Heart Issues: Mitral Valve Prolapse and Autonomic Dysregulation

Post-exercise body issues, mitral valve prolapse, autonomic nervous system dysfunction, chest tightness, palpitations?

Hello, Doctor.
Thank you for taking the time to read my message and assist with my questions! I would like to describe my current situation as follows:
1.
I experience a rapid heartbeat and dizziness after climbing about three flights of stairs, requiring me to rest before continuing.
2.
During physical activities such as exercise or climbing stairs, I often feel chest tightness, which is frequently accompanied by belching and a sensation similar to gastroesophageal reflux.
3.
I become easily fatigued when speaking, especially if I exhale for an extended period, leading to a feeling of breathlessness and cold hands.
4.
I tend to feel anxious and easily stressed about my physical symptoms.
5.
In winter, after taking a hot shower, I sometimes feel dizzy and experience a rapid heartbeat for a while (several hours), along with belching.
This was not the case in the past.
6.
My heart rate often increases to around 90 to 100 beats per minute.
These symptoms lead me to suspect that there may be an issue with my blood circulation.
I am hesitant to engage in vigorous activities or exercise, as the aforementioned discomfort frequently occurs, significantly impacting my daily life.
Regarding my past medical experiences:
1.
These symptoms have persisted for about a year and a half.
A year ago, in December, I mustered the courage to visit a large hospital's cardiology department, where the doctor suspected a thyroid issue.
They only conducted a blood test and suggested that I might have autonomic nervous system dysfunction, prescribing medications including rhythm control and Zoloft.
2.
I later switched to a medium-sized hospital's cardiology department near my home.
At that time, my heart rate would reach around 130 beats per minute during outpatient visits, and my blood pressure was measured to be relatively high.
The doctor performed an electrocardiogram (ECG), echocardiogram, and auscultation, discovering mitral valve prolapse.
Overall, they also believed I had autonomic nervous system dysfunction and advised me to continue taking rhythm control medication.
3.
Last month, on a day when my heart rate was elevated, I sought a second opinion from another cardiologist at a large hospital, where I underwent an ECG.
The doctor listened to my heart sounds and confirmed the presence of mitral valve prolapse without further testing, prescribing medication to slow my heart rate.
My questions are as follows:
1.
Doctor, are my symptoms adequately assessed through auscultation, ECG, and echocardiogram to rule out other issues and make a diagnosis? Are there additional tests you would recommend? What follow-up consultations would you suggest? (Additionally, why did the previous doctors not arrange for a stress test?)
2.
Regarding my gastrointestinal symptoms, should they be attributed to gastrointestinal issues or cardiac problems? I previously consulted a gastroenterologist who stated that gastroesophageal reflux does not occur during exercise, yet I consistently experience it during physical activity.
How should I interpret this?
3.
If I have mitral valve prolapse but also experience these troubling symptoms, what steps can I take to improve my condition? I sincerely request your assistance in addressing these concerns, as they greatly trouble me.
I am hesitant to travel far, speak extensively, or swim as I used to, and these physical symptoms often cause me discomfort.
Despite seeing multiple doctors, I still feel uncertain and anxious about my situation, and I am unsure how to proceed.
I apologize for taking up your time, and thank you for your help!
Lastly, I would like to provide some personal information.
I am a 27-year-old male.
My most recent health report indicated normal blood sugar and cholesterol levels, with triglycerides slightly elevated at 169 and uric acid levels also elevated, while other parameters were normal.
Additionally, I am attaching the results of my ECG and echocardiogram from the past six months:
1.
ECG: "SINUS TACHYCARDIA, INDETERMINATE AXIS, LATE TRANSITION"
2.
Echocardiogram:
- M-mode: LV Ao Mitral valve IVSd: 0.7cm, LVIDd: 4.8cm, LVPWd: 0.8cm, LVIDs: 3.1cm, LA/Ao 0.8, EF 64%, FS 35%
- Doppler: Aortic valve Vel 63cm/s, AoV PG 1.6mmHg, Mitral valve prolapse with trivial MR and TR.

Niming, 20~29 year old female. Ask Date: 2022/12/21

Dr. He Dongjin reply Cardiology

Hello, your symptoms are primarily related to autonomic nervous system issues combined with anxiety, which has led to some panic problems.
You can consider increasing the dosage of your medication; if there is no improvement, you may want to visit a psychosomatic medicine clinic for further medication adjustments.
Since you have consulted several hospitals and undergone numerous tests with no abnormalities found, and the diagnoses are consistent, there is no need to worry too much—just focus on adjusting your medication dosage.
Changhua Hospital cares about your well-being.

Reply Date: 2022/12/21

More Info

Understanding your symptoms and the potential underlying issues is crucial, especially when it comes to heart conditions like mitral valve prolapse (MVP) and autonomic dysregulation. Let's break down your concerns and provide some clarity.

Symptoms and Their Implications
1. Increased Heart Rate and Dizziness: Experiencing a rapid heartbeat (tachycardia) and dizziness after climbing stairs or during physical exertion can be indicative of several issues. In the context of MVP, this can occur due to the heart's response to physical stress. The heart may struggle to maintain adequate blood flow, leading to symptoms like dizziness and palpitations.

2. Chest Discomfort and Gastrointestinal Symptoms: The chest tightness you describe, especially when combined with gastrointestinal symptoms like belching or a sensation of acid reflux, can be perplexing. While MVP can cause chest discomfort, it’s also possible that your symptoms are related to gastrointestinal issues, such as gastroesophageal reflux disease (GERD). The overlap of these symptoms can make it challenging to pinpoint the exact cause.

3. Fatigue and Cold Extremities: Feeling fatigued after speaking or during exertion, along with cold hands, may suggest autonomic dysregulation. This condition can affect how your body responds to stress and physical activity, leading to symptoms like fatigue and changes in circulation.

4. Anxiety and Nervousness: Your heightened anxiety regarding your health can exacerbate physical symptoms. Anxiety can lead to increased heart rate and feelings of dizziness, creating a cycle of worry and physical discomfort.

Diagnostic Considerations
1. Diagnostic Tests: The tests you have undergone, including echocardiograms and electrocardiograms (ECGs), are essential for assessing heart function. While these tests can identify structural issues like MVP and assess heart rhythm, they may not fully explain your symptoms. If your doctors suspect autonomic dysregulation, additional tests such as a tilt table test or Holter monitor (24-hour ECG) may be beneficial to evaluate how your heart responds to changes in position and activity.

2. Gastrointestinal Evaluation: Since you experience gastrointestinal symptoms during exertion, it may be worthwhile to consult a gastroenterologist again. They can perform tests to rule out conditions like GERD or other gastrointestinal disorders that could be contributing to your symptoms.

3. Exercise Testing: You mentioned that previous doctors did not arrange for an exercise ECG. This test can provide valuable insights into how your heart performs under stress and can help differentiate between cardiac and non-cardiac causes of your symptoms.

Management Strategies
1. Lifestyle Modifications: Incorporating regular, moderate exercise can help improve your cardiovascular fitness and potentially alleviate some symptoms. However, it’s essential to start slowly and consult with your healthcare provider about an appropriate exercise regimen.

2. Stress Management: Techniques such as mindfulness, yoga, or cognitive behavioral therapy can help manage anxiety and improve your overall well-being. Reducing stress may also help mitigate some of the physical symptoms you experience.

3. Medication Review: If you are currently taking medications for your symptoms, it’s crucial to discuss their effectiveness and any side effects with your doctor. Adjustments may be necessary to optimize your treatment.

4. Regular Follow-ups: Given the complexity of your symptoms, regular follow-ups with your healthcare provider are essential. They can monitor your condition, adjust treatment plans, and ensure that any new symptoms are promptly addressed.

Conclusion
Your symptoms are multifaceted and may involve both cardiac and gastrointestinal components, along with autonomic dysregulation. A comprehensive approach that includes further diagnostic testing, lifestyle changes, and possibly medication adjustments will be beneficial. It’s essential to maintain open communication with your healthcare providers and advocate for the tests and treatments that will best address your concerns. Remember, you are not alone in this, and with the right support and management, you can work towards feeling better.

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