Heart Pain: When to Seek Medical Attention for Symptoms

Chest discomfort or chest pain?

Hello Doctor: I would like to ask about my heart.
Sometimes I experience sudden sharp pains and chest tightness.
Previously, I had an episode where I suddenly felt uncomfortable with chest tightness, as if being squeezed, which became increasingly uncomfortable.
I felt short of breath and dizzy, and then I experienced a moment of blackout.
Someone noticed my pale complexion and quickly helped me sit down, so I didn't faint, but I felt very unwell.
This situation has occurred more than once, and I often experience discomfort from chest tightness and pain.
I visited a doctor once before, and they mentioned that I might have mitral valve prolapse.
If that is the case, should I go to the hospital for further examination?

Jing, 20~29 year old female. Ask Date: 2008/04/07

Dr. He Dongjin reply Cardiology

The symptoms described suggest mitral valve prolapse, which can be further evaluated in a cardiology clinic.
The mitral valve is a set of valves located between the left atrium and left ventricle.
Its primary function is to control the direction of blood flow.
During diastole of the left ventricle, the valve opens to allow blood from the left atrium to fill the left ventricle.
During systole, the valve closes to prevent backflow as the left ventricle pumps blood into the aorta to supply the rest of the body.
The mitral valve consists of two leaflets, resembling the shape of a bishop's miter, hence it is also referred to as the bicuspid valve.
We can simply think of the mitral valve as two door panels that can open into the left ventricle.

Mitral valve prolapse occurs when one or both of these panels are slightly too wide, causing them to bulge into the left atrium when closed.
In more severe cases, this can prevent the valve from closing tightly, leading to mitral regurgitation.

What is mitral valve prolapse syndrome? Clinically, patients with mitral valve prolapse can be divided into two main categories: one group experiences significant regurgitation leading to pulmonary edema and dyspnea, which is relatively rare and typically occurs in older males who may require surgical valve replacement.
The majority of mitral valve prolapse cases are mild and commonly found in tall, slender young women, presenting symptoms such as chest pain, dyspnea, and palpitations, often referred to as "mitral valve prolapse syndrome."
What is the prevalence of mitral valve prolapse? It is estimated to occur in about 5-15% of the population.
The exact causes of mitral valve prolapse and mitral valve prolapse syndrome are not fully understood.
Some researchers suggest a genetic component, while a small number of cases may be associated with systemic connective tissue disorders.
Currently, it is often explained by autonomic nervous system dysregulation.
The prevalence in the general population is approximately 5 to 10%, and most cases are mild, so there is no need for excessive concern upon diagnosis.
Is there a genetic link? Yes, there are genetic factors involved.
Common symptoms and features include: chest pain, fatigue, palpitations, feeling like the heart skips a beat, dizziness, shortness of breath, anxiety, tension, headaches, poor exercise tolerance, mood swings, slender physique, abnormal chest or spinal structure, and low blood pressure.
Severe complications can include endocarditis and significant mitral regurgitation leading to stroke.
Treatment principles: For young women with "mitral valve prolapse syndrome," the current approach leans towards educating patients on lifestyle modifications to manage symptoms.
This includes regular exercise, avoiding caffeine-containing foods and beverages, maintaining a regular daily routine, and staying well-hydrated.
Most patients find that these measures alleviate or even eliminate their symptoms.
Some physicians recommend self-management techniques during symptom episodes, such as lying down with legs elevated during chest pain or taking deep breaths to alleviate shortness of breath.
If these strategies are ineffective, doctors may prescribe a short course of low-dose beta-blockers and mild anxiolytics.

In summary, mitral valve prolapse is generally not serious for most patients, who can lead lives similar to those of individuals without the condition.
The key is open discussion and collaboration with healthcare providers, along with maintaining a healthy lifestyle.

Reply Date: 2008/04/07

More Info

When it comes to heart pain and associated symptoms, it is crucial to understand the potential implications and when to seek medical attention. Your description of experiencing sudden chest pain, a feeling of pressure, shortness of breath, dizziness, and near-fainting episodes raises several important considerations.

Firstly, the symptoms you describe can be indicative of various conditions, some of which may be serious. For instance, the sensation of chest tightness and pressure, especially if it is accompanied by dizziness and changes in skin color (like paleness), can be concerning for cardiac issues. While you mentioned that a doctor previously diagnosed you with mitral valve prolapse (MVP), which is a relatively common and often benign condition, it is essential to note that MVP can sometimes be associated with palpitations and chest discomfort. However, it is not typically associated with severe symptoms like fainting or significant shortness of breath.

Given your history of recurrent symptoms, it is advisable to seek further evaluation. Here are several reasons why:
1. Recurrent Symptoms: The fact that you have experienced these symptoms multiple times suggests that there may be an underlying issue that needs to be addressed. Even if your previous evaluations did not reveal any acute problems, persistent symptoms warrant further investigation.

2. Risk Factors: While you may be young and without known chronic diseases, risk factors such as family history of heart disease, lifestyle factors (like stress, diet, and exercise), and even emotional factors can contribute to heart-related symptoms. It is essential to evaluate these factors comprehensively.

3. Potential for Serious Conditions: Symptoms like chest pain and dizziness can sometimes indicate more severe conditions, such as arrhythmias, ischemic heart disease, or even structural heart problems. Although MVP is generally not life-threatening, it is crucial to rule out other potential causes of your symptoms.

4. Diagnostic Tests: Further testing may include an echocardiogram to assess the structure and function of your heart, a Holter monitor to evaluate for arrhythmias, or even stress testing to see how your heart performs under exertion. These tests can provide valuable information about your heart's health and help guide treatment.

5. Management and Treatment: If your symptoms are indeed related to MVP or another benign condition, your doctor can provide reassurance and management strategies to help alleviate your symptoms. This might include lifestyle modifications, medication, or regular follow-up to monitor your condition.

In conclusion, given the nature of your symptoms and their recurrence, it is highly recommended that you return to your healthcare provider for a thorough evaluation. Do not hesitate to express your concerns and insist on further testing if you feel it is necessary. Your health and well-being are paramount, and understanding the root cause of your symptoms is essential for effective management. Remember, it is always better to err on the side of caution when it comes to heart health.

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