Managing Mitral Valve Prolapse: Treatment Options and Medication Guidance

Treatment directions and medication consultation for mitral valve prolapse?

In 2003, I visited the emergency department due to suspected panic attacks, and the electrocardiogram (ECG) showed no abnormalities.
In 2006, a health check revealed ST segment or T wave changes, and I was diagnosed with "myocardial infarction" at a regional hospital.
After medication, I could not relieve my chest tightness and shortness of breath, so I went to another regional hospital, where I was diagnosed with "mitral valve prolapse." I was prescribed Inderal and Erispan, which provided some control.
I continued medication in this regard.

In 2007, a health check showed sinus arrhythmia, and I continued treatment at a cardiology clinic, where I was diagnosed with "mitral valve prolapse and anxiety disorder" and prescribed Inderal, Cabudan, Cartil, and Erispan.
My condition was somewhat controlled, but I occasionally felt unwell.
In 2008/2009, a health check revealed incomplete right bundle branch block, and I continued treatment at the cardiology clinic, where I was prescribed Inderal, Cabudan, Cartil, and Aprazo.
My condition was somewhat controlled, but I still felt unwell occasionally.
In February 2009, I experienced sore throat, cough, fever, chills, dizziness, and chest tightness, leading to hospitalization.
The cardiology department diagnosed "mitral valve prolapse and anxiety disorder" but considered the condition not serious.
I was referred to psychiatry for treatment focused on "panic disorder and anxiety disorder," and prescribed Deanxit and Xanax XR (one in the morning and one at night), which improved my condition compared to before.
By July 2009, I was only taking one Xanax XR in the morning and was able to maintain a normal life.
In August 2009, I felt palpitations for two consecutive days (lasting several hours each time) but without chest tightness, so I returned to the cardiology clinic for treatment, where I was prescribed Inderal, Cabudan, and Cartil.
I am 170 cm tall and weigh 50 kg.
The regional hospital doctors ultimately concluded that there was no need for aggressive treatment of mitral valve prolapse and shifted focus to mental health treatment, which has improved my condition compared to before.
I suspect that previous heart medications caused side effects such as cold extremities, fatigue, mild diarrhea, and poor sleep (sometimes waking up at three or four in the morning).
Currently, these issues have resolved (except for slightly heavy eyelids during the day, as I take one Xanax in the morning).
However, the clinic doctor (who is a retired physician from the regional hospital and now practices independently, with ECG and ultrasound equipment available) believes that there is also mitral and tricuspid valve prolapse present, and that taking Inderal, Cabudan, and Cartil can protect the heart (as my resting heart rate is about 86 beats per minute) and prevent tachycardia.
Additionally, I consulted the regional hospital doctor regarding the medications prescribed by the clinic doctor (due to more side effects), and the regional hospital doctor advised that if I were to take medication, I should only take Inderal and avoid the other two, but did not explain the reason.

I have the following questions:
1.
How should I adjust my medication? Who is correct? I am concerned that taking Inderal and others might cause side effects that disrupt my life.
Would not taking them be worse for my heart? If I start taking them, will I need to continue indefinitely?
2.
How can I determine the severity of the prolapse and whether treatment is necessary? As mentioned in the Q&A, its prevalence is quite high, and for some, it may not require treatment.

I apologize for the lengthy description, but I hope it clearly conveys my situation, and I appreciate your guidance.

Tony, 30~39 year old female. Ask Date: 2009/08/21

Dr. He Dongjin reply Cardiology

Dear Tony, I also believe that there is no need for aggressive treatment of mitral valve prolapse; instead, focusing on mental health treatment is sufficient.
Taking Inderal can help avoid tachycardia.
I am skeptical about the claim that it protects the heart, and considering the use of multiple medications, blood pressure may drop, leading to more side effects.
Personally, I prefer to manage with simpler medications.
Additionally, I consulted a regional hospital physician regarding the medications prescribed by the clinic doctor (due to the higher incidence of side effects), and the regional hospital physician advised that if medication is necessary, only Inderal should be taken, and the other two should be avoided.
I agree that not taking medication may be worse for the heart.
If medication is needed, will it have to be taken indefinitely? Otherwise, adjustments can be made based on the situation at that time.
This is related to the autonomic nervous system; if it is overly stimulated, symptoms may manifest, but if stable, medication can be gradually reduced.
As mentioned in the Q&A, the prevalence of this condition is quite high, and in some cases, treatment may not be necessary.
Indeed, determining the severity of prolapse requires an ultrasound, and treatment should be based on symptoms.
Engaging in more exercise and maintaining a healthy lifestyle can gradually improve the condition.
Changhua Hospital cares about you.

Reply Date: 2009/08/21

More Info

Managing mitral valve prolapse (MVP) can be complex, especially when it is associated with anxiety and panic disorders, as you have described in your medical history. MVP is a common heart condition where the mitral valve does not close properly, which can lead to various symptoms, including palpitations, chest discomfort, and anxiety. Let's address your questions regarding medication adjustments and treatment options.

1. Medication Adjustment: It seems you have been prescribed a combination of medications, including Inderal (propranolol), Cabudan, Cartil, and Erispan, to manage your MVP and associated symptoms. Inderal is a beta-blocker that can help reduce heart rate and alleviate symptoms of anxiety, which may be beneficial for someone with MVP. However, it can also cause side effects such as fatigue, cold extremities, and gastrointestinal disturbances, as you mentioned.

The advice from your regional hospital physician to focus on Inderal alone may be based on the principle of minimizing polypharmacy, especially if the other medications are not providing significant benefits or are causing side effects. It is essential to have a thorough discussion with your healthcare provider about the necessity of each medication. If Inderal is effectively managing your symptoms without significant side effects, it may be reasonable to continue with it. However, if you experience adverse effects that impact your quality of life, it may be worth considering a reevaluation of your treatment plan.

It is also crucial to monitor your symptoms closely. If you notice an increase in palpitations or anxiety, it may indicate that the current regimen is not sufficient. Regular follow-ups with your healthcare provider can help assess the effectiveness of your treatment and make necessary adjustments.

2. Severity of Mitral Valve Prolapse: The severity of MVP can be determined through echocardiography, which assesses the degree of mitral valve regurgitation and the structural integrity of the valve. Many individuals with MVP experience mild symptoms or none at all and do not require treatment. In contrast, those with significant regurgitation or symptoms that interfere with daily life may benefit from more aggressive management, including medication or, in rare cases, surgical intervention.

It is essential to consider the overall clinical picture, including your symptoms, the degree of regurgitation, and any associated conditions like anxiety. If your MVP is mild and you are asymptomatic or only mildly symptomatic, it may not require any specific treatment beyond monitoring. On the other hand, if you experience significant symptoms, a more proactive approach may be warranted.

In conclusion, managing MVP involves a careful balance between controlling symptoms and minimizing side effects from medications. Regular communication with your healthcare provider is vital to ensure that your treatment plan aligns with your current health status and lifestyle. If you have concerns about your medications or symptoms, do not hesitate to reach out to your healthcare provider for guidance. They can help you navigate the complexities of your condition and adjust your treatment plan as necessary.

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