Non-Rheumatic Mitral Valve Prolapse and Its Impact on Heart Rhythm

Non-rheumatic mitral valve prolapse

Hello, Dr.
He.
I would like to ask about my noticeable arrhythmia (premature ventricular contractions) that has been occurring intermittently over the past year or two.
Previously, I only experienced palpitations with a strong heartbeat, but now my heart feels like it's getting stuck.
In 2016, after an initial examination, the doctor only mentioned that the results of my standard ECG were benign and advised me to reduce my tea intake and adjust my lifestyle, without prescribing any medication.
However, about two to three months ago, the symptoms recurred, and after seeing different doctors, I underwent a standard ECG, a 24-hour Holter monitor (which indicated a high frequency), and an echocardiogram.
Before these tests, the doctor listened with a stethoscope and noted the sound of mitral valve prolapse.
After the echocardiogram, it was confirmed that my arrhythmia was caused by mitral valve prolapse.
The doctor advised me to take medication (Inderal) long-term, one tablet in the morning and evening, and an additional dose at noon if I feel unwell, with regular follow-ups to check for any worsening of the valve leakage in a year.
Is it safe to take this medication daily? Additionally, during this episode, I have experienced prolonged symptoms along with coughing.
Sometimes, after taking the medication, I don't feel my heart racing or getting stuck, but at other times, it suddenly acts up.
I often experience episodes after eating or drinking.
Dr.
He, would you consider this arrhythmia serious? Also, prior to the episodes in the last two to three months, I had three wisdom teeth extracted (one each week).
Could this have been a key factor in triggering the episodes?

Kyle, 20~29 year old female. Ask Date: 2017/05/20

Dr. He Dongjin reply Cardiology

Hello, first of all, taking INDERAL this way is fine.
This medication can indeed be taken daily or adjusted based on your symptoms.
You can take an additional pill when your heart rate is noticeably elevated, and reduce the dosage when your symptoms stabilize.
May I ask, Doctor, is this arrhythmia considered serious? I apologize, but I cannot explain the severity of your condition without seeing the report.
However, based on your description, it should be manageable.
You had three wisdom teeth extracted earlier this year, and since it has been a while, it should not have a significant impact.
Don't worry, and take care.
Changhua Hospital is concerned about you.

Reply Date: 2017/05/20

More Info

Mitral valve prolapse (MVP) is a condition where the mitral valve does not close properly, which can lead to mitral regurgitation (MR) and various symptoms, including arrhythmias. Your experience with palpitations and the sensation of your heart "skipping" beats is not uncommon among individuals with MVP. The relationship between MVP and arrhythmias, particularly premature ventricular contractions (PVCs), is well-documented.

Understanding Mitral Valve Prolapse and Its Impact on Heart Rhythm
MVP can lead to a range of symptoms, including palpitations, chest pain, and anxiety. The underlying mechanism involves the abnormal structure of the mitral valve, which can cause it to bulge (prolapse) into the left atrium during the heart's contraction. This abnormality can irritate the heart's electrical system, leading to arrhythmias such as PVCs. While PVCs are often benign, they can be distressing and may require monitoring and treatment, especially if they occur frequently.

Your Symptoms and Management
You mentioned that your symptoms have worsened over the past few months, leading to increased frequency of PVCs. The fact that your doctors have prescribed Inderal (propranolol), a beta-blocker, is a common approach to manage symptoms associated with MVP and arrhythmias. Beta-blockers can help reduce the frequency of PVCs and alleviate symptoms such as palpitations and anxiety. It is generally safe to take this medication daily as prescribed, but it is essential to follow your doctor's guidance regarding dosage and frequency.

The Role of Lifestyle Factors
You also noted that your symptoms seem to worsen after eating or drinking. This could be related to several factors, including increased vagal tone after meals, which can influence heart rhythm. Additionally, caffeine and certain foods can exacerbate palpitations in sensitive individuals. It may be beneficial to monitor your diet and identify any specific triggers that worsen your symptoms.

The Impact of Recent Dental Procedures
Regarding your question about the extraction of your wisdom teeth, while dental procedures can cause temporary stress and discomfort, they are not typically associated with the onset of arrhythmias unless there is significant pain, anxiety, or changes in medication (e.g., painkillers). However, if you experienced increased anxiety or stress during this time, it could have contributed to your symptoms.

When to Seek Further Evaluation
It is crucial to maintain regular follow-ups with your cardiologist, especially since your symptoms have changed. If you experience any new symptoms, such as increased frequency of palpitations, chest pain, or shortness of breath, you should contact your healthcare provider promptly. Additionally, if you notice that your symptoms are not well-controlled with medication, further evaluation may be warranted, which could include additional imaging or even electrophysiological studies to assess the nature of your arrhythmias.

Conclusion
In summary, while MVP can lead to arrhythmias like PVCs, many individuals manage their symptoms effectively with lifestyle modifications and medications like beta-blockers. It is essential to communicate openly with your healthcare provider about your symptoms and any concerns you may have. Regular monitoring and a tailored treatment plan can help you manage your condition effectively and maintain a good quality of life.

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