Cardiologist Questions Mitral Valve Prolapse

Can I have mitral valve prolapse when doctor can not hear heart murmur?

My doctor suspects that I have mitral valve prolapse- but she says that a heart murmur is not audible. I also had an echo six years ago that never showed it. I do have a lot of the symptoms- fluttering, shortness of breath, etc, but have never been formally diagnosed.

Is it possible to have mitral valve prolapse and for the doctor not be able to hear a murmur- or to have an echo six years ago that was normal that never showed it?

28 Answers

Hearing a murmur by itself isn’t the only issue in mitral valve prolapse. You need to now how does the does mitral valve appear on the original echocardiogram. Some prolapse need be monitored more often if they were very abnormal and think due to myxomatou degenerative changes even without leakage in the valve. Most prolapses are benign and don’t need close monitoring so often. I suggest you check with your doctor to see what else wrong in the mitral valve besides a prolapse.
YES: Mitral Valve prolapse can come and go under various circumstances. Especially if it is a mild case. There are certain maneuvers that can be done to help bring it out. The murmur is not always audible.
Depends on the criteria used for the diagnosis.I suspect this patient does not have mitral valve prolapse and does not require SBE prophlaxis.My answer is very unlikely.
Not having it on either exam, physical and echo, would be very rare and the symptoms can be due to a lot of other things. Studies show that you either have the click/murmur, or the echo findings to have MVP. Otherwise, it's essentially not there. Also, there are many causes of MVP and some of these may improve or go away.
It is certainly possible to have a mitral valve prolapse seen on echo even though it is not audible. However if mitral valve prolapse is causing a signifigant mitral regurgitation (blood leaking back from left ventricle to left atrium during systole) this would usually be audible. It is possible for mitral valve prolapse to be acquired since your echo 6 years ago or to even be intermittent.
Yes, it is possible to have Mitral Valve Prolapse in the absence of a murmur. The murmur is actually the result of mitral regurgitation which is a leakage of blood backwards across the mitral valve. While mitral valve prolapse is often associated with mitral regurgitation it is possible to have mitral valve prolapse without mitral regurgitation. An echocardiogram is the gold standard for diagnosis of mitral valve prolapse however studies can vary in quality. My recommendation would be for a repeat echocardiogram if there is concerns about mitral valve prolapse.
I would consider having the echocardiogram repeated.
You can have mitral valve prolapse and a doctor cannot hear the characteristic click or murmur.
Extremely unlikely.
Yes, you absolutely can have mitral valve prolapse without hearing a murmur. There are many things that affect the ability to hear a murmur. The classic sound you would hear with mitral valve prolapse would be a click. It is best to have a repeat ultrasound from a cardiologist office or hospital system you trust and the reason for the study should be possible mitral valve prolapse. Hope this helps.

Jason Talavera, MD, FACC

Western Washington Cardiology

Western Washington Medical Group
Many people have mitral valve prolapse and it is not significant and causes no problems. Often, if mild echo does not show it.
Hi, if your doctor thinks you have mitral valve prolapse a repeat echo maybe be prudent, but also should consider alternative diagnosis that could be responsible for your symptoms such as an arrhythmia. I would be happy to discuss it in person if you would like to make an appointment.
Dr. Lutz
The most accurate way of diagnosing mitral valve prolapse is a current echocardiogram.. you definitely could have a normal echo 6 years ago and now have it and the murmur might not be that audible. Mitral valve prolapse on its own dose not cause the symptoms to describe.. unless there is significant mitral valve regurgitation (blood leaking through the valve) you will be completely without symptoms, any symptoms you have is likely not related to the valve in this case.
yes it is possible to not hear the murmur and still have mitral prolapse. In the past they used to over diagnose mitral valve prolapse but a repeat echo can answer that question. More importantly the above symptoms you mentioned can be due to a cardiac arrhythmia or heart failure or even coronary disease. see your cardiologist so they can decide what to order. I would start with some basic blood work including TSH, CBC, BMP, and echo and a holter

Gail Kay R.N.
Yes, it is possible the first echo (or second) missed it or that you didn't meet the strictest criteria for MVP by echo
Yes it is possible to have MVP without a heart murmur as MVP is a disease of the tissue of the valve that results in a thickening and redundancy of the valve leaflets which "bow" like a parachute upon closing. This may result in a sound called a "click", which is very hard to hear on exam and most of the time is not present. The valve may or may not leak and therefore a murmur may or may not be heard. Even in the presence of a valve that leaks, a murmur may not be heard or could be very soft making it difficult to hear.

If you had an echo 6 yrs ago that was normal, the likelihood that mitral valve prolapse (MVP) is present is extremely low provided the echo was of good quality at that time. If so, I would not repeat the echo at present just to reevaluate for MVP.
It is possible for MVP, or a murmur, not to be heard depending on a person's hydration and/or blood pressure at the time of examination. If it was not seen on echo, then it is most likely not significant enough to cause concern. Symptoms as you describe can be due to lack of sleep, too much caffeine and/or stress. Sometimes I will recommend over the counter fish oil and/or magnesium to help with palpitations (extra beats) if that is an issue. Check with your doctor, if symptoms change, to see if any further testing would be helpful.
It is possible to have mitral valve prolapse without hearing a murmur. It is not possible without seeing it on echocardiogram. If it is the cause of your symptoms, it would definitely show upon the echocardiogram.

Robert Roberts MD, MACC, FRSC, FRCPC
Yes you can. Mitral valve prolapse can vary based upon the filling conditions of the heart i.e. dehydration, the more concerning scenario is when there is an associated murmer from mitral regurgitation and a click.
Yes. Prolapse may be related to sympathetic tone, blood pressure, posture, and volume issues. It may come and go on exam. Likewise, a small amount of prolapse can be missed on echo.
Mitral valve prolapse is a very common disorder affecting about 2% of people. Having said that, many patients were told that they had mitral valve prolapse in the past when in fact they did not have it. Usually, during auscultation (listening to the heart with a stethoscope) the doctor hears a click that may or may not be followed by a heart murmur. This click is usually more pronounced in certain positions such as while lying supine with the legs raised and clenching your fists. This maneuver makes the click and the murmur more audible during examination of the patient. Findings are usually confirmed by an echocardiogram (ultrasound of the heart)
Yes. Sometimes prolapse will cause the click but murmur will only appear if the valve is leaking. But to diagnose prolapse it needs to be present on echo / imaging test. So a normal echo means no prolapse at rest.

Dr. Robert Kelly
The answer is yes. You may have MVP without an audible murmur, or that your Dr. cannot appreciate one. To begin with, you need to understand what a "murmur" is. In the case of MVP, it is a sound created by the mitral valve leaking. Not all MVP cases have a leaking valve. So it may be that you have a prolapsing valve without a leak, hence no murmur. The more important question is if when listening to your valve, can a "click" be heard. That is how MVP is diagnosed at the bed side. An echo cardiogram may be helpful, but only if it clearly shows prolapse. As to leaking valve, if present, it is easily demonstrated by echo/doppler.

Yes you can have mitral valve prolapse without a definitive murmur. It would likely be mild in nature.

Joel R. Garcia, M.D., F.A.C.C.
Orlando Health Heart Institute
Cardiology Group
Chairman, Department of Cardiology
Orlando Health Dr. P. Phillips Hospital
Assistant Professor of Medicine
UCF College of Medicine
Echo is the most reliable tool even if it cannot be heard by the physician.
Yes, of course.

Yes you may not always have an audible murmur.