Mild Mitral Valve Prolapse and Heart Failure Symptoms

Q: Mild Mitral Valve Prolapse and Heart Failure Symptoms

Hello： MVP is a common condition characterized by the prolapse of one or both leaflets of the mitral valve into the left atrium during systole due to mitral valve insufficiency. <br>The pathological mechanism is not fully understood. <br>Pro-BNP testing can assist in the diagnosi

Suspected heart failure with mitral valve issues?

Hello Doctor, thank you for your response.
To provide some background, last year I experienced several months of sleep deprivation.
I usually do not drink alcohol, but one night while out with friends, I was forced to drink a cocktail after a night of insomnia.
Following that, I began to feel unwell and frequently experienced insomnia.
My condition worsened, and one time while climbing stairs, I suddenly felt short of breath for a couple of seconds.
Consequently, I underwent various cardiac evaluations.

Echocardiogram: The first ejection fraction was 63, indicating mild mitral valve prolapse; the second ejection fraction was 66, showing mild mitral valve prolapse and very mild aortic regurgitation.

MRI: Ejection fraction was 59.

CT scan: No coronary artery obstruction.

BNP blood test: Normal.

Exercise ECG: The first test was normal; the second test was positive (the report suggested suspected MVP syndrome).
Symptoms:
1.
Occasionally, when speaking intensely, I experience sudden chest tightness, a sensation of my heart stopping, shortness of breath, and dizziness (I used to exercise regularly).
2.
I feel unrefreshed after sleep, and walking gives me a sense of fluctuating oxygen levels.
3.
After exercising, or if I drink insufficient water or eat too much, I feel extremely fatigued and need to lie down immediately to sleep, but my breathing feels weak.
4.
At times, my heart rate is very fast, but my blood pressure is low, or my blood pressure is high but my heart rate is slow.
5.
When fatigued, I experience symptoms similar to central sleep apnea, feeling unable to breathe autonomously, and I have woken up gasping for air; during that time in the emergency room, my respiratory rate was noted to be slow.
6.
I have a sensation of heart dilation.
7.
On one occasion, I suddenly felt short of breath while lying down.
I would like to ask the following questions: Given the symptoms described above, have I entered the early stages of heart failure, or could my mitral valve prolapse be worsening? Is mild mitral valve prolapse a result of weakened heart function? What could be the possible causes of these cardiac symptoms? Past medical history: cervical spine hyperlordosis.

A Cheng, 30~39 year old female. Ask Date: 2024/05/04

Dr. Xie Rongyuan reply Internal Medicine

Hello: MVP is a common condition characterized by the prolapse of one or both leaflets of the mitral valve into the left atrium during systole due to mitral valve insufficiency.
The pathological mechanism is not fully understood.
Pro-BNP testing can assist in the diagnosis of congestive heart failure.
If symptoms do not improve, it is recommended to follow up with a cardiologist for further treatment.
Thank you for your message!

Reply Date: 2024/05/04

More Info

Mild mitral valve prolapse (MVP) is a condition where the mitral valve does not close properly, which can lead to various symptoms, including palpitations, chest pain, and fatigue. Your symptoms, particularly the episodes of chest tightness, shortness of breath, and fatigue, warrant careful evaluation, especially considering your history of MVP and the recent cardiac assessments you've undergone.

From your description, it seems that you have experienced a range of symptoms that could be associated with both MVP and potential heart failure. The echocardiograms you've had show mild mitral valve prolapse with a left ventricular ejection fraction (LVEF) ranging from 59% to 66%. While these values indicate that your heart is still functioning adequately, the presence of MVP can sometimes lead to complications, including mitral regurgitation, which may not always be evident on initial imaging.

Your symptoms of sudden chest tightness, especially during physical exertion or emotional stress, could be related to the MVP itself or to other underlying cardiovascular issues. The sensation of your heart "stopping" or feeling like it is racing could be due to arrhythmias, which are not uncommon in individuals with MVP. Additionally, the episodes of shortness of breath, particularly when climbing stairs or after exertion, could suggest that your heart is struggling to meet the increased demands placed on it, potentially indicating early signs of heart failure.

The fact that you have experienced episodes of feeling faint or dizzy, especially when your heart rate is high or your blood pressure is low, is concerning. These symptoms could indicate that your heart is not pumping effectively, which can happen in the context of heart failure or significant mitral regurgitation. The fatigue you describe, particularly after exertion or dehydration, may also suggest that your body is not receiving adequate blood flow during these times, which can be a sign of reduced cardiac output.

In terms of your question about whether you are entering a pre-heart failure stage or if your MVP is worsening, it is essential to consider the overall clinical picture. Mild MVP itself does not typically lead to heart failure, but if it progresses to moderate or severe regurgitation, it could contribute to heart failure symptoms. Your symptoms, combined with the echocardiographic findings, suggest that while you may not be in full heart failure, you are experiencing significant symptoms that warrant further investigation.

It is crucial to follow up with your cardiologist to discuss these symptoms in detail. They may recommend additional testing, such as a Holter monitor to assess for arrhythmias or further imaging to evaluate the severity of the mitral regurgitation. Lifestyle modifications, including managing stress, ensuring adequate hydration, and possibly adjusting your activity levels, may also be beneficial.

In summary, while mild mitral valve prolapse is often benign, your symptoms suggest that there may be more going on that requires careful monitoring and possibly intervention. Regular follow-ups with your healthcare provider are essential to manage your condition effectively and to prevent any potential progression to heart failure.

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