Left Chest Discomfort: Is It Mitral Valve Prolapse or Something Else?

Left chest tightness?

Hello Doctor, I often feel a tightness in my left chest accompanied by a sense of weakness.
Sometimes it feels as if my entire left chest is empty.
During these episodes, I instinctively press on my left chest and feel very dizzy and uncomfortable.
My hands are cold.
I have previously consulted a cardiologist who mentioned that it might be related to mitral valve prolapse.
I was prescribed Cardolol to take during episodes, but the symptoms have not improved.
Sometimes, even after taking the medication at night, I wake up in the middle of the night feeling tightness, and lying down feels worse than sitting up.
Recently, I tried measuring my pulse during an episode (before taking the medication) and found my heart rate was only in the 50s (which is lower than usual).
I would like to ask the doctor if this is related to the mitral valve issue (the echocardiogram showed that the mitral valve prolapse is not severe), or if there might be another condition? Should I undergo further testing? Thank you for your patient response.

Xiao Fang, 30~39 year old female. Ask Date: 2004/03/10

Dr. Zhong Yuxun reply Cardiology

Dear Xiaofang,
Based on your letter, it seems that the symptoms you are experiencing are likely due to mitral valve prolapse.
Mitral valve prolapse is often associated with autonomic nervous system dysregulation, which can lead to systemic symptoms.
In addition to the commonly used Cardolol (also known as Inderal), it is often necessary to include autonomic nervous system modulators in the treatment plan.
Cardolol can cause a reduction in heart rate.
I recommend that you continue to seek treatment from a cardiologist.
Sincerely,
Dr.
Zhong Yuxuan
Taoyuan Hospital, Department of Health, Executive Yuan

Reply Date: 2004/03/10

More Info

Left chest discomfort can be a concerning symptom, and it is essential to understand the potential causes and appropriate actions to take. Based on your description, it seems you are experiencing a range of symptoms, including chest tightness, weakness, dizziness, and a sensation of coldness in your hands. You have also mentioned a previous diagnosis of mitral valve prolapse (MVP) and the use of a medication called Cardolol, which is a beta-blocker often prescribed to manage symptoms related to MVP and other heart conditions.

Mitral valve prolapse is a condition where the mitral valve does not close properly, which can lead to various symptoms, including palpitations, chest pain, and even anxiety. While many individuals with MVP experience mild symptoms or none at all, some may have more pronounced issues, particularly if there is associated mitral regurgitation (backward flow of blood into the left atrium). The symptoms you describe, such as feeling faint and having a low heart rate (bradycardia), could be related to several factors, including the effects of the medication, anxiety, or even a more complex cardiac issue.

Given that your echocardiogram indicated that the mitral valve prolapse is not severe, it is crucial to consider other potential causes of your symptoms. Here are some possibilities:
1. Anxiety and Panic Attacks: Many individuals with MVP report anxiety symptoms, which can manifest as chest discomfort, palpitations, and dizziness. The sensation of your heart racing or slowing down can be distressing and may lead to further anxiety, creating a cycle of symptoms.

2. Cardiac Arrhythmias: While your echocardiogram may not show significant issues, it is still possible to have arrhythmias that could cause symptoms like dizziness and a low heart rate. A Holter monitor or an event monitor could be beneficial in capturing any irregular heartbeats over a more extended period.

3. Musculoskeletal Issues: Sometimes, chest pain can stem from musculoskeletal problems, such as costochondritis or muscle strain, especially if the pain worsens with certain positions (like lying down).

4. Gastroesophageal Reflux Disease (GERD): Acid reflux can cause chest discomfort that may mimic cardiac pain. Symptoms can be exacerbated by lying down or after eating.

5. Other Cardiac Conditions: Although less likely given your previous evaluations, it is essential to rule out other heart conditions, such as ischemic heart disease, especially if you have risk factors like a family history of heart disease, smoking, or high blood pressure.

Given your ongoing symptoms and the fact that the medication has not provided relief, it would be prudent to follow up with your healthcare provider. They may recommend further testing, such as:
- Holter Monitor: To assess your heart rhythm over 24-48 hours.

- Stress Test: To evaluate how your heart performs under physical stress.

- Repeat Echocardiogram: To monitor any changes in your mitral valve function or heart structure.

In the meantime, consider keeping a symptom diary to track when your symptoms occur, their duration, and any potential triggers. This information can be invaluable for your healthcare provider in determining the next steps.

Lastly, if you experience any new or worsening symptoms, such as severe chest pain, shortness of breath, or fainting, seek immediate medical attention. Your health and well-being are paramount, and addressing these symptoms promptly is crucial.

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