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How Is Mitral Valve Prolapse Diagnosed?

Examination of the patient reveals characteristic findings unique to mitral valve prolapse. Using a stethoscope, a clicking sound is heard soon after the ventricle begins to contract. This clicking is felt to reflect tightening of the abnormal valve leaflets against the pressure load of the left ventricle. If there is associated leakage of blood through the abnormal valve opening, a "whooshing" sound can be heard immediately following the clicking sound.

 

Echocardiography is the most useful test for mitral valve prolapse. Echocardiography can measure the severity of prolapse and the degree of mitral regurgitation. It can also detect areas of infection on the abnormal valves. Valve infection is called endocarditis and is a very rare, but potentially serious complication of mitral valve prolapse. Echocardiography can also evaluate the effect of prolapse and regurgitation on the functioning of the muscles of the ventricles.

 

Abnormally rapid or irregular heart rhythms can occur in patients with mitral valve prolapse, causing palpitations. A 24-hour Holter monitor is a continuous cassette recording of the patient's heart rhythm as the patient carries on his/her daily activities. Abnormal rhythms occurring during the test period are captured on tape and analyzed at a later date. If abnormal rhythms do not occur every day, the Holter recording may fail to capture the abnormal rhythms. These patients then can be fitted with a small "event-recorder" to be worn for up to several weeks. When the patient senses a palpitation, an event button can be pressed to record the heart rhythm prior to, during, and after the palpitations.

 

Mitral valve prolapse (MVP) most often is found during a routine physical exam when your doctor uses a stethoscope to listen to your heart.

 

Your doctor listens for a certain "click" and/or murmur. Stretched valve flaps, as seen in MVP, can make a clicking sound as they shut. If the valve is leaking blood back into the atrium, a murmur or whooshing sound often can be heard.

 

However, these abnormal heart sounds may come and go. Thus, your doctor may not hear them at the time of an exam, even if you have MVP. As a result, you also may have diagnostic tests and procedures to diagnose MVP.

 

 

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Diagnostic Tests and Procedures

Echocardiography

Echocardiography (echo) is the most useful test for diagnosing MVP. This painless test uses sound waves to create a moving picture of your heart. An echo provides information about the size and shape of your heart and how well your heart chambers and valves are working.

 

The test also can identify areas of heart muscle that aren't contracting normally due to poor blood flow or injury to the heart muscle. In MVP, an echo is used to look for prolapse of the mitral valve flaps and for backflow of blood through the leaky valve.

 

There are several types of echo, including a stress echo. A stress echo is done before and after a stress test. During a stress test, you exercise or take medicine to make your heart work hard and beat fast.

 

A stress echo usually is done to find out whether you have decreased blood flow to your heart (a sign of coronary heart disease, also called coronary artery disease).

 

An echo also can be done by placing a tiny probe down your esophagus to get a closer look at the mitral valve. The esophagus is the passage leading from your mouth to your stomach.

 

The probe takes sound wave pictures of your heart. This form of echo is called a transesophageal echocardiogram, or TEE.

 

Doppler Ultrasound

A Doppler ultrasound is part of an echo test. A Doppler ultrasound is used to show the speed and direction of blood flow through the mitral valve.

 

Other Tests

Other tests that can help diagnose MVP are: