Heart Weakness: Symptoms and Concerns Explained - Cardiology

Dr. He Dongjin reply Cardiology

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Dear patient,
You are experiencing symptoms such as chest tightness, chest pain (sharp pain), shortness of breath (with wheezing), palpitations, a feeling of weakness in the heart, cold sweats during episodes, and sometimes these symptoms can persist throughout the day.
The timing of these episodes is unpredictable.
These symptoms are likely related to autonomic nervous system dysregulation and mitral valve prolapse.
To understand mitral valve prolapse, we first need to look at the structure of the heart.
The heart consists of four chambers: the right and left atria and the right and left ventricles, separated by valves that function like doors between rooms, allowing for one-way blood flow and preventing backflow.
The mitral valve is located between the left atrium and left ventricle and is also known as the bicuspid valve due to its resemblance to a bishop's miter.
During diastole, blood flows from the left atrium through the open mitral valve into the left ventricle.
When the left ventricle is filled with blood from the left atrium and enters systole, the mitral valve closes automatically, allowing blood to flow from the left ventricle into the aorta and throughout the body without flowing back into the left atrium.
Mitral valve prolapse occurs when congenital or acquired factors cause the annulus of the mitral valve (analogous to a door frame) to enlarge, resulting in a relatively smaller mitral valve (the door frame is larger than the door), which cannot close properly and partially bulges into the left atrium.
Alternatively, the mitral valve may undergo degenerative changes or become elongated (the door is larger than the frame), causing part of it to be forced back into the left atrium during closure, leading to mitral valve prolapse.
It is estimated that about 5-10% of the population has mitral valve prolapse, with an unclear etiology, but the majority are related to genetic factors.
It is more common in females than in males, with a ratio of approximately 3:1.
Most patients are asymptomatic and discover the condition during routine examinations or evaluations for other diseases.
Those with symptoms typically experience at least two of the following: chest pain, palpitations, fatigue, shortness of breath, dizziness, insomnia, anxiety, panic attacks, or even syncope.
These symptoms do not originate from the heart but are due to excessive sympathetic nervous system activation, leading to a syndrome often referred to as autonomic nervous system dysregulation syndrome.
Mitral valve prolapse is merely another manifestation of this syndrome and does not have a causal relationship with other symptoms.
In some patients, the mitral valve fails to close tightly, leading to some blood flowing backward into the left atrium during left ventricular contraction, clinically known as mitral regurgitation.
Mitral valve prolapse, in addition to causing regurgitation and left atrial enlargement, can also lead to young-onset stroke, infective endocarditis, or even sudden death, so caution is warranted.
Diagnosis of mitral valve prolapse can be made through clinical auscultation, where a characteristic click or murmur may be heard, but electrocardiograms and chest X-rays have limited diagnostic value.
The most important examination is echocardiography, which can visualize mitral valve prolapse and assess for mitral regurgitation or other related conditions such as rheumatic heart disease or ischemic heart disease.
The frequency, timing, triggers, and severity of symptoms in patients with mitral valve prolapse can vary widely.
Some may experience episodes weekly, while others may have them only every few months or even years.
Symptoms can last from a day or two to several weeks.
Triggers can include: colds, menstruation, emotional stress, lack of sleep, delayed meals, excessive fatigue, engaging in unfamiliar physical activities, prolonged exposure to dry and hot enclosed spaces, dehydration from excessive sweating, or the use of stimulants such as tobacco, alcohol, caffeine, or drugs.
Most patients can tolerate these symptoms, but a small number may find them severely debilitating, leading to frequent emergency room visits, overwhelming emergency physicians, and disrupting their daily lives, resulting in what is termed a life crisis.
There are instances where patients with severe chest pain are diagnosed with angina and undergo cardiac catheterization, but fatalities due to life-threatening conditions are extremely rare.
Medications can only provide symptomatic relief and cannot cure mitral valve prolapse.
Surgery is only indicated for patients with significant mitral regurgitation affecting heart function or those with infective endocarditis, and it does not alleviate the aforementioned symptoms.
Fortunately, clinically, the number of cases requiring surgery is quite rare, and most patients can achieve some degree of symptom relief through medication.
Patients should also come to terms with living with this condition as an invisible defect in their bodies.
If you suspect you have mitral valve prolapse due to the symptoms described, you should consult a cardiologist for evaluation.
If echocardiography confirms mitral valve prolapse, you should be aware of the situations that may trigger your symptoms and strive to avoid them, while also adhering to your physician's prescribed medications, which can help control most symptoms effectively.
If you also have moderate to severe regurgitation, you should inform your physician about the need for prophylactic antibiotics during invasive procedures or dental extractions to reduce the risk of infective endocarditis.
Unless there is significant regurgitation affecting heart function, the vast majority of patients can have children.
As for the safety of exercise, opinions vary.
If exercise triggers symptoms, consult your cardiologist to assess what types of exercise are appropriate for you.
Changhua Hospital cares about your health.

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Reply Date: 2006/07/27