In an asymptomatic patient with mitral valve prolapse, which management approach is most appropriate?

• A. Initiate anticoagulation therapy
• B. Reassurance and promotion of healthy lifestyle; beta-blockers may be used for autonomic symptoms; avoid contact sports if severe disease or LV changes, uncontrolled tachyarrhythmias, aortic root enlargement, or prolonged QT interval
• C. Recommend daily calcium channel blocker for all
• D. Schedule immediate mitral valve repair

Answer: (B)

Mitral valve prolapse that doesn’t cause symptoms is usually benign, so the best approach is to reassure the patient and encourage a healthy lifestyle. If autonomic symptoms such as palpitations or anxiety are bothering the patient, a beta-blocker can help reduce these adrenergic symptoms. Lifestyle and activity can generally be maintained, with restriction on contact sports considered only if there are high‑risk features like severe disease with LV changes, uncontrolled tachyarrhythmias, aortic root enlargement, or a prolonged QT interval.

Anticoagulation isn’t indicated in an asymptomatic MVP unless there’s another reason to need it (for example, atrial fibrillation or a history of embolic events). Daily calcium channel blockers aren’t prescribed for all patients with MVP. Surgical mitral valve repair isn’t warranted in an asymptomatic patient without severe MR or LV dysfunction.