Mitral Valve Prolapse and Premature Heartbeats: A Patient's Journey

Mitral valve prolapse and premature ventricular contractions?

Hello Doctor, I was diagnosed with mitral valve prolapse two years ago, but the doctor said it was mild, so I didn't pay much attention to it.
However, this year, I started experiencing more frequent palpitations, and just last week, I felt my heart racing, with elevated blood pressure (170/100) and chest discomfort, so I went to the emergency room.
It was later discovered that I have arrhythmia, and during a follow-up visit, I was found to have premature atrial contractions (PACs).
1.
I do not smoke or drink excessively, and I believe I do not experience more stress than others my age.
I have no bad habits.
Why am I experiencing premature atrial contractions? If I were to mention poor lifestyle habits, it might be that I did not exercise at all last year while preparing for exams, mostly sleeping and sitting for the entire year, often staying up until 2 AM.
2.
Since all these tests were done at the same hospital and I will be going abroad to study in August, I am very worried about these issues.
Should I go to a larger hospital for further cardiac evaluation, such as National Taiwan University Hospital or Veterans General Hospital? Or would a large hospital only provide a 24-hour Holter monitor and echocardiogram?
3.
I am currently taking Dronedarone for the second day, but I still feel my heart racing.
I notice that apart from sleeping and walking, I can feel my heart beating rapidly while sitting or lying down.
Does the medication take longer to show effects?
4.
I would like to ask if this condition can be completely cured.
The doctor mentioned that mitral valve prolapse is congenital and cannot be cured, and now with the sudden onset of premature atrial contractions, I feel anxious about the future.
Being young, I worry that it might worsen as I age.
Here are the results from my tests:
ECG on 5/28: Sinus rhythm with frequent premature ventricular complexes, incomplete right bundle branch block, borderline ECG.
Portable ECG on 4/19: Unknown sinus rhythm at 1:05 PM.
Analysis results:
1.
Suspected LBBB pattern conduction with a rate of 45-131/min and a mean of 71/min; the max heart rate was 131 bpm at 9:21 PM due to sinus tachycardia.
2.
Frequent VPCs: Total of 445 beats with bigeminy and quadrigeminy.
3.
Rare APCs: Total of 9 beats with pairs and nonsustained PAT.
4.
The longest R-R interval was 1.5 seconds at 3:09 AM due to VPC.
5.
There were intermittent end-diastolic VPCs.
6.
There were ectopic atrial beats and wandering atrial pacemaker.
7.
There was "J" point elevation.
8.
Events in the symptom patient diary were associated with normal tracings.
There were a total of 100,772 beats.
Echocardiogram on 4/15:
RVD (7~23)= mm, IVSd (6~11)= 12 mm, LVDd (36~52)= 50 mm, AoRoot (20~37)= 32 mm, IVS excursion (5~11)= mm, LVDs (20~36)= 30 mm, AV opening (15~26)= mm, LVPWD (6~11)= 10 mm, EPSS (<5)= mm, LA (19~40)= 38 mm, LVPW excursion (9~14)= mm, EF= 70.1%, EF Slop (60~176)= mm/sec, LVEDV= 118 ml, LVESV= 35 ml, IVC Diam= 1.54 cm.

Other findings:
Structure abnormality: No pericardial effusion.

2D Structure analysis:
AV: TV: MV: Mild mitral valve prolapse, PV: Others:
Trans-mitral inflow: E/A: 97 / 49 = 2, DT: 244.6 msec, LA volume index (16~34)= ml/m2, E/E’ Med: 6.8, E/E’ Lat: Normal LV wall motion.

1.
Mild MR
2.
Trivial TR (PG: 23 mmHg, VMAX: 240 cm/s)
3.
Trans-mitral inflow: E/A: 2, DT: 244.6 msec; E/E’ Med: 6.8.

1.
Mild MVP of AML with mild MR
2.
Trivial TR with normal PA pressure, PASP: 19 mmHg
3.
Septal hypertrophy with preserved LV systolic function, LVEF: 70.1%
4.
No IVC engorgement
5.
No pericardial effusion.

Thank you, Doctor.

Howard, 20~29 year old female. Ask Date: 2022/05/31

Dr. Wu Xueming reply Cardiology

1.
I do not smoke or drink excessively, and I believe I do not experience more stress than others my age.
I also do not have any bad habits.
Why do I have symptoms of premature atrial contractions? If we consider bad lifestyle habits, it might be that I did not exercise at all last year due to preparing for exams, basically just sleeping and sitting for an entire year, and staying up until 2 AM.
=> Occasional premature atrial contractions are considered normal.
It is recommended to manage emotional stress, maintain a regular schedule, ensure adequate sleep, and avoid excessive intake of caffeinated beverages.
2.
Since all these tests were done at the same hospital, and I will be going abroad to study in August, these matters are causing me a lot of anxiety.
Therefore, I would like to ask the doctor if I need to go to a larger hospital for a heart examination, such as National Taiwan University Hospital or Veterans General Hospital.
Or do large hospitals only perform 24-hour Holter monitoring and echocardiograms? => The aforementioned tests are already very detailed, and there is no need for further examinations.
3.
I am currently taking Dronedarone for the second day, and I can still feel my heart pounding.
I have noticed that besides when I am sleeping or walking, I can still feel my heartbeat while sitting or lying down.
Does the medication need to be taken for a longer period before its effects are felt? => It is recommended to manage emotional stress, maintain a regular schedule, ensure adequate sleep, and avoid excessive intake of caffeinated beverages.
4.
I would like to ask the doctor if this condition can be cured.
I was told that mitral valve prolapse is congenital and cannot be cured.
This year, I have unexpectedly developed premature atrial contractions, which makes me feel anxious about the future.
Since I am still young, will my heart condition worsen as I age? => Mild mitral valve prolapse does not worsen with age.

Reply Date: 2022/05/31

More Info

Mitral Valve Prolapse (MVP) and premature heartbeats, such as premature atrial contractions (PACs) and premature ventricular contractions (PVCs), can often cause concern for patients, especially when they experience symptoms like palpitations, increased heart rate, or elevated blood pressure. Your situation, where you have been diagnosed with mild MVP and are now experiencing more frequent heart palpitations, is not uncommon. Let’s break down your concerns and the implications of your findings.

Understanding Mitral Valve Prolapse
MVP is a condition where the mitral valve does not close properly, which can lead to a variety of symptoms, including palpitations, chest pain, and in some cases, anxiety. It is often considered a benign condition, especially when it is classified as mild. Many individuals with MVP lead normal, healthy lives without any significant complications. However, in some cases, MVP can be associated with arrhythmias, such as PACs and PVCs, which may explain your recent symptoms.

Premature Heartbeats
PACs and PVCs are types of arrhythmias that occur when the heart beats earlier than expected. They can be triggered by various factors, including stress, caffeine, lack of sleep, or even prolonged periods of inactivity, such as sitting for long hours while studying. Your recent lifestyle changes, particularly the lack of physical activity and irregular sleep patterns, could contribute to the increased frequency of these premature beats.

Symptoms and Concerns
You mentioned experiencing a rapid heartbeat and elevated blood pressure during an episode, which can be alarming. While your blood pressure of 170/100 is concerning, it’s important to note that acute stress or anxiety can temporarily elevate blood pressure. Given that you have no history of smoking or excessive alcohol consumption, and you describe your lifestyle as generally healthy aside from recent stress, it’s possible that your symptoms are related to anxiety or stress rather than a significant underlying heart condition.

Diagnostic Tests and Findings
Your electrocardiogram (ECG) and echocardiogram results indicate that while you have some arrhythmias, your left ventricular function is preserved (LVEF of 70.1%), and there are no significant structural abnormalities noted aside from mild MVP. The presence of mild mitral regurgitation (MR) and trivial tricuspid regurgitation (TR) is not uncommon and often does not require intervention unless symptoms worsen.

Next Steps
1. Follow-Up with a Specialist: Given your symptoms and the findings, it would be prudent to follow up with a cardiologist, especially since you are planning to study abroad. A cardiologist can provide a comprehensive evaluation and determine if further testing, such as a 24-hour Holter monitor or additional echocardiography, is necessary.

2. Lifestyle Modifications: Incorporating regular physical activity, managing stress through relaxation techniques, and maintaining a consistent sleep schedule can help mitigate your symptoms. Avoiding stimulants like caffeine and ensuring adequate hydration may also be beneficial.

3. Medication Review: You mentioned taking a medication (likely a beta-blocker) to manage your symptoms. It may take some time for the medication to stabilize your heart rhythm, and it’s important to communicate with your healthcare provider about your ongoing symptoms.

4. Long-Term Outlook: MVP and associated arrhythmias can often be managed effectively. While MVP is typically a lifelong condition, many individuals do not experience significant issues. Regular monitoring and lifestyle adjustments can help you manage your symptoms and maintain a good quality of life.

Conclusion
In summary, while your symptoms are understandably concerning, the findings from your tests suggest that you are not facing an immediate threat to your heart health. However, continued monitoring and lifestyle adjustments are essential. Consulting with a cardiologist will provide you with tailored advice and reassurance as you navigate your health journey. Remember, many people with MVP live full, active lives, and with the right management, you can too.

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