A Potential Mechanism for Mitral Valve Prolapse Syndrome

Mitral valve prolapse (MVP) is the most common cardiac valvular abnormality, with a prevalence ranging from 2% to 17%.^Patients with MVP often complain of palpitations and chest pain. Despite its prevalence, the precise physiologic mechanisms underlying the development of chest pain and arrhythmias in patients with MVP remain unresolved, and the symptoms are often difficult to treat. In this report, we propose a unifying theory to help explain a potential mechanism for the MVP syndrome. Based upon the observation that the AV valves are heavily innervated, we propose that the symptoms associated with MVP syndrome result from enhanced firing of afferent nerves located within the prolapsing mitral valve leaflets and at the junctions of the leaflets and the AV groove. Once triggered, the nerves release catecholamines and neurofieptides into the tissue at the valve-muscle-AV ring interface, which, in turn, activate pain receptors in the heart. In some cases, ectopy and the Bezold-Jarisch reflex are stimulated.

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