Palpitations: The Link Between Tricuspid Valve Prolapse and Panic Disorder

Q: Palpitations: The Link Between Tricuspid Valve Prolapse and Panic Disorder

Hello： Panic disorder and mitral valve prolapse are two distinct conditions, but they can both affect the autonomic nervous system, leading to very similar clinical presentations. <br>Individuals with panic disorder do not necessarily have mitral valve prolapse, but it is possibl

Palpitations

Dear Dr.
Lin,
Two to three years ago, I sought medical attention for palpitations, but doctors from Tzu Chi, Veterans General Hospital, and Christian Hospital all insisted that my heart was fine (I underwent an electrocardiogram, echocardiogram, and thyroid function tests).
Consequently, I was diagnosed with autonomic nervous system dysfunction and referred to a psychiatrist, where I was determined to have panic disorder.
However, after taking antidepressants for over a year, I still experienced palpitations.
Two months ago, a psychiatrist at Kaohsiung Medical University arranged for another echocardiogram, which revealed that I have tricuspid valve prolapse.
Since receiving treatment at National Taiwan University Yunlin Branch, my palpitations have improved.

While it is noted that patients with panic disorder often have mitral or tricuspid valve prolapse, I would like to know if all patients with tricuspid valve prolapse necessarily have panic disorder? Additionally, is there a possibility that the cardiologists who previously examined me misdiagnosed my condition?
As a side question, why does the echocardiogram show tricuspid valve prolapse while the electrocardiogram appears normal?
Wishing you a prosperous New Year.

Ginny, 20~29 year old female. Ask Date: 2005/02/06

Dr. Lin Liangyu reply Cardiology

Hello: Panic disorder and mitral valve prolapse are two distinct conditions, but they can both affect the autonomic nervous system, leading to very similar clinical presentations.
Individuals with panic disorder do not necessarily have mitral valve prolapse, but it is possible to have both issues simultaneously.
Additionally, an electrocardiogram cannot detect valvular heart disease.
Wishing you a Happy New Year!

Reply Date: 2005/02/06

More Info

Palpitations can be a distressing symptom, and understanding their potential links to structural heart issues, such as tricuspid valve prolapse (TVP), as well as psychological conditions like panic disorder, is crucial for effective management. Your experience highlights a common scenario where patients may undergo extensive cardiac evaluations, only to find that their symptoms persist despite normal results.

Tricuspid valve prolapse is a condition where the tricuspid valve does not close properly, which can lead to trivial regurgitation. While this condition is often benign and may not cause significant symptoms, it can be associated with palpitations in some individuals. The presence of palpitations in patients with TVP is not uncommon, but it does not imply that all patients with TVP will experience panic disorder or anxiety. The relationship between structural heart abnormalities and anxiety disorders is complex and multifactorial.

Panic disorder is characterized by recurrent, unexpected panic attacks, which can manifest as physical symptoms such as palpitations, shortness of breath, and dizziness. It is important to note that while some studies suggest a higher prevalence of mitral valve prolapse (MVP) and tricuspid valve prolapse among patients with panic disorder, this does not establish a direct causative relationship. Many individuals with TVP may not experience anxiety or panic symptoms, and conversely, many individuals with panic disorder may not have any structural heart abnormalities.

Regarding your concern about the accuracy of previous diagnoses, it is possible for doctors to miss subtle findings, especially if the symptoms are primarily psychological. The fact that your palpitations improved after the identification of TVP suggests that there may have been a physiological component to your symptoms that was previously overlooked. However, it is also essential to recognize that anxiety and panic can coexist with physical conditions, complicating the clinical picture.

As for the discrepancy between your echocardiogram showing tricuspid valve prolapse and your normal electrocardiogram (ECG), this is not unusual. An echocardiogram is a structural imaging study that assesses the anatomy and function of the heart valves and chambers, while an ECG primarily evaluates the electrical activity of the heart. Therefore, it is entirely possible for a patient to have a structural abnormality like TVP without any electrical conduction issues, which would be reflected on an ECG.

In conclusion, while tricuspid valve prolapse can be associated with palpitations, it does not necessarily mean that all patients with this condition will develop panic disorder. The interplay between physical and psychological factors in heart-related symptoms is complex, and a multidisciplinary approach involving both cardiology and psychiatry may be beneficial for comprehensive management. If you continue to experience symptoms, it would be prudent to maintain open communication with your healthcare providers, ensuring that both your physical and mental health needs are addressed.

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