Heart Issues: Symptoms and Concerns About Valve Prolapse

Cardiac issues

Previously, I underwent a stress echocardiogram, which was normal, and I do not have high blood pressure or thyroid issues.
The echocardiogram showed mild prolapse and regurgitation of the mitral and tricuspid valves.
However, recently I have been experiencing pain in my left shoulder, numbness in my hand, and a sharp pain near my left rib cage.
These sensations occur intermittently, lasting about 3 to 5 seconds, and sometimes I also feel a sharp pain just below the left clavicle.
Could this be a precursor to a medical condition?

JOJO, 20~29 year old female. Ask Date: 2018/06/11

Dr. He Dongjin reply Cardiology

Hello, your exercise electrocardiogram is normal, and there are no signs of hypertension, thyroid issues, or significant tricuspid valve prolapse with regurgitation.
You are experiencing left shoulder pain, numbness in your hand, and some sharp pain near the left rib area.
These symptoms resemble mitral valve prolapse or tendonitis rather than heart disease, angina, or myocardial infarction.
Don't worry, Changhua Hospital cares about you.

Reply Date: 2018/06/11

More Info

Understanding heart issues, particularly concerning valve prolapse, can be quite complex, especially when accompanied by symptoms such as shoulder pain, numbness in the hand, and localized discomfort in the rib area. Based on your previous medical evaluations, including a normal exercise electrocardiogram and echocardiogram showing mild mitral and tricuspid valve prolapse with regurgitation, it is essential to consider several factors regarding your current symptoms.

Symptoms and Their Implications
1. Valve Prolapse and Regurgitation: Mitral valve prolapse (MVP) is a condition where the valve between the heart's left atrium and left ventricle doesn't close properly, which can lead to regurgitation (backward flow of blood). While many individuals with MVP experience no significant symptoms, some may report palpitations, chest pain, or discomfort. The presence of mild regurgitation typically does not lead to severe complications, especially if there are no other significant heart issues.

2. Shoulder Pain and Numbness: The left shoulder pain and hand numbness you describe could be indicative of several conditions. While these symptoms can be associated with cardiac issues, they are also commonly linked to musculoskeletal problems, nerve compression (such as thoracic outlet syndrome), or even anxiety-related symptoms. It is crucial to differentiate between cardiac-related pain and pain stemming from other sources.

3. Localized Rib Pain: The sharp, transient pain near the left rib area could be related to muscle strain, costochondritis (inflammation of the cartilage connecting ribs to the sternum), or even gastrointestinal issues such as acid reflux, which can sometimes mimic cardiac symptoms.

Potential Cardiac Concerns
While your previous tests have shown no significant heart disease, the combination of symptoms you are experiencing warrants further investigation. Here are some considerations:
- Cardiac Ischemia: Although less likely given your normal stress tests, ischemic heart disease can present with atypical symptoms, especially in younger individuals. If there is any concern about the heart's blood supply, further testing such as a stress echocardiogram or coronary angiography might be warranted.

- Arrhythmias: Even if your previous tests were normal, intermittent arrhythmias can occur. If you experience palpitations or a sensation of your heart racing, a Holter monitor could help capture any transient arrhythmias that may not have been evident during previous tests.

- Anxiety and Stress: Given the psychological aspect of health, anxiety can manifest physically, leading to symptoms such as chest pain, shoulder discomfort, and numbness. If you have a history of anxiety or panic attacks, this could be a contributing factor.

Recommendations
1. Consult Your Cardiologist: Given your symptoms, it is advisable to discuss your concerns with your cardiologist. They may recommend further testing or monitoring to rule out any potential cardiac issues.

2. Consider a Comprehensive Evaluation: A thorough evaluation including a physical examination, possibly imaging studies, and an assessment of your neurological status may be beneficial. This can help determine if your symptoms are cardiac-related or due to another underlying condition.

3. Lifestyle Modifications: Regardless of the underlying cause, maintaining a healthy lifestyle can help manage symptoms. Regular exercise, a balanced diet, and stress management techniques can be beneficial.

4. Monitor Symptoms: Keep a detailed record of your symptoms, including their frequency, duration, and any associated activities. This information can be invaluable for your healthcare provider in determining the next steps.

In conclusion, while your previous cardiac evaluations have been reassuring, the new symptoms you are experiencing should not be ignored. A proactive approach involving further discussion with your healthcare provider and possibly additional testing will help clarify the situation and ensure your health and peace of mind.

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