Despite the high prevalence of straight back syndrome (SBS), there is still limited research on this condition, posing challenges for effective diagnosis and treatment. The disease has been known for a long time, but there have been few related studies, which mostly consist of case reports. These studies have not been systematically summarized, making it difficult to meet the current needs of diagnosis and treatment. This article summarized the existing literature and comprehensively reviewed the diagnosis, pathogenesis, treatment, and research status of mitral valve prolapse related to SBS. We specifically emphasized the mechanisms and prognosis of SBS combined with mitral valve prolapse and discussed the latest research progress in this disease.

Although both are initially asymptomatic, mitral valve prolapse/myxomatous mitral valve disease (MVP/MMVD) and bicuspid aortic valve (BAV), with its associated aortic disease, are currently the two most common congenital valvular heart diseases. Severe mitral regurgitation due to rupture of chordae tendineae (CTR) prompts surgery for MVP/MMVD. Surgery for BAV is performed for severe aortic stenosis and/or regurgitation, often with management of root and/or ascending aortic enlargement. There may be an association between straight back syndrome (SBS) and MVP/MMVD, which may be a key to earlier diagnosis. Other associations link weightlifting with ascending aortic enlargement and with CTR, where the common theme is blood pressure elevation. As the number of people with fitness center memberships continues to increase, this potentially exposes more undiagnosed individuals with MVP/MMVD or BAV to risk from weightlifting. Challenges include making the public aware of this risk and preparing the osteopathic physician to recognize patients at risk through a structured history-taking and targeted cardiovascular examination.

Fifty consecutive patients (36 male, 14 female, mean age 28 years) who had heart murmurs and clinical and radiographic evidence of straight upper dorsal spine (straight back syndrome, SBS) underwent detailed clinical, electrocardiographic, roentgenographic, and echocardiographic evaluation. Palpable systolic thrill noted in one (2%) and widened S2 with persistent splitting in 2 (4%) patients were uncommon. Murmurs were invariably systolic in nature. Those located at the base of the heart in 19 (38%) patients were ejection in type and best heard during expiration. Those located at the apex in 26 (52%) patients were either mid-, late-, or pansystolic, and often associated with midsystolic click. Five (10%) patients had both types of murmurs. Diastolic murmurs were not heard in any patient. EKGs were normal in the majority. Cardiomegaly (C:T greater than 55%) was present in only 5 (10%) and dilatation of the main pulmonary artery in 2 (4%) patients. Thus the incidence of pseudoheart disease (PsHD) was small (14%). Echocardiograms were normal in 18 (36%) and abnormal in 32 (64%) patients. There was evidence of mitral valve prolapse (MVP) in 29 (58%) patients and 3 (6%) had evidence of bicuspid aortic valve (BAV). In a control group of 40 age- and sex-matched patients (26 male, 14 female, mean age 29.5 years), who also had heart murmurs but lacked straight upper dorsal spine, only 7 (17.5%) had MVP and none had BAV. The difference is both clinically and statistically significant (p less than 0.001). It is concluded that SBS is more often associated with valvular heart disease (MVP and BAV) than PsHD. Therefore, the diagnosis of SBS should remain presumptive until echocardiography has been performed to exclude MVP and BAV. SBS patients who have valvular heart disease should receive infective endocarditis prophylaxis.