Mitral Valve Prolapse (cont.)

If typical symptoms of mitral valve prolapse are present, the primary care provider or an emergency department physician will suspect a heart problem.

• The health care provider will ask questions about symptoms, overall medical condition, lifestyle, and medications.
  
  
• The physical examination may or may not reveal signs that suggest mitral valve prolapse, such as a "click" with each heartbeat or a heart murmur that can be heard when the health care provider listens to the chest while a person is in multiple positions. The midsystolic click and late systolic murmur are very position- and heart volume -dependent, so they are possible to miss if the person is only examined when lying face upward.

Diagnostic tests help rule out serious heart disease by evaluating how the heart is pumping and how well the valves are working. These tests are noninvasive, painless, and quick. The following tests are most common:

• Electrocardiogram (ECG): ECG records the rhythm and the electrical activity of the heart from a variety of angles. This information is very helpful in diagnosing a variety of heart problems, such as cardiac arrhythmias, heart attack, or thickening of the heart muscle.
  
  
• Echocardiogram (ECHO): ECHO uses sound waves (ultrasound) to provide a moving picture of the heart on a video screen. ECHO shows the motion of all the cardiac valves and whether the mitral valve flops backward when it closes. ECHO is usually sufficient to establish a diagnosis of mitral valve prolapse, but in some cases, it can miss the condition. The echo will also quantitate the degree of abnormality, including any significant leaky mitral valve or mitral insufficiency. If associated conditions are present, like Marfan's syndrome, these will also be diagnosed or excluded.
  
  
• Ambulatory ECG: A device called a Holter monitor records heart rhythms and electrical activity over an extended period, usually 24 hours. The person has this device attached to his chest while going about his usual activities. A diary of the person's activities are kept during the recording period so any abnormalities seen on the ECG can be linked with what the person was doing and feeling at the time. This test may be recommended if the person is having dizziness, light-headedness, fainting spells, or palpitations.

• Stress ECG: This test is similar to a regular ECG except it shows the heart's response to stress, usually exercise. With ECG electrodes attached, the person walks on a treadmill or rides a stationary bike. Most people with symptoms, especially chest pain or signs of rhythm disturbances, should undergo the stress test since most patients have benign results that can be very reassuring.