Mitral Valve Prolapse and Exercise Stress Testing

Q: Mitral Valve Prolapse and Exercise Stress Testing

Hello： Mitral valve prolapse can sometimes be associated with chest discomfort and arrhythmias. <br>However, in certain situations, such as stress, anxiety, medications, or food, these arrhythmias may worsen. <br>If your exercise electrocardiogram or echocardiogram shows no abnor

Regarding the mitral valve and exercise electrocardiogram?

Hello Doctor: I previously experienced symptoms of chest tightness and difficulty breathing, so I went to the hospital for examinations (resting electrocardiogram, 24-hour Holter monitor, auscultation), all of which showed no abnormalities.
However, I remain anxious and constantly check my heart rate.
This has been going on for almost a year, and I have noticed a significant decline in my physical endurance.
The most noticeable issue occurs when I stand up after sitting for a long time, where I experience significant chest tightness and a sudden decrease in heart rate, but it usually recovers within about ten seconds.
A few weeks ago, while playing basketball intensely, I felt a bit dizzy and a sensation of blood not flowing properly after rapid jumps.
I measured my heart rate, which was alarmingly fast.
I am unsure if this was due to sudden anxiety or something else, but I increasingly feel like I can't catch my breath, and my chest feels constricted.
This frightened me, and I quickly took a break.
The feeling of not being able to breathe lasted only a few seconds, but I continued to feel unwell (dizziness, weakness).
I then returned to the hospital for a follow-up with a cardiologist, where I described my symptoms.
The doctor performed an echocardiogram, a stress test, and a resting electrocardiogram.
There were no abnormal sounds during auscultation, but the echocardiogram revealed mitral valve prolapse.
The doctor noted some unusual data on the stress test, but it was not at a level that could be deemed abnormal.
The doctor explained that the stress test was used to screen for any signs of coronary artery disease.
Ultimately, the doctor prescribed me Inderal, Xanax, and Nitroglycerin (sublingual tablets).

My questions are: When the nurse performed the echocardiogram, I was asked to lie on my left side.
Is the echocardiogram accurate when taken in this position? Additionally, during the stress test, it seemed that one or two of the electrodes became loose, and the nurse reapplied some stickers while I was running.
Did this affect the data? I am very concerned about what the doctor said and constantly worry about my condition, which prevents me from engaging in any exercise, even jogging or aerobic activities, as I feel anxious.
Should I consider getting a second opinion at another hospital?
Lastly, I would like to ask about an experience I had while riding my motorcycle through a tunnel, which was a long downhill stretch.
I felt a tightness in my chest and had difficulty breathing, which was quite distressing, but it resolved once I reached flat ground.
Now, when I am in a vehicle and encounter steep inclines or declines, I feel something strange in my chest and have an involuntary urge to take deep breaths, often feeling like I can't catch my breath.
I also find myself very anxious about watching horror movies; I feel uncomfortable as soon as I see those scenes.
Could this be related to my mitral valve prolapse? Two years ago, I did not have any of these symptoms.
I used to enjoy watching horror movies, riding roller coasters, and engaging in intense physical activities, but now I find it difficult to do so.
If heart disease is congenital, why am I only experiencing these symptoms recently? I started noticing these symptoms around the time I switched to a stressful and busy engineering job; I wonder if there is a connection.
I have many questions, and I would greatly appreciate your answers.
Thank you very much.

Yong Bao An Kang, 20~29 year old female. Ask Date: 2007/01/14

Dr. Huang Guosheng reply Cardiology

Hello: Mitral valve prolapse can sometimes be associated with chest discomfort and arrhythmias.
However, in certain situations, such as stress, anxiety, medications, or food, these arrhythmias may worsen.
If your exercise electrocardiogram or echocardiogram shows no abnormalities, your condition is likely just benign arrhythmia and poses no life-threatening risk.
Generally, regular exercise and daily activities should not be affected.
If you experience discomfort, medications can help alleviate the symptoms.
If you continue to have discomfort or issues, you may visit an outpatient clinic for further evaluation.

Reply Date: 2007/01/14

More Info

Mitral Valve Prolapse (MVP) is a condition where the mitral valve, which separates the left atrium from the left ventricle, does not close properly. This can lead to a variety of symptoms, including palpitations, chest pain, and shortness of breath, especially during physical exertion. Your experience of chest tightness, difficulty breathing, and increased heart rate during activities may be related to MVP, particularly if you have been under significant stress or anxiety, which can exacerbate these symptoms.

The exercise stress test you underwent is a valuable tool for assessing cardiac function and detecting any underlying ischemic heart disease. The fact that your resting and exercise electrocardiograms (ECGs) did not show significant abnormalities is reassuring. However, the mention of "some data being strange" during the exercise test indicates that there may have been some transient changes that warrant further investigation, especially given your symptoms.

Regarding your concerns about the accuracy of the echocardiogram performed while lying on your side, it is common practice to obtain images in various positions to get the best view of the heart structures. Lying on your left side can sometimes provide clearer images of the mitral valve and left atrium, so this positioning is generally acceptable and should not significantly affect the results.

As for the adhesive patches during the exercise stress test, any detachment could potentially affect the quality of the ECG readings. However, if the nurse was able to reattach them promptly, it may not have had a significant impact on the overall results. It is crucial that the ECG is monitored closely during exercise to ensure accurate data collection.

Your psychological response to your symptoms is also important to consider. Anxiety can manifest physically, leading to increased heart rate, chest tightness, and a feeling of breathlessness. This can create a cycle of fear and avoidance of physical activity, which may further decrease your fitness level and exacerbate your symptoms. It is not uncommon for individuals with MVP to experience heightened anxiety, especially if they are aware of their condition.

The symptoms you described, such as feeling short of breath while riding downhill or experiencing discomfort during sudden changes in elevation, could be related to your MVP, but they may also be influenced by anxiety or other factors. It is essential to discuss these symptoms with your healthcare provider, as they can help determine if further evaluation is necessary.

Given your history and the recent onset of symptoms, it may be beneficial to seek a second opinion or further evaluation, especially if you continue to feel anxious about your heart health. A cardiologist may recommend additional tests, such as a Holter monitor to assess your heart rhythm over 24 hours or a cardiac MRI for a more detailed view of the heart structures.

In summary, while MVP can cause symptoms similar to what you are experiencing, it is essential to address both the physical and psychological aspects of your health. Regular follow-ups with your cardiologist, along with a focus on managing anxiety and gradually reintroducing physical activity, can help improve your overall well-being. Remember, it is crucial to communicate openly with your healthcare provider about your concerns and symptoms to ensure you receive the appropriate care and support.

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