What is floppy valve syndrome? Condition blamed for sudden death of congressman's wife

The condition is seen in 3-5% of the general population and it affects more women than men.
Rep. Andy Barr and his wife, who went by Carol, speak with reporters outside his polling place in Lexington on Nov. 6, 2018.
Rep. Andy Barr and his wife, who went by Carol, speak with reporters outside his polling place in Lexington on Nov. 6, 2018.Timothy D. Easley / AP

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/ Source: TODAY
By A. Pawlowski

The sudden passing of Eleanor Carol Barr, the 39-year-old wife of U.S. Rep. Andy Barr of Kentucky, is putting the spotlight on mitral valve prolapse, or floppy valve syndrome, listed as the cause of her death after a preliminary autopsy.

Barr passed away unexpectedly Tuesday evening at home in Lexington, Kentucky.

Normally, people don’t die from the condition, said Dr. Jennifer Haythe, the co-director of the Women's Center for Cardiovascular Health at the Columbia University Medical Center and a cardiologist at New York-Presbyterian hospital. She did not treat Barr.

“It might create a lot of anxiety for people who have mitral valve prolapse to see a story like this, but in general, they can be reassured that this is not something we normally see,” Haythe told TODAY.

“Sudden death is very, very rare and is probably related to arrhythmia.”

What is mitral valve prolapse?

The heart has four valves that open and close to ensure healthy blood circulation that moves forward. The mitral valve, which is composed of two flaps, allows blood to be pumped from left atrium into the left ventricle of the heart, but not back the other way.

In a mitral valve prolapse, the two valve flaps don't close properly, but bulge or flop back into the left atrium, according to the American Heart Association. That may lead to the backflow of blood, which can cause a heart murmur — an unusual “whooshing or swishing” sound heard between heartbeats.

What causes a mitral valve prolapse?

The exact cause is a mystery — most people with the condition are born with it and it tends to run in families, according to the National Heart, Lung and Blood Institute.

It’s estimated 3-5% of the general population has MVP, the Cleveland Clinic noted.

What are the risk factors?

Women are affected twice as often as men, according to the Cleveland Clinic.

Aging also raises the risk. “Sometimes, it can progress and… should be followed over time,” Haythe cautioned. “As the valve prolapses more, you develop more leakiness of the valve and you need a valve replacement potentially down the road.”

The National Heart, Lung and Blood Institute said other conditions associated with MVP include:

  • A history of rheumatic fever
  • Connective tissue disorders, such as Marfan syndrome or Ehlers-Danlos syndrome
  • Graves’ disease
  • Scoliosis and other skeletal problems
  • Some types of muscular dystrophy

How is it diagnosed?

Usually, a person’s doctor will hear a murmur while listening to the heart with a stethoscope during a routine physical exam, Haythe said. Since the condition tends to run in families, patients will often know one of their parents has MVP and get checked for it, she added.

Sometimes, it’s picked up on an echocardiogram that was ordered for another reason.

The condition can be mild or severe — in mild cases, it’s possible for people to not know they have it.

“If you don’t have a loud murmur from it and if it’s mild, it could go undetected,” Haythe noted. “If it’s significant enough that you can hear a murmur or there’s a leakiness in the valve, it should be picked up by a physician.”

What are the symptoms?

Most people don’t have any symptoms. Most also live a normal, active life, Haythe said.

When symptoms do appear, the National Heart, Lung and Blood Institute listed these warning signs:

  • Heart palpitations, or the feeling that your heart is skipping a beat, fluttering or beating too fast
  • Shortness of breath
  • Cough
  • Fatigue, dizziness or anxiety
  • Migraine headaches
  • Chest discomfort

What is the treatment for a mitral valve prolapse?

Most people don’t need any treatment because they either have no symptoms or it doesn’t impact their health. MVP rarely becomes a serious condition, the American Heart Association noted. Haythe said she sees it often in her practice and has never had a patient suffer a sudden death.

Palpitations and chest discomfort can be treated with medicines.

Only a small percentage of patients with MVP have a severe form of it, which can cause life-threatening arrhythmia, or abnormal heartbeats, and complications such as heart attack and stroke. Those cases may require heart surgery to repair or replace the mitral valve.