Abstract Few disorders have evoked more interest and controversy over the last 3 decades than mitral valve prolapse. Mitral valve prolapse occurs more frequently in women than men, occurs at any age, and is the most common cardiac valvular abnormality. The diagnosis of mitral valve prolapse is generally made by detection of typical auscultatory or echocardiographic findings. However, many patients with mitral valve prolapse present to the physician with a variety of features that together constitute a mitral valve prolapse syndrome, thus a classification of patients with mitral valve prolapse has been proposed: Anatomic mitral valve prolapse includes patients with a wide spectrum of mitral valve abnormalities from mild to severe. Symptoms and physical findings in these patients are directly related to mitral dysfunction and progressive mitral regurgitation. Mitral valve prolapse syndrome refers to the occurrence of symptoms such as palpitations, chest pain, fatigue, exercise intolerance, dyspnea, and syncope that cannot be explained on the basis of the mitral valve abnormality alone in patients with mitral valve prolapse. The pathogenesis of these symptoms is thought to be related to metabolic neuroendocrine dysfunction. The most important therapeutic approach in patients with mitral valve prolapse relates to the identification of those patients at risk for complications and reassurance of those patients with benign disease.