CARDIOVASCULAR JOURNAL OF AFRICA • Vol 21, No 6, November/December 2010
AFRICA
327
Mitral valve prolapse and conduction disturbances:
the forgotten association
A D’ALOIA, E VIZZARDI, E ANTONIOLI, E CHIARI, A CURNIS, L DEI CAS
Summary
Various cardiac arrhythmias and conduction defects have
been described in patients with mitral valve prolapse. We
describe a case of a young woman affected by a mitral valve
prolapse, involving the posterior mitral leaflet, with mild
mitral regurgitation and an episode of syncope due to asys-
tolia. It is hoped that this short communication will once
again focus attention on the as yet unexplained association
between mitral valve prolapse and various cardiac conduc-
tion disorders.
Submitted 11/5/09, accepted 10/3/10
Cardiovasc J Afr
2010;
21
: 327–329
Various cardiac arrhythmias and conduction defects have been
described in patients with mitral valve prolapse (MVP).
1-4
These
include: sino-atrial and atrio-ventricular (AV) node dysfunction,
prolongation of the QT interval, cases of refractory ventricular
tachycardia and fibrillation, and dysautonomia.
5-9
In sympto-
matic patients with mitral valve prolapse, infranodal conduction
abnormalities as well as dual AV nodal pathways have been
documented in electrophysiological studies.
10
This is a case report of a 23-year-old woman who presented
to our Department of Cardiology with an episode of syncope.
Clinical examination revealed a grade II systolic murmur and the
electrocardiogram showed a first-degree atrio-ventricular block
(Fig. 1). Echocardiography demonstrated mitral valve prolapse
involving the posterior leaflet, with mild mitral regurgitation
(Figs 2, 3).
Further diagnostic tests, including a chest X-ray, thyroid
function tests and coronary angiography were all within normal
limits. Telemetric electrocardiography revealed multiple episodes
of asystole, the longest of which lasted for four seconds (Fig. 4).
Following this, a permanent cardiac pacemaker was inserted.
Tachyarrhythmias have been shown to represent the most
frequent and potentially dangerous clinical manifestation of
MVP and there is an association between mitral valve prolapse
and sudden cardiac death.
11-13
Atrio-ventricular conduction disturbances occur in mitral
valve prolapse but the true mechanism(s) of arrhythmia is still
unclear. In some patients with mitral valve prolapse, electro-
Case Report
Department of Cardiology, University of Brescia, Italy
ANTONIO D’ALOIA, MD
ENRICO VIZZARDI, MD,
ELENA ANTONIOLI, MD
ERMANNA CHIARI, MD
ANTONIO CURNIS, MD
LIVIO DEI CAS, MD
Fig. 1. ECG showing first-degree atrio-ventricular block.
