Intermittent Chest Pain and Discomfort in Mitral Valve Prolapse - Internal Medicine

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Cardiac discomfort?


Hello Doctor: I have symptoms of mitral valve prolapse, and I would like to inquire why I feel that my chest pain occurs intermittently.
When it doesn't flare up, I feel fine, but when it does, the pain is unbearable and quite frequent.
Additionally, every morning when I wake up (even when I'm not experiencing frequent chest pain), my heart feels particularly uncomfortable, as if it's empty, and my breathing isn't very smooth.
It takes nearly an hour each morning for this feeling to subside.
Is this also within the range of symptoms associated with mitral valve prolapse? I have also experienced waking up in the middle of the night with tightness around my heart area, which radiated pain to my shoulder, causing me to wake up in pain while holding my left chest without moving.
Recently, these occurrences have become more frequent, especially when I am sitting or lying down, and the vibrations from my heart are so strong that I can feel my body shaking.
This has caused me some concern.
Thank you for your response!

Pan, 20~29 year old female. Ask Date: 2005/05/09

Dr. Zhao Chongliang reply Internal Medicine


Mitral valve prolapse often leads to transient arrhythmias, which can cause various symptoms or vague discomfort that is difficult to pinpoint.
By the time a patient arrives at the hospital for examination, the arrhythmia may have resolved.
Repeated visits to the doctor can sometimes lead to the misconception of a neurological disorder (neuroticism).
If episodes occur daily, a 24-hour Holter monitor can be arranged in the cardiology clinic for further evaluation.
If no abnormalities are detected, a short hospital stay for continuous ECG monitoring may be beneficial.
Additionally, arrhythmias associated with mitral valve prolapse can sometimes be severe and lead to sudden cardiac death, so long-term follow-up with a cardiologist is recommended.

Reply Date: 2005/05/09

More Info


Mitral valve prolapse (MVP) is a condition where the mitral valve, which separates the left atrium from the left ventricle of the heart, does not close properly. This can lead to various symptoms, including intermittent chest pain, palpitations, and feelings of discomfort. Your experience of chest pain occurring intermittently, along with the sensation of your heart feeling "empty" or not beating smoothly, is not uncommon among individuals with MVP.


Understanding Intermittent Chest Pain in MVP
1. Nature of Chest Pain: The chest pain associated with MVP can be sharp or aching and is often described as being more intense during periods of stress or anxiety. The intermittent nature of your pain may be related to the heart's mechanics during these episodes. When the mitral valve does not close properly, it can lead to a backflow of blood (regurgitation), which may cause the heart to work harder and can result in discomfort or pain.

2. Frequency and Triggers: The frequency of your chest pain and its occurrence during specific positions (like sitting or lying down) can be influenced by changes in blood flow and pressure within the heart. Certain positions may exacerbate the symptoms due to increased pressure on the heart or changes in how blood is pumped through the heart chambers.

3. Morning Discomfort: Waking up with a sensation of discomfort or an "empty" feeling in the heart can be attributed to several factors. During sleep, especially in certain positions, the heart may experience variations in blood flow and pressure. Additionally, anxiety or stress can manifest physically, leading to sensations of tightness or discomfort upon waking.

4. Palpitations and Nerve Sensations: The sensation of your heart "vibrating" or causing discomfort that radiates to your shoulder can be a sign of palpitations, which are common in MVP. These palpitations can sometimes feel like a fluttering or pounding in the chest and can be accompanied by anxiety or panic, which may further exacerbate the sensation.


When to Seek Medical Attention
While MVP is often benign, certain symptoms warrant further evaluation. If you experience:
- Severe or worsening chest pain
- Shortness of breath that is new or worsening
- Dizziness or fainting
- Symptoms that interfere with your daily activities
It is essential to consult a healthcare provider. They may recommend an echocardiogram to assess the severity of the mitral valve prolapse and any associated regurgitation.

Management and Lifestyle Considerations
1. Monitoring Symptoms: Keeping a diary of your symptoms, including when they occur and any potential triggers, can help your healthcare provider understand your condition better.

2. Stress Management: Since anxiety can exacerbate symptoms, incorporating stress-reducing techniques such as mindfulness, yoga, or deep-breathing exercises may help alleviate some discomfort.

3. Regular Check-ups: Regular follow-ups with a cardiologist are crucial to monitor the condition of your mitral valve and overall heart health.

4. Medication: In some cases, medications may be prescribed to manage symptoms, especially if anxiety or palpitations are significant.

In conclusion, while your symptoms may be related to mitral valve prolapse, it is essential to have a thorough evaluation to rule out other potential causes of your chest pain and discomfort. Maintaining open communication with your healthcare provider will ensure that you receive the appropriate care and management for your condition.

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