# Cardiac valve prolapse

- Category: chronic
- Review status: reviewed (every claim checked against a document named on this page)
- Sources: ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class KD71.00 - condition scope only, no dose · Mitral Valve Prolapse - StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK430788/ · No dose - referral pathway, no medicine given in primary care
- Verified date: 2026-08

## Verified against

- No dose - referral pathway, no medicine given in primary care
- Cardiac valve prolapse - disease-level clinical article (cardiac-valve-prolapse-clinical.txt)

## Treatment metadata

- No drug therapy in primary care (Recognition & Referral)

## Complete treatment card

```text
CARDIAC VALVE PROLAPSE
Sources: ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class KD71.00 -
         condition scope only, no dose · Mitral Valve Prolapse - StatPearls -
         https://www.ncbi.nlm.nih.gov/books/NBK430788/ · No dose - referral pathway, no medicine
         given in primary care
Review status: REVIEWED against No dose - referral pathway, no medicine given in primary care,
               Cardiac valve prolapse - disease-level clinical article (cardiac-
               valve-prolapse-clinical.txt)  (2026-08)

IS IT THIS? - reference only, to read alongside your own examination
  SYMPTOMS - what the patient reports (2)
    - Most patients with MVP are asymptomatic; when symptoms occur they tend to be autonomic in
      nature
    - Higher-risk history includes sustained palpitations or complex ventricular arrhythmia, Marfan
      or connective tissue disease, exertional or emotional presyncope/syncope, or a first-degree
      relative with MVP-related sudden death  [arrhythmia · palpitations · sudden cardiac arrest ·
      syncope]
  SIGNS - what you find (3)
    - Squatting delays the click and shortens the murmur, while standing or Valsalva brings the
      click earlier and lengthens the murmur  [heart murmur]
    - Handgrip delays the MVP click and shortens its murmur, but quiets the murmur of hypertrophic
      cardiomyopathy - a useful way to tell the two apart  [heart murmur]
    - With a flail leaflet the click may disappear, replaced by a holosystolic murmur resembling
      mitral regurgitation  [heart murmur]
  TESTS (6)
    - Transthoracic echo is the primary diagnostic test; MVP is defined by leaflet displacement of 2
      mm or more above the annular plane
    - Classic MVP pairs that displacement with leaflet thickness over 5 mm; nonclassic MVP has
      thickness of 0 to 5 mm
    - On cardiac MRI, the extent of midwall late gadolinium enhancement is the strongest predictor
      of arrhythmic MVP
    - A mechanical dispersion index of 65 ms or more on CMR is another, less-robust predictor of
      arrhythmic MVP
    - ECG changes can include inferior T-wave inversion, Tpeak-Tend beyond 90 ms, or PVCs from the
      papillary muscles/outflow tract with right-bundle morphology
    - Holter monitoring is considered when a high PVC burden, 5% or more, is suspected
  IF NOT THIS - what else fits (2)
    - Hypertrophic cardiomyopathy, which the handgrip maneuver helps tell apart from MVP
    - Other causes of mitral regurgitation: secondary MR from papillary dysfunction, rheumatic
      disease, infective endocarditis with leaflet damage, annular calcification, and congenital
      cleft mitral valve
  Source  StatPearls "Mitral Valve Prolapse" - disease-level clinical article
  Status  traced to the source above

1. NO DRUG THERAPY IN PRIMARY CARE (RECOGNITION & REFERRAL)[1st line]
   Adult    Mitral valve prolapse is most commonly an asymptomatic, benign echocardiographic
            finding. In primary care, reassure asymptomatic patients without significant
            regurgitation that routine antibiotic prophylaxis is not required. Refer to cardiology
            if the patient develops symptoms such as palpitations, chest pain, syncope, severe
            mitral regurgitation, or signs of heart failure. - Refer
   Peds     Children follow the same pathway: recognise and refer. No primary-care medicine is
            implied.
   Source   No dose - referral pathway, no medicine given in primary care
   Why      Mitral valve prolapse is most commonly an asymptomatic, benign echocardiographic
            finding. In primary care, reassure asymptomatic patients without significant
            regurgitation that routine antibiotic prophylaxis is not required. Refer to cardiology
            if the patient develops symptoms such as palpitations, chest pain, syncope, severe
            mitral regurgitation, or signs of heart failure.
   Caution  RED FLAG - Infective endocarditis presentation (fever, new or changing murmur): assess
            urgently and refer.
            RED FLAG - Embolic stroke / TIA: assess urgently and refer.
            Significant valve regurgitation, palpitations or arrhythmia, chest pain, symptoms of
            heart failure.
            No medicine is prescribed for this in primary care - this entry is for recognition and
            referral. Anything given is decided by the service it is referred to.
            RED FLAG - Family history of arrhythmogenic mitral valve prolapse (AMVP) requires
            cardiology evaluation/referral for primary prevention strategies such as ICDs.

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