Valve Insufficiency and Vaccination Concerns

Valvular insufficiency and vaccines?

Hello Doctor: I have a few reports of incomplete closure as follows:
2023/05/06 BP 104/63 mmHg PR 66
2023/01/10 BP 96/64 mmHg PR 64
S: Intermittent dyspnea on exertion for months.
STILL INTERMITTENT chest tightness (TET: POSITIVE by Songshan Hospital on 2017.7.05) Dizziness, multiple somatic complaints.
CAD treatment ongoing at TShung-Shan with Aspirin, possible panic disorder?
PMHx: MVP since age 20, denied HTN or hyperlipidemia.

Family Hx: (-)
O: BP 102/59 mmHg PR 67
RHB SIS2S3-S4 - NO LEG EDEMA
EKG: SRTET outside TSGH-SH branch: positive
SMOKING (+) QUIT FOR 3 YEARS
Examination date: 2023/05/19 00:08
M-mode + Section Scan
LVIDd (35-51 mm) 46
Aortic Root (20~37 mm) 29
VS (6-10 mm): 7
LAD (19~40 mm) 40
LVIDs (28-35 mm): 31
PW (6-10 mm) 7
Comment: (M-mode, 2-D, Doppler & Color Flow Mapping)
• Normal heart chamber size.

• Preserved LV and RV systolic function, LVEF = 61%
• Preserved LV diastolic function: E/A 1.6, Em/Am 1.9, Em = 15.7 cm/s, E/Em = 4.4
MR: Mild
TR: Mild to Moderate, RVSP = 32 mmHg.

PR: Mild.

To be honest: My actual symptoms started a few years ago when I unknowingly consumed caffeinated beverages, drinking 1-2000cc of large cups of red and green tea milk tea daily, which resulted in severe palpitations.
For three days (with episodes occurring successively), since then, I have needed to sleep every four to five hours; otherwise, my chest becomes increasingly tight, my vision blurs, and I experience headaches and dizziness that have not stopped for years.
I also have indigestion, reflux, and severe sinusitis, which flares up every two to three days.
When it flares up, my stomach also becomes unable to digest, and I often have to sit uncomfortably for half an hour to an hour after meals until I feel better before I can move.
After contracting the virus twice, if I eat something that doesn't agree with my stomach, I experience palpitations at 90-100 beats per minute, making it impossible to use the elevator.
Since the onset of the pandemic, my body has been like this.
I was worried about side effects and didn't get vaccinated in time, contracting the virus twice within six months.
The most painful symptom has been the palpitations; when my heart rate exceeds 85 beats per minute, I start to feel chest tightness, and at times it has reached 110 to 119 beats per minute.
I had to take antiarrhythmic medication and antipyretics to manage it.
Now, I often feel fatigued due to palpitations (sometimes experiencing back pain after digestive-related palpitations).

May I ask if it is suitable for me to receive the XBB vaccine? Is it okay for my heart to frequently beat between 90 to 110 beats per minute (now, when my heart rate exceeds 90, the sudden strong beat characteristic of valvular heart disease has become more frequent)? How long should I expect to have a fever after vaccination? Can I take antiarrhythmic medication, antipyretics, and Xanax together? (I am unsure if my heart can handle it).
Thank you for your assistance.

Xiao Gao, 40~49 year old female. Ask Date: 2023/12/17

Dr. Wu Xueming reply Cardiology

Mild valve prolapse will not affect vaccination.
If you experience side effects after receiving the vaccine, please rest more and stay hydrated.

Reply Date: 2023/12/17

More Info

Valve insufficiency, particularly mitral valve prolapse (MVP) and related conditions, can lead to various symptoms, including dyspnea, chest tightness, and palpitations. Your medical history indicates that you have been experiencing intermittent dyspnea on exertion, chest tightness, and dizziness, which can be concerning, especially in the context of your valve issues. The echocardiogram results show mild mitral regurgitation (MR) and mild to moderate tricuspid regurgitation (TR), with preserved left ventricular (LV) and right ventricular (RV) systolic function. This suggests that while there is some degree of valve insufficiency, your heart's pumping ability remains intact.

Given your symptoms and the history of MVP, it is essential to monitor your condition closely. The palpitations you experience, particularly when your heart rate exceeds 90 beats per minute, could be related to anxiety, caffeine intake, or the underlying valve insufficiency. It is worth noting that excessive caffeine consumption can exacerbate palpitations and should be avoided, especially if you have a history of sensitivity to caffeine.

Regarding your concerns about vaccination, particularly with the XBB vaccine, it is crucial to weigh the benefits against the potential risks. Vaccination is generally recommended for individuals with underlying health conditions, including those with heart issues, as it can help prevent severe illness from COVID-19. However, given your history of palpitations and concerns about potential side effects, it would be prudent to consult with your cardiologist before proceeding with vaccination. They can provide personalized advice based on your current health status and the severity of your valve insufficiency.

In terms of post-vaccination symptoms, mild fever is a common side effect of many vaccines, including COVID-19 vaccines. Typically, any fever or discomfort following vaccination should resolve within a few days. It is essential to monitor your symptoms closely and consult your healthcare provider if you experience significant or prolonged symptoms.

As for the medications you mentioned, it is generally safe to take anti-inflammatory medications like acetaminophen (Tylenol) or ibuprofen (Advil) for fever or discomfort after vaccination, but you should confirm this with your healthcare provider, especially since you are on heart medications. They can provide guidance on potential interactions and the best approach to manage any side effects you may experience.

In summary, while your heart function appears to be preserved, your symptoms warrant careful management. Discussing your vaccination concerns with your cardiologist is essential to ensure that you make an informed decision that prioritizes your health and safety. Additionally, managing your lifestyle factors, such as caffeine intake and stress, may help alleviate some of your symptoms. Regular follow-ups with your healthcare provider will be crucial in monitoring your condition and adjusting your treatment plan as necessary.

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