Heart Issues: Concerns About Mitral Valve Regurgitation and Symptoms

Cardiac issues

Hello Doctor,
Around the end of September, I noticed that my heart was beating very fast, and I experienced chest pain and tightness.
I immediately went to see a cardiologist.
At that time, my blood pressure was 170/88/103.
Initially, the ECG showed some arrhythmia (which could have been due to anxiety).
Later, I had an X-ray, and the doctor mentioned that I might have had high blood pressure for a while.
In early October, I underwent an echocardiogram, and the doctor said that both my heart function and structure were normal.
He also told me that I did not have high blood pressure, except for mild mitral regurgitation, which he said was not a significant concern.
He prescribed a three-month supply of medications: BISOPROLOL FUMARATE 1 tablet daily, Diltiazem 0.5 tablet daily, and Inderal 1 tablet at bedtime.

Recently, however, I have been experiencing chest tightness and heart pain more frequently, along with shortness of breath.
When the shortness of breath is severe, I also feel chest tightness and dizziness, as if I can't get enough air.
Originally, I was scheduled to return for a follow-up in January, but out of concern, I went back this past Monday.
I explained my recent symptoms to the doctor, who performed another ECG.
He said that aside from a heart rate of 98, everything else looked normal.
I asked if I needed another echocardiogram, but he said it wasn't necessary since I had one in early October, which showed no issues.
I expressed my concerns about the shortness of breath, and he prescribed a one-month supply of Cintsu for use during acute episodes.
Currently, my blood pressure is controlled at an average of 115-130/70-85/65-80.

Note: I have a severe nasal allergy and am receiving treatment from a traditional Chinese medicine practitioner (I do not rule out that my shortness of breath may be related to this).

Here are my questions:
1.
Regarding mild mitral regurgitation, I understand that it does not require treatment, but I am concerned that it may worsen over the next few months.
Is this a possibility, or am I overthinking it? Also, does mild mitral regurgitation typically present with symptoms? I worry that my shortness of breath may be related to this.

2.
Do I need to see a pulmonologist?
3.
Given my recent cough and chest pain, am I at risk for a myocardial infarction?
4.
Is mitral regurgitation the same as mitral valve prolapse? Or is everything as the doctor said, and I am just overly worried?
Thank you, Doctor!

Ken, 20~29 year old female. Ask Date: 2022/12/08

Dr. He Dongjin reply Cardiology

Hello, mild mitral regurgitation generally does not present with symptoms, and the likelihood of it suddenly worsening over a few months is low.
Mitral regurgitation is different from mitral valve prolapse, but it can occur alongside myocardial infarction.
The symptoms are not typical, such as cough or chest pain; it can resemble a panic attack.
A doctor is unlikely to tell you that you have a problem if there is none, so don’t worry.
Changhua Hospital cares about you.

Reply Date: 2022/12/08

More Info

Understanding heart issues, particularly mitral valve regurgitation (MVR), can be quite complex and often leads to anxiety, especially when symptoms like chest pain, shortness of breath, and palpitations arise. Let's address your concerns systematically.

1. Mild Mitral Valve Regurgitation: Mild MVR is a common finding and often does not require treatment. It can be asymptomatic, meaning many individuals may not experience any noticeable symptoms. However, in some cases, mild regurgitation can lead to symptoms like palpitations, fatigue, or shortness of breath, especially during exertion. The concern about the progression of MVR is valid; while it can worsen over time, many individuals with mild regurgitation remain stable for years without significant changes. Regular follow-ups with your cardiologist are essential to monitor any changes in your condition.

2. Symptoms and Their Causes: You mentioned experiencing increased chest tightness, pain, and shortness of breath. While these symptoms can be related to MVR, they can also stem from other conditions, including anxiety, respiratory issues, or even allergic reactions, especially considering your history of severe nasal allergies. It’s crucial to differentiate whether these symptoms are cardiac-related or due to other factors. If your symptoms persist or worsen, further evaluation by a pulmonologist (chest specialist) may be warranted, particularly if you suspect a respiratory component.

3. Concerns About Myocardial Infarction: Given your symptoms of chest pain and shortness of breath, it’s understandable to worry about the possibility of a heart attack (myocardial infarction). However, your recent evaluations, including an echocardiogram and ECG, showed normal heart function and structure, which is reassuring. It’s important to note that while MVR can lead to complications, the likelihood of a heart attack is generally associated with other risk factors such as high blood pressure, high cholesterol, smoking, and a family history of heart disease. Your blood pressure readings appear to be well-controlled, which is a positive sign.

4. Mitral Valve Regurgitation vs. Mitral Valve Prolapse: MVR and mitral valve prolapse (MVP) are related but distinct conditions. MVP occurs when the mitral valve leaflets bulge (prolapse) back into the left atrium during contraction, which can sometimes lead to regurgitation. In contrast, MVR specifically refers to the backward flow of blood due to improper closure of the mitral valve. While MVP can lead to MVR, not all cases of MVR are due to prolapse. Your cardiologist's reassurance about your condition suggests that while you have mild regurgitation, it is not currently causing significant issues.

5. Management and Follow-Up: Your current medications, including bisoprolol and diltiazem, are commonly prescribed for managing heart rate and blood pressure, which can help alleviate some of your symptoms. The use of Cintsu (a bronchodilator) for your shortness of breath is also appropriate, especially if your symptoms are related to bronchospasm or allergies. It’s essential to maintain open communication with your healthcare providers about your symptoms and any changes you experience.

In summary, while mild mitral valve regurgitation can be a source of concern, it is often manageable and does not always lead to significant symptoms or complications. Regular follow-ups with your cardiologist, monitoring your symptoms, and addressing any respiratory issues with appropriate specialists will help ensure that you remain healthy and informed about your heart condition. If you continue to experience anxiety about your symptoms, discussing this with your healthcare provider may also be beneficial, as they can provide additional support and reassurance.

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