Ventricular Premature Contractions in Mitral Valve Prolapse Patients

Ventricular premature contraction (VPC)

Hello Doctor: I have mitral valve prolapse, and during my recent follow-up visit, I underwent a 24-hour Holter monitor which revealed issues with premature ventricular contractions (PVCs).
I am still trying to understand my condition, so I would appreciate your clarification! Thank you!
Echocardiogram: Tape: DVD C 231 Clinical Diagnosis: M-mode + Section Scan: Aortic Root (20∼37mm): 28, Left Anterior Descending artery (19∼40mm): 37, Left Ventricular Internal Diameter at end-diastole (LVIDd) (35∼51mm): 42, Left Ventricular Internal Diameter at end-systole (LVIDs) (28∼35mm): 27, Ventricular Septum (VS) (6∼10mm): 9, Posterior Wall (PW) (6∼10mm): 9.
Comments: (M-mode, 2-D, Doppler & Color Flow Mapping) 1.
Normal heart chamber size.
2.
Preserved left ventricular (LV) and right ventricular (RV) systolic function, LV ejection fraction (LVEF) = 65%.
3.
Preserved LV diastolic function, E/A = 1.3, Em/Am = 1.6, E/Em = 6.4, Em = 15.1 cm/s.
4.
Mitral Regurgitation (MR): Minimal.
5.
Tricuspid Regurgitation (TR): Mild, Right Ventricular Systolic Pressure (RVSP) = 32 mmHg.
6.
Pulmonary Regurgitation (PR): Mild.
24-hour Holter Monitor: 1.
Basic rhythm was sinus rhythm.
Heart rate ranged from 50 to 122 BPM, mean HR = 75 BPM.
2.
Minimal HR was 50 BPM at 07:00 due to sinus bradycardia.
3.
Maximal HR was 122 BPM at 10:15 due to sinus tachycardia.
4.
88 Atrial Premature Contractions (APCs), 8 burst APCs (maximum 6 beats).
5.
6960 Ventricular Premature Contractions (VPCs), multiform, no ventricular tachycardia (VT).
6.
No long pauses.
7.
2 patient events with symptoms of palpitations at 10:50 and 19:23 showed sinus rhythm with VPCs.

Hedwig, 30~39 year old female. Ask Date: 2021/09/15

Dr. He Dongjin reply Cardiology

Hello, there are some issues with premature ventricular contractions, which are not considered serious.
It is advisable to monitor the situation or discuss with your attending physician whether medication is necessary.
Changhua Hospital cares about you.

Reply Date: 2021/09/15

More Info

Ventricular premature contractions (VPCs) are common arrhythmias that can occur in individuals with mitral valve prolapse (MVP). Understanding the relationship between MVP and VPCs is crucial for managing symptoms and determining the appropriate treatment.
Mitral valve prolapse is a condition where the mitral valve does not close properly, which can lead to mitral regurgitation (MR). While many patients with MVP are asymptomatic, some may experience palpitations, which can be attributed to VPCs. These contractions occur when the ventricles contract prematurely, leading to an irregular heartbeat. In your case, the 24-hour Holter monitor revealed 6960 VPCs, which is significant and warrants further discussion.

The presence of VPCs in patients with MVP can be attributed to several factors. First, the structural changes in the heart associated with MVP, such as altered ventricular wall motion or increased left ventricular mass, can predispose individuals to arrhythmias. Additionally, the autonomic nervous system's influence on heart rate and rhythm can also play a role. Stress, anxiety, and stimulants like caffeine can exacerbate VPCs, leading to increased awareness of palpitations.

In your report, the findings indicate that your left ventricular (LV) and right ventricular (RV) systolic function is preserved, with an ejection fraction (EF) of 65%. This is a positive sign, as it suggests that your heart is pumping effectively despite the presence of VPCs. The minimal mitral regurgitation and mild tricuspid regurgitation also indicate that while there are some valve issues, they are not severe enough to cause significant hemodynamic compromise.

The management of VPCs in the context of MVP typically involves reassurance, especially if the patient is asymptomatic or has only mild symptoms. However, since you have experienced palpitations, it is essential to monitor the frequency and severity of these episodes. Lifestyle modifications, such as reducing caffeine intake, managing stress, and avoiding stimulants, can be beneficial.
In some cases, if VPCs are frequent and symptomatic, further evaluation may be necessary. This could include an electrophysiological study to assess the origin of the VPCs and determine if any intervention is needed. Medications such as beta-blockers may be prescribed to help manage symptoms, particularly if they are causing significant discomfort or anxiety.

It is also important to maintain regular follow-ups with your cardiologist to monitor your condition. Given that you have MVP and are experiencing VPCs, your doctor may recommend periodic echocardiograms to assess any changes in your heart's structure or function over time.

In summary, while VPCs can be concerning, they are often benign, especially in the context of MVP. Your preserved LV function and minimal regurgitation are reassuring. Focus on lifestyle modifications, regular follow-ups, and open communication with your healthcare provider to manage your symptoms effectively. If your symptoms worsen or you have concerns, do not hesitate to seek further evaluation or a second opinion.

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