of 2-4% among the general
population. This is comparable to the global prevalence of MVP. MVP can have a significant impact on the lives of
individuals affected by the condition. Symptoms such as chest pain, shortness of breath, and fatigue can affect quality of
life and limit daily activities. In severe cases, MVP can lead to complications such as heart failure and endocarditis.
Treatment for MVP in the Philippines is similar to that in other countries. For most cases, no treatment is necessary, and
symptoms can be managed with lifestyle changes such as weight loss, exercise, and stress management. In cases of
severe MR or other complications, medication or surgery may be required.

ANATOMY AND PHYSIOLOGY

Mitral valve prolapse (MVP) is a prevalent heart condition characterized by

the abnormal bulging or prolapse of one or both leaflets of the mitral valve,
the valve that separates the left atrium and left ventricle of the heart. This
prolapse can disrupt the normal closing mechanism of the valve, potentially
leading to blood leakage back into the left atrium during ventricular
contraction, a condition known as mitral regurgitation (MR).

Mitral Annulus: A fibrous ring that anchors the valve leaflets to the heart
muscle.

Components of the Mitral Apparatus

The mitral apparatus works in conjunction with the mitral valve to ensure efficient blood
flow and prevent regurgitation. It comprises three main components:

Chordae tendineae: Thin, fibrous strings that connect the papillary muscles to the mitral
valve leaflets, acting as tethers to prevent excessive leaflet prolapse during systole.

Papillary muscles: Protruding muscles attached to the chordae tendineae, originating

from the left ventricle wall, they actively shorten during systole, pulling the chordae
tendineae and preventing the mitral valve leaflets from prolapsing excessively into
the left atrium.

Mitral Leaflets: Two thin, flexible flaps of tissue (anterior and posterior) that form the
valve's closing mechanism.

 Anterior leaflet: Larger, longer, and thicker than the posterior leaflet, it is
divided into three scallops: lateral, central, and medial.
 Posterior leaflet: Wider and divided into three scallops: anterolateral,
posteromedial, and mural, it is located posterior to the two commissural
areas.
ETIOLOGY AND SYMPTOMATOLOGY
PREDISPOSING FACTORS
GENETIC
PRECIPITATING FACTOR
Connective Tissue Disorders
Rheumatic Fever
Ischemic Heart Disease
Hormonal Changes
ACTUAL FINDINGS IMPLICATIONS
PRESENT Heritability studies have shown that
individuals with a family history of
MVP are more likely to develop the
condition themselves. This suggests
that there may be underlying
genetic variations that increase
susceptibility to MVP.
ACTUAL FINDINGS IMPLICATIONS
PRESENT MVP is associated with several
connective tissue disorders, such as
Marfan syndrome and Ehlers-Danlos
syndrome. These disorders affect
the structure and strength of
connective tissues throughout the
body, including the heart valves.
PRESENT This bacterial infection can damage
the heart valves, including the
mitral valve, and can lead to MVP in
some cases. Rheumatic fever is
caused by the bacterium
Streptococcus pyogenes, which can
trigger an autoimmune response
that attacks the heart valves. The
inflammation and scarring
associated with rheumatic fever can
weaken and deform the mitral valve
leaflets, increasing the risk of
prolapse.
ABSENT MVP is more common in individuals
with ischemic heart disease, a
condition that reduces blood flow to
the heart muscle. The decreased
blood flow can weaken the mitral
valve leaflets, making them more
susceptible to prolapse. This is
because the papillary muscles,
which attach to the chordae
tendineae and help support the
mitral valve leaflets, are also
affected by reduced blood flow.
When the papillary muscles become
weakened, they may not be able to
prevent the mitral valve leaflets
from bulging during systole.
ABSENT MVP is more prevalent in women,
(expect lalake ang px so no need particularly during pregnancy and
Hormonal changes pero ug baba perimenopause. Hormonal
pwede nimo ni e present) fluctuations during these periods
may contribute to changes in the
structure and function of the mitral
valve. Estrogen, a female sex
hormone, has been shown to relax
the connective tissues in the heart
valves, which may make them more
susceptible to prolapse.
SYMPTOMATOLOGY

SYMPTOMS PRESENT/ NOT PRESENT RATIONALE

Chest pain This is the most common symptom
of MVP. The pain can be sharp,
stabbing, or aching, and it is often
located in the center of the chest. It
may worsen with activity or lying
down.
Palpitations These are sensations of a fluttering
or pounding heartbeat. Palpitations
can be brief or last for several
minutes. They may be accompanied
by dizziness, lightheadedness, or
shortness of breath.
Shortness of breath This may occur during exercise or
even at rest. The shortness of
breath can be mild or severe, and it
may worsen with exertion or lying
down.
Fatigue This is a feeling of tiredness or
exhaustion that is not relieved by
rest. Fatigue can be a persistent
symptom in some people with MVP.
Anxiety This can be caused by the
awareness of heart symptoms and
the fear of complications.

PATHOPHYSIOLOGY

PREDISPOSING FACTOR PRECIPITATING FACTOR

GENETICS Connective Tissue Disorders

Rheumatic Fever

ALTERATIONS WITHIN THE MITRAL VALVES LEAFLETS

 If not treated:

Worsening mitral valve

Regurgitation

 Enlargement
of the Left
Atrium
 Weakened Left
Ventricle
 Heart Failure
Infective Endocarditis
Cardiovascular
Events

 Stroke

Sudden Cardiac Death

MEDICAL MANAGEMENT

Medical Management of Mitral Valve Prolapse (MVP)

Mitral valve prolapse (MVP) is a common heart condition characterized by the bulging or prolapse of one or both leaflets
of the mitral valve, the valve separating the left atrium and left ventricle of the heart. This prolapse can lead to blood
leakage back into the left atrium during ventricular contraction, a condition known as mitral valve regurgitation (MR).

Non-Pharmacological Management

In most cases, MVP does not require specific treatment. However, lifestyle modifications can play a significant role in
managing MVP and reducing the risk of complications. These modifications may include:

 Maintaining a healthy weight: Excess weight can put additional strain on the heart and worsen symptoms of
MVP.
 Engaging in regular physical activity: Regular exercise can improve overall cardiovascular health and may help
manage symptoms such as fatigue and shortness of breath. It is important to discuss exercise limitations with a
healthcare provider.
 Adopting a balanced diet: A diet low in saturated and trans fats, cholesterol, and sodium can help maintain a
healthy heart and reduce the risk of cardiovascular complications.
 Managing stress levels: Stress can exacerbate symptoms of MVP, such as palpitations and anxiety. Relaxation
techniques such as deep breathing, meditation, or yoga can help manage stress.
 Abstaining from smoking and excessive alcohol consumption: Smoking and excessive alcohol consumption can
damage the heart and worsen MVP symptoms.
 Maintaining good dental hygiene: Regular dental checkups and preventive care can help prevent infective
endocarditis, a serious infection of the inner lining of the heart, including the heart valves. Individuals with MVP
are at an increased risk of infective endocarditis.

Pharmacological Management
In some cases, medication may be prescribed to manage symptoms or prevent complications of MVP. The specific
medications used will depend on the severity of the condition and the individual's symptoms.

 Beta-blockers: Beta-blockers, such as propranolol, can be used to reduce palpitations, chest pain, and anxiety.
They work by slowing the heart rate and lowering blood pressure.
 Antiarrhythmic drugs: Antiarrhythmic drugs, such as flecainide or amiodarone, may be prescribed to treat atrial
fibrillation, an irregular heartbeat that can occur as a complication of severe MR. These drugs help regulate the
heart's electrical rhythm.
 Diuretics: Diuretics, such as furosemide, may be used to reduce fluid buildup in the lungs and legs if MR is severe
and causing heart failure. They work by increasing urine output, helping to remove excess fluid from the body.
 Blood thinners: Blood thinners, such as warfarin or apixaban, may be prescribed in rare cases to prevent blood
clots if MR is severe and atrial fibrillation is present.

Laboratories

 Complete Blood Count (CBC): This test measures the number of red blood cells, white blood cells, and platelets
in the blood. It can help identify anemia, infection, or other underlying conditions.
 Basic Metabolic Panel (BMP): This test measures electrolytes, such as sodium, potassium, chloride, and
bicarbonate, as well as kidney function markers, such as creatinine and blood urea nitrogen (BUN). It can help
assess overall electrolyte balance and kidney function.
 Troponin Test: This test measures the level of troponin, a protein released into the bloodstream when heart
muscle is damaged. It can help diagnose heart muscle damage or injury, such as that caused by severe MR.
 B-type Natriuretic Peptide (BNP) Test: This test measures the level of BNP, a hormone released by the heart in
response to stress or stretching. It can help assess the severity of heart failure and is often used to monitor
patients with severe MR.
 Thyroid Function Tests: These tests measure the levels of thyroid hormones in the blood. Thyroid dysfunction
can affect the heart and can worsen MVP symptoms.
 Chest X-ray to assess the size and shape of the heart and lungs
 Electrocardiogram (ECG) to measure the heart's electrical activity
 Echocardiogram to visualize the heart valves and assess their function
 Stress test to evaluate how the heart responds to physical exertion
 Cardiac catheterization, a more invasive procedure that involves inserting a thin tube into the heart to measure
blood pressures and oxygen levels.
Treatment Surgical Treatment:

In rare cases, surgical intervention may be necessary if MVP or MR is severe and causing significant symptoms or
complications. Surgical options include:

 Mitral valve repair: This involves repairing the prolapsed leaflets of the mitral valve, restoring their normal
function.
 Mitral valve replacement: If repair is not feasible, the mitral valve may be replaced with an artificial valve.
 Percutaneous mitral valve repair: This is a minimally invasive procedure that uses a catheter to repair the
prolapsed mitral valve. It is an alternative to open-heart surgery for selected patients.
 Mitral valve annuloplasty: This procedure tightens the ring around the mitral valve, reducing the leakage of
blood back into the left atrium. It is typically performed in combination with other mitral valve repair
techniques.

Nursing Management

1. Comprehensive Patient Education: Empower patients with knowledge about MVP, including its causes, symptoms,
potential complications, and treatment options. This understanding allows them to make informed decisions about their
health and collaborate effectively with their healthcare team.

2. Symptom Management and Lifestyle Modifications: Provide guidance on managing symptoms such as palpitations,
chest pain, and shortness of breath. Encourage lifestyle modifications that promote cardiovascular health, including
maintaining a healthy weight, engaging in regular physical activity, adopting a balanced diet, and managing stress levels.
3. Medication Adherence and Monitoring: Ensure patients understand the purpose, dosage, and potential side effects
of their medications. Encourage adherence to the treatment plan and monitor for medication-related adverse effects.
Educate patients about the importance of antibiotic prophylaxis before dental procedures or other activities that may
introduce bacteria into the bloodstream.

4. Regular Monitoring and Assessment: Perform regular clinical assessments to monitor for signs of worsening MVP or
MR. This includes monitoring vital signs, assessing heart sounds for murmurs, and evaluating for signs of edema or
fatigue. Encourage patients to report any new or worsening symptoms promptly.

5. Emotional Support and Patient Advocacy: Provide emotional support and counseling to address anxiety and fear
related to the diagnosis and potential complications. Facilitate communication with healthcare providers and advocate
for patients' needs and concerns within the healthcare system.

Nursing diagnosis
Nursing Diagnosis 1:
Risk for Ineffective Tissue Perfusion related to decreased cardiac output secondary to mitral valve prolapse
Goal: Patient will maintain adequate tissue perfusion as evidenced by stable vital signs, absence of edema, and normal
skin color and temperature.
Nursing Interventions:
1. Monitor vital signs, including blood pressure, heart rate, and respiratory rate, every 4-6 hours or as needed.
2. Assess for signs of edema, such as swelling in the ankles, legs, and sacrum.
3. Monitor skin color and temperature, noting any pallor or coolness.
4. Encourage adequate fluid intake to maintain hydration and support cardiac function.
5. Administer diuretics as prescribed to reduce fluid overload and improve tissue perfusion.
6. Collaborate with the healthcare provider to adjust medications and interventions as needed.
Nursing Diagnosis 2:
Anxiety related to fear of complications secondary to mitral valve prolapse
Goal: Patient will experience reduced anxiety as evidenced by verbalization of decreased anxiety, relaxed body posture,
and improved sleep patterns.
Nursing Interventions:
1. Provide a calm and supportive environment for the patient.
2. Listen attentively to the patient's concerns and educate them about MVP and its management.
3. Encourage relaxation techniques, such as deep breathing or meditation, to manage anxiety and promote
emotional well-being.
4. Administer anti-anxiety medications as prescribed to reduce anxiety symptoms.
5. Collaborate with the healthcare provider to address any underlying psychological factors contributing to anxiety.
Nursing Diagnosis 3:
Deficient Knowledge related to lack of understanding of mitral valve prolapse and its management
Goal: Patient will demonstrate improved knowledge of mitral valve prolapse and its management as evidenced by
accurate answers to questions, adherence to treatment plan, and ability to self-manage symptoms.
Nursing Interventions:
1. Provide clear and concise explanations about MVP, including its causes, symptoms, potential complications, and
treatment options.
2. Utilize educational materials, such as diagrams, brochures, and videos, to enhance understanding.
3. Encourage patients to ask questions and clarify any doubts they may have.
4. Reinforce patient education at each encounter and provide written instructions for home care.
 5. Collaborate with the healthcare provider to assess the patient's knowledge and provide ongoing education as
needed.
Prognosis
The prognosis for patients with mitral valve prolapse (MVP) is generally favorable. Most individuals with MVP live long
and healthy lives without experiencing any significant complications. However, the prognosis can vary depending on the
severity of the prolapse and the presence of any complications.
Prognosis for Mild MVP:
Patients with mild MVP typically do not experience any symptoms or complications.
Regular monitoring is recommended to assess for any changes in the condition.
The overall outlook for mild MVP is excellent, with a low risk of complications.
Prognosis for Moderate MVP:
Patients with moderate MVP may experience occasional symptoms such as palpitations, chest pain, or shortness of
breath.
These symptoms can usually be managed with lifestyle modifications and medication.
The prognosis for moderate MVP is also good, with a low to moderate risk of complications.
Prognosis for Severe MVP:
Patients with severe MVP are at an increased risk of complications such as severe mitral regurgitation (MR), heart
failure, and infective endocarditis.
These complications may require surgical intervention or lifelong medication.
The prognosis for severe MVP is more guarded, with a higher risk of complications and a potential impact on life
expectancy.