Myocardial Ischemia and Mitral Valve Prolapse Symptoms

Myocardial ischemia, coronary artery insufficiency, palpitations, mitral valve prolapse?

Hello Doctor: For the past few years, I have frequently experienced chest tightness, palpitations, rapid heart rate, dizziness, fatigue, excessive sleepiness, and headaches, particularly from September to November each year.
These symptoms can last for several hours daily and have significantly impacted my life and work.
Recently, the situation has worsened; even while sitting still, my heart often beats over a hundred times per minute, and sometimes I experience sharp pains in my heart.

I visited a cardiology clinic and underwent a stress test with an electrocardiogram.
The doctor indicated that there are signs of myocardial ischemia in one area of my heart and insufficient blood supply from the coronary arteries, suggesting that one of the blood vessels may be too narrow.
Blood tests showed no anemia or high cholesterol, ruling out vascular obstruction.
Currently, I take 1/4 of a Isosorbide tablet every night, but I feel it is not effective.

Since these issues are affecting my daily life, I am unsure what to do.
Is this considered serious? Should I seek treatment at a larger hospital? Which specialty should I consult, cardiology or autonomic nervous system disorders? My grandmother had a stroke due to sudden atrial fibrillation and thrombosis; does this indicate a hereditary risk for me? In the past, during my junior and senior years of high school, I often experienced palpitations and had depression, which may be related to my emotions.

Last year, during a health check-up, a doctor mentioned that I have mitral valve prolapse and mitral regurgitation.
I wonder if these conditions are related to my current symptoms.
How can I improve my situation? I do not usually exercise, which may contribute to my heart discomfort.
Do you recommend any devices that I can wear to monitor my heart rate for 24 hours? Can I record this data myself for my doctor’s diagnosis? Thank you very much for taking the time to read and respond!

Miao Miao, 30~39 year old female. Ask Date: 2017/11/09

Dr. He Dongjin reply Cardiology

Hello, it sounds more like your grandmother's arrhythmia, atrial fibrillation, and subsequent stroke may be caused by autonomic nervous system dysfunction, which should not be related to you.
I recommend visiting a major hospital's cardiology department for a 24-hour electrocardiogram monitoring.
The psychosomatic department can conduct autonomic nervous system testing.
Wishing you good health.
Sincerely, Dr.
He Dongjin, Cardiologist, Changhua Hospital.

Reply Date: 2017/11/09

More Info

Myocardial ischemia and mitral valve prolapse (MVP) are two distinct yet potentially interrelated cardiac conditions that can significantly impact a person's quality of life. Your symptoms of chest tightness, palpitations, dizziness, fatigue, and headaches are concerning and warrant further investigation and management.

Understanding Your Symptoms
1. Myocardial Ischemia: This condition occurs when there is insufficient blood flow to the heart muscle, often due to narrowed coronary arteries. Symptoms can include chest pain (angina), shortness of breath, and palpitations. The fact that your symptoms are exacerbated during specific months and are associated with physical or emotional stress may suggest a link to ischemia, particularly if you have a history of coronary artery disease (CAD) or risk factors such as family history.

2. Mitral Valve Prolapse (MVP): MVP is a condition where the mitral valve does not close properly, which can lead to mitral regurgitation (backward flow of blood). While many individuals with MVP are asymptomatic, some may experience palpitations, chest pain, and anxiety. Your echocardiogram findings of MVP and regurgitation could be contributing to your symptoms, especially if the regurgitation is significant.

Risk Factors and Family History
Your family history of atrial fibrillation and stroke raises concerns about inherited cardiac conditions. While not all cases of MVP lead to serious complications, the combination of your symptoms and family history suggests that a thorough evaluation is necessary.

Diagnostic Steps
Given your symptoms and the findings from your previous evaluations, it would be prudent to consider the following steps:
1. Holter Monitor: This device records your heart's rhythm continuously for 24 hours or longer, allowing for the detection of arrhythmias that may not be captured during a standard ECG. This could help correlate your symptoms with any abnormal heart rhythms.

2. Stress Testing: If not already performed, a stress test (either exercise or pharmacological) can help assess how your heart responds to increased workload and may reveal inducible ischemia.

3. Echocardiogram: A follow-up echocardiogram can evaluate the severity of your mitral valve prolapse and any associated regurgitation. This is crucial to determine if your symptoms are related to MVP.

Management Strategies
1. Medication: If your current medication (Isosorbide mononitrate) is not providing relief, discuss with your cardiologist the possibility of adjusting your treatment plan. Other medications, such as beta-blockers, may help with palpitations and anxiety.

2. Lifestyle Modifications: Incorporating regular physical activity can improve cardiovascular health and reduce symptoms. Aim for at least 150 minutes of moderate aerobic exercise weekly, as tolerated.
3. Stress Management: Given the potential link between your symptoms and emotional stress, consider techniques such as mindfulness, yoga, or cognitive behavioral therapy to help manage anxiety and stress.

4. Dietary Considerations: A heart-healthy diet rich in fruits, vegetables, whole grains, and lean proteins can support overall cardiovascular health.

When to Seek Further Care
If your symptoms worsen or you experience new symptoms such as severe chest pain, shortness of breath, or fainting, seek immediate medical attention. Given your concerns and the impact on your daily life, it may be beneficial to consult a cardiologist at a larger medical center for a comprehensive evaluation.

Conclusion
Your symptoms are significant and should not be ignored. While MVP and myocardial ischemia can be managed effectively, a tailored approach based on your specific situation is essential. Regular follow-ups with your healthcare provider, adherence to prescribed treatments, and lifestyle changes can significantly improve your quality of life. Don't hesitate to advocate for your health and seek further evaluations as needed.

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