Mitral Valve Prolapse: Symptoms and Anxiety Connection

Mitral valve prolapse, suspected autonomic nervous system dysfunction?

Hello Doctor, at the beginning of November, I experienced left chest pain and discomfort in my back (which I believe is around the shoulder blade area, but that area has been sore for a long time).
I also had numbness in my left hand, and I felt so unwell that I broke out in a cold sweat and had a rapid heartbeat, prompting me to go to the emergency room at Chung Cheng Hospital in the middle of the night.
In the ER, I had a slight fever (around 38 degrees Celsius) and underwent three blood tests for cardiac enzymes, an EKG, and multiple X-rays of my upper body.
I also had blood drawn for bacterial cultures, all of which came back normal (only the first EKG showed some arrhythmia, but the subsequent tests the next day indicated improvement).
The ER suspected atypical pneumonia and acute muscle inflammation, prescribing antibiotics and pain relief for me.
A few days later, I followed up with specialists in infectious diseases (who ruled out pneumonia), immunology and rheumatology, orthopedics, and family medicine, but no cause was identified.
The X-ray indicated slight scoliosis, and I was advised to undergo rehabilitation.
I work in IT and spend most of my time sitting in an office, and even at home, I often sit in front of the computer.
After the ER visit, I still felt uncomfortable (mainly concerned about the left chest area, which sometimes feels sore, occasionally has a sharp sensation near the ribs, and sometimes feels tight around the collarbone; my shoulders and neck are also stiff, and I experience tingling in my left fingers).
My gastrointestinal health seems to be poor as well.
Later, I consulted a cardiologist, who performed an echocardiogram and an exercise EKG (I have been hesitant to move much for almost a month, mostly resting at home, so I couldn't exercise much; I stopped the test after reaching the target heart rate in the second phase).
A few days ago, I returned for the report, and the doctor mentioned mild mitral valve prolapse, with normal results for both the exercise EKG and the resting EKG.
The doctor seemed quite relaxed and simply stated that the mitral valve prolapse was not a concern and that I could gradually resume exercise, prescribing cardiac rehabilitation for me.
I felt very uncomfortable taking it, and the doctor didn't specify if I needed to return for follow-up or explain much, so I forgot to ask many questions.

I would like to ask you, Dr.
He, if the discomfort I am feeling lately is due to my anxiety and excessive worry? I have never felt this way before; the most I experienced was some shortness of breath and fatigue during physical fitness activities.
I have only seen a doctor regarding my heart this time, and no cause has been identified despite consulting many specialists.
However, I am now very concerned about my heartbeat and wonder if there might be any issues.
Could it be that my anxiety and worry about my health have led to autonomic nervous system dysregulation? I have started to walk (casual walking or brisk walking), but I still feel some tightness in my chest during increased physical activity; is this normal? I used to walk without feeling short of breath or fatigued over similar distances, but now I feel tired and slightly breathless (accompanied by tinnitus and a feeling of ear fullness).
I also feel a bit lightheaded and unsteady, but I'm not sure if it's psychological.
(In the past, I sometimes experienced a brief feeling of dizziness when standing up suddenly, akin to anemia.) I am also concerned about my heartbeat, which seems to race when I stand up or move; could this be due to a lack of exercise after being ill and sitting at home for so long? Additionally, I have noticed that my palms often appear pale, and sometimes when I raise my hands and then lower them, they turn white before regaining color.
I wonder if this indicates any issues (previously, my hands were generally colder, but I didn't pay much attention to this).
Furthermore, I have plans to travel to Tokyo, Japan, for New Year's Eve.
Given my current condition, I am concerned about flying, going to a colder climate, and planning to soak in hot springs.
I apologize for asking so many questions, and I appreciate your help.

Jacky Wang, 20~29 year old female. Ask Date: 2019/12/21

Dr. He Dongjin reply Cardiology

Hello, it seems that your anxiety and overthinking may have led to autonomic nervous system dysregulation.
Both your exercise electrocardiogram and resting electrocardiogram are normal, indicating that your heart is fine.
There's no need to worry about sudden issues; just relax and enjoy life.
You can travel to Tokyo, take a flight, visit colder places, and enjoy hot springs without any problems.
Changhua Hospital cares about you.

Reply Date: 2019/12/21

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 anxiety. Your recent experiences of left chest pain, back discomfort, and left arm numbness, along with the episodes of sweating and increased heart rate, can understandably cause significant concern, especially when combined with the diagnosis of MVP.

The connection between MVP and anxiety is well-documented. Many individuals with MVP report experiencing anxiety symptoms, which can exacerbate the perception of physical symptoms. This is often due to the body's heightened response to stress, which can lead to increased heart rate, palpitations, and even feelings of breathlessness. In your case, the anxiety surrounding your health and the symptoms you are experiencing may be contributing to a cycle of fear and physical discomfort.
It's important to note that MVP itself is often benign, especially when it is classified as mild. Many people with MVP live normal, healthy lives without significant complications. The symptoms you describe, such as chest tightness, tingling in the fingers, and feelings of dizziness, can be related to anxiety and stress rather than a direct result of the MVP. The body's response to anxiety can lead to hyperventilation, which may cause sensations of lightheadedness and tingling in the extremities.

Your recent medical evaluations, including echocardiograms and stress tests, have shown normal heart function, which is reassuring. The fact that your heart rhythm improved after initial irregularities in the emergency department suggests that your heart is responding well under normal conditions. It is also common for individuals who have been less active due to health concerns to feel more fatigued or short of breath when they resume physical activity. This can be a normal response as your body readjusts to increased exertion.

Regarding your concerns about flying and traveling to colder climates, it is generally safe for individuals with mild MVP to fly, provided they do not have other significant health issues. However, it is always best to consult with your healthcare provider before making travel plans, especially if you have ongoing symptoms that concern you.
To manage your symptoms and anxiety, consider the following strategies:
1. Gradual Increase in Activity: As you begin to walk and increase your physical activity, do so gradually. Start with short walks and slowly increase the duration and intensity as your body allows.

2. Stress Management Techniques: Engage in relaxation techniques such as deep breathing exercises, meditation, or yoga. These can help reduce anxiety and improve your overall sense of well-being.

3. Regular Check-ups: Keep regular appointments with your healthcare provider to monitor your symptoms and discuss any new concerns. This can help alleviate anxiety about your health.

4. Stay Hydrated and Nourished: Ensure you are drinking enough water and eating a balanced diet, as dehydration and poor nutrition can exacerbate feelings of fatigue and dizziness.

5. Monitor Symptoms: Keep a journal of your symptoms, noting when they occur and any potential triggers. This can help you and your healthcare provider identify patterns and adjust your management plan accordingly.

In conclusion, while your symptoms may be concerning, they are likely influenced by a combination of MVP and anxiety. With appropriate management and support, many individuals with MVP can lead active and fulfilling lives. If you continue to experience significant discomfort or anxiety, consider discussing these feelings with a mental health professional who can provide additional support.

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