Mitral Valve Prolapse and Its Connection to Autonomic Dysfunction

Regarding mitral valve prolapse?

Hello, doctor: Is it common for mitral valve prolapse to be associated with autonomic dysfunction? Why is that? I consulted two doctors; one said I have mitral valve prolapse, while the other said I have autonomic dysfunction.
I only feel uncomfortable and tense when I'm not taking anti-arrhythmic medication.
A few days ago, I accidentally lost my medication, and that night I experienced palpitations, chest tightness, and chest pain, which even radiated to my back.
My left arm and shoulder were sore and painful, and I felt stiffness in my left neck.
The next day, I woke up shivering and had no strength to speak.
I was supposed to take the medication in the morning and evening, but sometimes I would start feeling unwell before noon, often not being able to last until evening without discomfort.
Also, if I may ask, have you treated patients at Chiayi Hospital? If so, I am your patient; I only visited once, and you diagnosed me with mitral valve prolapse and prescribed a lighter medication, advising me to return for a follow-up if it didn't improve.
After finishing that medication, since my home is far from Chiayi and I wanted to see if my condition improved, I ended up experiencing palpitations, chest tightness, and chest pain for two consecutive days, which made it hard to breathe.
I couldn't take it anymore and sought nearby medical attention.
That doctor said I have autonomic dysfunction.
Regardless of what the doctors say about my symptoms, as long as there is a prescription for anti-arrhythmic medication, I feel extremely uncomfortable without it, to the point where I feel like I'm going to die.

A Miao, 20~29 year old female. Ask Date: 2008/02/20

Dr. He Dongjin reply Cardiology

Dear Y Mau, I have seen you in Chiayi.
Your symptoms are typical manifestations of autonomic nervous system dysfunction combined with mitral valve prolapse, but we should also consider endocrine disorders, such as thyroid dysfunction.
Please seek nearby medical attention for examination.
Once your medication is stabilized, we can discuss further.

The concern from Changhua Hospital regarding your tall and slender physique, which is often desired by girls aspiring to be models, is noted.
However, in the eyes of a physician, this slender body type and sensitive personality are characteristic of patients with mitral valve prolapse, also known as mitral valve prolapse syndrome.
About 5% of the population is affected by this condition, with a notably higher incidence in females, who are twice as likely to be affected as males.
The primary characteristics of these patients are being thin and tall.

If during embryonic development, the connective tissue of the valve undergoes myxomatous changes, leading to elongated and lax valves, prolapse may occur later in life.
When the heart contracts, the elongated valve fails to close properly, resulting in the backflow of blood from the left ventricle into the left atrium.
In addition to the characteristic click of the prolapsed valve, heart murmurs may also be audible.
Patients with this abnormal constitution often experience a variety of symptoms "from head to toe," such as dizziness, insomnia, palpitations, chest pain, panic, fatigue, chest tightness, generalized numbness, shortness of breath, and gastrointestinal discomfort.

These symptoms may be related to autonomic nervous system dysfunction, which involves either excessive or insufficient responses from the sympathetic or parasympathetic nervous systems.
Clinically, patients may present with various types of arrhythmias, including sinus tachycardia (the most common), bradycardia, ventricular tachycardia, atrial flutter, atrial fibrillation, or even cardiac arrest.
The chest pain associated with mitral valve prolapse can sometimes be difficult to distinguish from angina or myocardial infarction.
The underlying cause may be the excessive movement of the elongated valve during opening and closing, which can overly strain the heart muscle, leading to localized hypoxia, arrhythmias, and autonomic nervous system dysfunction.
Mitral valve prolapse is also commonly found in patients with congenital heart diseases (such as atrial septal defects), hypertrophic cardiomyopathy, and some congenital connective tissue disorders (such as Marfan syndrome).
Although patients with valve prolapse may seem to have widespread health issues, over 90% of cases are benign.
Aside from being somewhat anxious, they do not pose significant health risks.
Regular exercise, adequate rest, and occasional use of low-dose beta-blockers or sedatives are usually sufficient.
Only a small percentage of patients (about 1%) may develop complications such as heart failure, endocarditis, arrhythmias, stroke, or sudden death.
Therefore, patients with mitral valve prolapse, especially those with significant heart murmurs, should have follow-up examinations at least once a year.

Reply Date: 2008/02/20

More Info

Mitral Valve Prolapse (MVP) is a condition where the two flaps of the mitral valve do not close properly, which can lead to various symptoms, including palpitations, chest pain, and anxiety. It is not uncommon for individuals with MVP to also experience autonomic dysfunction, which refers to a disorder of the autonomic nervous system (ANS) that can manifest as symptoms like dizziness, heart palpitations, and gastrointestinal issues.

The connection between MVP and autonomic dysfunction can be explained through the role of the autonomic nervous system in regulating heart function. The ANS is divided into two main branches: the sympathetic nervous system, which prepares the body for 'fight or flight' responses, and the parasympathetic nervous system, which promotes 'rest and digest' activities. In individuals with MVP, there may be an imbalance in these systems, leading to heightened sympathetic activity or reduced parasympathetic tone. This imbalance can exacerbate symptoms such as palpitations and anxiety, which you have described.

Your experience of feeling discomfort when not taking your anti-palpitations medication suggests that your symptoms may be closely linked to both MVP and autonomic dysfunction. The medication likely helps to stabilize your heart rhythm and alleviate the anxiety associated with your symptoms. When you missed your medication, the return of symptoms such as palpitations, chest tightness, and discomfort in your left arm and shoulder could indicate that your autonomic nervous system was reacting to the stress of the situation, possibly exacerbated by the underlying MVP.

It's also worth noting that stress and anxiety can significantly impact the autonomic nervous system, leading to a cycle where symptoms of MVP can provoke anxiety, which in turn can worsen the symptoms. This cycle can create a challenging situation for patients, as the physical symptoms can lead to increased anxiety, which can further amplify the physical symptoms.

In terms of management, it is crucial to maintain regular follow-ups with your healthcare providers. If you have been prescribed medication for your symptoms, it is important to adhere to the prescribed regimen and communicate any side effects or concerns with your doctor. If you find that your symptoms are not well-controlled or if they worsen, it may be necessary to revisit your treatment plan, which could include adjustments to your medication or additional therapies aimed at managing anxiety and autonomic dysfunction.

Additionally, lifestyle modifications such as stress management techniques, regular exercise, and a healthy diet can also play a role in managing symptoms associated with both MVP and autonomic dysfunction. Techniques such as mindfulness, yoga, or cognitive behavioral therapy may help in reducing anxiety and improving overall well-being.

In summary, there is a recognized connection between mitral valve prolapse and autonomic dysfunction, and your symptoms may be reflective of this relationship. It is essential to work closely with your healthcare providers to develop a comprehensive management plan that addresses both the physical and psychological aspects of your condition. Regular follow-ups and open communication with your doctors will be key in navigating your health concerns effectively.

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