Snapshot A 40-year-old woman presents to the emergency department complaining that she can feel her heart beating. She occasionally experiences difficult breathing following exercise and reports an intermittent cough. Her echocardiogram is shown. Introduction Mitral valve prolapse occurs when the mitral leaflets do not close properly resulting in a bulging of one or both leaflets into the left atrium during systole and backflow of blood from the LV to the LA during contraction Epidemiology more frequently in younger women tends to be familial up to 10% of the population having some degree of MVP It is usually an isolated abnormality but may be associated with Marfan's syndrome atrial septal defect Presentation Symptoms most patients are asymptomatic when symptomatic, patients may present with a range of symptoms including palpitations chest pain (not associated with CAD or MI) exertional dyspnea fatigue cough orthopnea MVP rarely presents in a form of panic disorder Physical exam cardiac ausculation demonstrates mid-systolic click or late systolic murmur may find palpable thrill over the chest wall Evaluation Doppler echocardiography is gold standard for diagnosis shows regurgitant flow into LA from LV ECG may show resultant arrythmias atrial fibrillation is not uncommon Differential Systolic Murmors Diastolic Murmors Hypertrophic obstructive cardiomyopathy Aortic Stenosis loud crescendo-decrescendo systolic ejection murmor in right 2nd intercostal space Mitral Regurgitation high pitched holosystolic loudest at apex radiating to axilla Tricuspid Regurgitation (soft holosystolic at right sternal border) Aortic Regurgitation high pitched blowing early diastolic decrescendo murmur at left sternal border Mitral Stenosis Rumbling mid-diastolic murmur with accentuated S1. S2, best heard on expiration or when the patient is squating or excercising because venous return is increased Treatment No treatment indicated in most cases of asymptomatic to mild disease Surgical repair indicated in cases of severe, symptomatic disease Prophylactic antibiotics indicated in patients with history of infectious endocarditis prior to dental or other surgical procedures Prognosis, Prevention, and Complications Prognosis is excellent in the majority of cases most have no effect on patient lifestyle Complications may include bacterial endocarditis progression to regurgitation arrythmias