Mitral Valve Prolapse: Causes of Fainting and Heart Pain

Mitral valve prolapse, sudden fainting while sitting?

Hello Doctor: First of all, I want to thank you for your hard work! I am a freshman in college.
During high school, I often stayed up late studying, and later I began to experience intermittent sharp pains in my heart.
After researching online, I found that it matched symptoms related to mitral valve issues.
I went to the hospital for an examination, and it was confirmed that it was not related to anemia, but rather "mitral valve prolapse." The doctor advised me to avoid vigorous exercise, stating that my condition would only cause discomfort and not to worry too much.
However, about three months ago during my senior year, while attending a lecture in an air-conditioned room and sitting down, I raised my hand to answer a question.
As soon as I did, my vision went black, and I lost consciousness.
When I woke up, I was lying on the ground with blurred vision, and I could hear many people talking, seemingly trying to help me.
According to the school nurse, when she arrived at the scene, my body was very stiff, face down on the floor.
When she turned me over, my face had already started to turn black.
She checked my pulse and found that I had no breathing or heartbeat (or it may have been extremely weak).
She assisted me with an oxygen tank, and just as she was about to perform CPR, I regained consciousness (the above account is a paraphrase, and I apologize if the sequence is not accurate).
In fact, I felt difficulty breathing before I woke up, and I also experienced urinary incontinence and generalized weakness.
I was then taken to the emergency room, where I was fully conscious.
Later, blood tests and an electrocardiogram were performed, but everything came back normal.
(The day before I fainted, I had coffee and had stayed up late until 2 AM for three consecutive days, but I did have breakfast that day.)
Prior to this, in the eighth grade, I suddenly felt very short of breath while sleeping, as if I couldn't breathe.
I woke up startled, and according to my parents, before I regained consciousness, I was moaning and my limbs were twisted (similar to having a nightmare), followed by rolling my eyes back, and I had no breathing or heartbeat (or it may have been very weak).
Finally, I woke up, and there was also urinary incontinence at that time.
I previously consulted with a doctor at a small clinic, who suggested that I might have epilepsy.
However, my family and a friend's husband also have mitral valve prolapse and have fainted multiple times, which leaves me puzzled.
Is my condition purely a heart issue, or could there be something else? Could you please advise me on which specialty I should consult for further examination? Or should I follow up with a cardiologist soon? (The last time I had an echocardiogram was two years ago, and the electrocardiogram was three months ago.)

Youyun, 10~19 year old female. Ask Date: 2016/07/31

Dr. He Dongjin reply Cardiology

Hello, there is a possibility of epilepsy as well as postural hypotension.
It is recommended to visit the neurology department and then follow up with the cardiology department.
Changhua Hospital cares about you.

Reply Date: 2016/07/31

More Info

Mitral Valve Prolapse (MVP) is a condition where the mitral valve, which separates the left atrium from the left ventricle of the heart, does not close properly. This can lead to a variety of symptoms, including chest pain, palpitations, and in some cases, fainting or syncope. Your experience of intermittent sharp chest pain, particularly during periods of stress or physical exertion, is not uncommon among individuals with MVP.
The symptoms you describe, including the fainting episode, could be related to several factors. MVP itself is often benign and may not cause significant issues for many individuals. However, in some cases, it can lead to mitral regurgitation, where blood leaks backward into the left atrium, potentially causing symptoms like palpitations, fatigue, and even fainting spells due to decreased cardiac output.
Your fainting episode, particularly in a setting where you were sitting and suddenly raised your hand, raises a few considerations. It could be related to a vasovagal response, which is a common cause of fainting that occurs when the body overreacts to certain triggers, such as stress, pain, or prolonged standing. This response can lead to a sudden drop in heart rate and blood pressure, resulting in fainting. The fact that you experienced this after a period of stress, including late-night studying and caffeine consumption, could have contributed to this response.

Additionally, the history of feeling breathless and experiencing episodes of waking up gasping for air may suggest a possible sleep-related breathing disorder, such as sleep apnea, which can also lead to significant fatigue and cardiovascular strain. The combination of MVP and potential sleep apnea could exacerbate symptoms, particularly if you are not getting restful sleep.

Given your history and the concerning nature of your fainting episode, it is advisable to follow up with a cardiologist for a comprehensive evaluation. This may include:
1. Echocardiogram: To assess the severity of the mitral valve prolapse and any associated regurgitation. Since your last echo was two years ago, a new one could provide updated information on your heart's function.

2. Holter Monitor: A 24-hour Holter monitor can help detect any arrhythmias that may be contributing to your symptoms, especially during periods of exertion or stress.

3. Electrophysiological Study: If arrhythmias are suspected, this study can provide more detailed information about the electrical activity of your heart.

4. Sleep Study: Given your symptoms related to sleep, a sleep study may be warranted to evaluate for conditions like sleep apnea.

5. Lifestyle Modifications: Reducing caffeine intake, ensuring adequate sleep, and managing stress through relaxation techniques or counseling can also be beneficial.

In summary, while MVP can cause symptoms, the fainting episodes and other symptoms you describe warrant further investigation to rule out other potential causes, including arrhythmias or sleep disorders. It is essential to communicate all your symptoms to your healthcare provider, who can guide you through the appropriate diagnostic steps and management strategies. Regular follow-up with a cardiologist is crucial, especially given your history and the potential impact on your daily life and future health.

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