Palpitations and Mitral Valve Prolapse: Causes and Concerns

Palpitations, arrhythmias, and mitral valve prolapse issues?

Hello Doctor: A month ago, I started a low-carb, high-protein diet and entered a state of ketosis, with blood ketone levels between 4-6.
One day, I drank very little water during the day and was quite active.
Before bed, I consumed over 800 cc of water, which resulted in severe palpitations and insomnia that night (my heart was beating strongly, with a heart rate of about 60).
I usually wear a fitness watch, and my resting heart rate while sleeping typically ranges from 49 to 55.

1.
I would like to ask the doctor what could be the cause of my sudden palpitations? Is it due to high blood ketone levels? Low blood sugar (my pre-meal blood sugar was 55)? Drinking too much water before bed? Or could it be heart disease triggered by these factors? I later visited a cardiology clinic and discovered that I have mild mitral valve prolapse, along with mild regurgitation and arrhythmia, which surprised me.
Prior to this low-carb diet, I had a regular exercise routine, including aerobic training and strength training, and I had never experienced any heart discomfort.
Furthermore, in December 2021, I had chest tightness after receiving a vaccine and went to the hospital for an examination, where both the ECG and echocardiogram were normal.
How could I suddenly have heart disease a month or two later? To be honest, the low-carb, high-protein diet has made me feel very weak, prone to headaches, and lacking in energy.
My platelet count has also dropped to over 40,000 (originally around 100,000).

2.
I would like to ask the doctor if this two-week diet has damaged my heart? Now, whenever I jog lightly, I feel discomfort in my heart, and occasionally I experience a stabbing pain.
Is there a chance for my heart to recover to normal?
3.
The doctor prescribed me anti-arrhythmic medication (pink pills).
However, since I have low blood pressure and a slower heart rate, I only took the medication for three days.
Can anti-arrhythmic medication be stopped at will?
4.
I read that you mentioned heart rate is controlled by the brain.
I would like to ask one last question: ever since my heart issues began, I have been monitoring my heart rate while sleeping (my fitness watch records it).
There have been a few strange days when, around 4 AM, my heart rate spikes to 66-77 and stays elevated for a few minutes before gradually decreasing.
My resting heart rate while sleeping usually remains between 50-55.
During that time when my heart rate increased, I was asleep and completely unaware of what was happening.
I am very worried about my heart having issues while I sleep.
I have returned to a normal diet for two weeks, yet my heart still feels strange, and I am hesitant to exercise.
There are many concerns, and I hope the doctor can provide some clarity.
I am very grateful, thank you, doctor.

Ru, 30~39 year old female. Ask Date: 2022/02/26

Dr. He Dongjin reply Cardiology

Hello, when losing weight, if your body lacks energy, it can certainly make you feel weak, but it doesn't necessarily mean your heart is damaged, especially if previous examinations showed no issues.
An increased heart rate during sleep may be caused by autonomic nervous system dysregulation.
You are aware that you feel very weak, and once your physical strength is restored, your heart has a chance to return to normal.
Don't worry; focus on regaining your strength first.
Changhua Hospital cares about you.

Reply Date: 2022/02/26

More Info

Understanding palpitations and mitral valve prolapse (MVP) can be complex, especially when combined with dietary changes and underlying health conditions. Your experience with palpitations, particularly after adopting a low-carb, high-protein diet, raises several important considerations.

1. Causes of Your Palpitations
Palpitations can arise from various factors, and in your case, several potential causes may be contributing:
- Ketosis and Electrolyte Imbalance: When you enter a state of ketosis, your body undergoes significant metabolic changes. This can lead to alterations in electrolyte levels, particularly sodium, potassium, and magnesium, which are crucial for maintaining normal heart rhythm. Dehydration from reduced water intake, combined with increased physical activity, may exacerbate this imbalance, potentially leading to palpitations.

- Blood Sugar Levels: You mentioned a blood sugar level of 55 mg/dL before meals, which is considered low (hypoglycemia). Low blood sugar can trigger the release of stress hormones like adrenaline, which can cause palpitations.
- Fluid Intake: Drinking a large volume of water before bed can lead to nocturia (frequent urination at night), disrupting sleep and potentially causing anxiety or stress, which can also manifest as palpitations.

- Mitral Valve Prolapse (MVP): The diagnosis of mild MVP with regurgitation and arrhythmias can explain your symptoms. MVP is a common condition where the mitral valve does not close properly, which can lead to palpitations, especially during times of stress or physical exertion.

2. Impact of Dietary Changes on Heart Health
Your concerns about whether the two-week low-carb, high-protein diet has harmed your heart are valid. While such diets can lead to weight loss and improved metabolic markers for some, they can also cause stress on the body, particularly if not balanced properly. The symptoms of weakness, headaches, and low platelet counts suggest that your body may not have been receiving adequate nutrition or hydration during this period.

The heart can often recover from transient stressors, but it is essential to ensure that you are consuming a balanced diet that includes adequate carbohydrates, proteins, fats, vitamins, and minerals. If you are experiencing discomfort with physical activity, it is advisable to consult with a healthcare provider for a thorough evaluation and possibly a tailored dietary plan.

3. Medication Management
Regarding the antiarrhythmic medication prescribed for your irregular heartbeat, it is crucial to follow your physician's guidance. Stopping medication abruptly can lead to rebound effects or worsening of your condition. If you have concerns about side effects or interactions with your low blood pressure, discuss these with your doctor. They may adjust your dosage or consider alternative treatments that are more suitable for your condition.

4. Heart Rate Variability During Sleep
The fluctuations in your heart rate during sleep, particularly the increase to 66-77 beats per minute, could be attributed to several factors, including sleep stages, stress, or even sleep apnea. It is not uncommon for heart rates to vary during sleep, but if you are experiencing significant anxiety about these changes, it may be beneficial to discuss this with your healthcare provider. They may recommend a sleep study or further cardiac monitoring to assess your heart's behavior during sleep.

Conclusion
Your symptoms and experiences highlight the importance of a comprehensive approach to health, particularly when making significant dietary changes. It is essential to maintain open communication with your healthcare provider, who can help you navigate these changes and monitor your heart health. Regular follow-ups, a balanced diet, proper hydration, and adherence to prescribed medications are key to managing your condition effectively. If symptoms persist or worsen, do not hesitate to seek immediate medical attention. Your health and peace of mind are paramount.

Similar Q&A

Understanding Mitral Valve Prolapse: Causes of Palpitations and Anxiety

Hello, doctor. During my previous echocardiogram, I was found to have mild mitral valve prolapse. I would like to know if this condition is more likely to cause palpitations, especially since I tend to have a nervous personality. Recently, I have been experiencing a rapid heartbe...

Dr. He Dongjin reply Cardiology
Hello, your easily anxious personality has led to autonomic nervous system dysfunction, along with mitral valve prolapse, resulting in symptoms such as palpitations. If the symptoms are significant, it is recommended to consider medication to manage them. Changhua Hospital cares ...

Understanding Heart Weakness: Causes and Risks of Mitral Valve Prolapse

Mitral valve prolapse can sometimes lead to symptoms such as palpitations and a feeling of weakness, especially after standing for a prolonged period. This discomfort may be due to the way the heart is functioning and how blood is being pumped, which can be affected by the prolap...

Dr. He Dongjin reply Cardiology
This is primarily a symptom caused by autonomic nervous system dysfunction. If the symptoms are significantly bothersome, medication treatment can be used. Generally, there is no life-threatening danger, so there is no need to be anxious. Changhua Hospital cares about you.

Understanding Mitral Valve Prolapse: Symptoms and Concerns

Hello, doctor! Recently, I've been experiencing frequent chest tightness and palpitations. I was diagnosed with mitral valve prolapse and have been taking medication to lower my heart rate. However, I still experience chest tightness, palpitations, nausea, weakness in my lef...

Dr. He Dongjin reply Cardiology
Hello, it seems that having valve prolapse along with autonomic nervous system dysfunction is normal. You can manage symptoms by taking medication when they occur. Changhua Hospital cares about you.

Understanding Mitral Valve Prolapse and Its Impact on Blood Flow

Hello Doctor, I previously consulted with you, and my current situation is that I visited a cardiothoracic surgeon. After reviewing my chest X-ray, I was diagnosed with mitral valve prolapse. My blood pressure readings were 139 and 129 (after resting), and my pulse (or the heart ...

Dr. Wu Xueming reply Cardiology
If symptoms persist after taking medication, please visit the outpatient clinic for further evaluation.