Mitral valve prolapse medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Medical Therapy

Most patients only need reassurance. Those with mitral valve prolapse and symptoms of dysautonomia (palpitations, chest pain) may often benefit from beta-blockers (e.g., propranolol). Patients with prior stroke and/or atrial fibrillation may require anticoagulation is, such as aspirin or warfarin.

2008 ACC/AHA Guidelines for the Management of Patients with Valvular Heart Disease - Medical Therapy in Mitral Valve Prolapse

Class I

"1. Aspirin therapy (75 to 325 mg per day) is recommended for symptomatic patients with MVP who experience cerebral transient ischemic attacks. (Level C)"

"2. In patients with MVP and atrial fibrillation, warfarin therapy is recommended for patients aged greater than 65 or those with hypertension, MR murmur, or a history of heart failure. (Level C)"

"3. Aspirin therapy (75 to 325 mg per day) is recommended for patients with MVP and atrial fibrillation who are less than 65 years old and have no history of MR, hypertension, or heart failure. (Level C)"

"4. In patients with MVP and a history of stroke, warfarin therapy is recommended for patients with MR, atrial fibrillation, or left atrial thrombus. (Level C)"

Class III

"1. In patients with MVP and a history of stroke who do not have MR, atrial fibrillation, or left atrial thrombus, warfarin therapy is reasonable for patients with echocardiographic evidence of thickening (5 mm or greater) and/or redundancy of the valve leaflets. (Level C)"

"2. In patients with MVP and a history of stroke, aspirin therapy is reasonable for patients who do not have MR, atrial fibrillation, left atrial thrombus, or echocardiographic evidence of thickening (5 mm or greater) or redundancy of the valve leaflets. (Level C)"

"3. Warfarin therapy is reasonable for patients with MVP with transient ischemic attacks despite aspirin therapy. (Level C)"

"4. Aspirin therapy (75 to 325 mg per day) can be beneficial for patients with MVP and a history of stroke who have contraindications to anticoagulants. (Level B)"

Class IIb

"1. Aspirin therapy (75 to 325 mg per day) may be considered for patients in sinus rhythm with echocardiographic evidence of high-risk MVP. (Level C)"

Sources

• 2008 ACC/AHA Guidelines incorporated into the 2006 guidelines for the management of patients with valvular heart disease