Mitral Valve Prolapse and Its Impact on Heart Rhythm Changes

Mild mitral valve prolapse and regurgitation?

Previously, I went to the emergency room due to symptoms of generalized numbness, shaking, weakness, difficulty swallowing, inability to stand, and dizziness.
I was later diagnosed with hyperventilation.
During my second visit to the emergency room, I began to experience chest pain.
Subsequent tests, including a resting electrocardiogram, chest X-ray, and exercise electrocardiogram, all returned normal results.
However, an echocardiogram revealed mild mitral valve prolapse with mild regurgitation.
Currently, I am experiencing significant weakness, especially at night, although the chest pain has decreased and palpitations have become less frequent.

I have noticed a significant difference in my heart rate when standing versus lying down or sitting.
Yesterday, I began to feel unwell as I was about to sleep.
While standing, my heart rate was 91, which seemed high, so I lay down, and my heart rate dropped to 65.
When I felt better, my heart rates were 58 while lying down, 64 while sitting, and 76 while standing.
When I felt unwell, my heart rates were 80 while lying down, 85 while sitting, and 101 while standing.

Is this considered arrhythmia, or is it simply related to the mitral valve? Sometimes, when I measure my heart rate while sitting, it is only 65-75, but I feel very uncomfortable, and standing makes me feel weak and unstable.
My question is whether the changes in heart rate due to posture are indicative of arrhythmia or just a result of the mitral valve issue.
Do I need further evaluation? Thank you, doctor.

A Yu, 20~29 year old female. Ask Date: 2015/07/12

Dr. He Dongjin reply Cardiology

Hello, your heart rate is not a concern, and the numbers you mentioned are all within the normal range.
The symptoms you described sound like they are related to autonomic nervous system dysfunction.
Please consult your primary physician regarding medication for autonomic nervous system disorders.
Changhua Hospital cares about you.

Reply Date: 2015/07/12

More Info

Mitral Valve Prolapse (MVP) is a condition where the mitral valve, which separates the left atrium from the left ventricle of the heart, does not close properly. This can lead to mitral regurgitation, where blood leaks backward into the left atrium when the left ventricle contracts. MVP is relatively common and often benign, but it can be associated with various symptoms, including palpitations, chest pain, and in some cases, anxiety or panic attacks.

Your experience of feeling weak, especially at night, and the variations in your heart rate based on your position (lying down, sitting, or standing) can be concerning. The changes in heart rate you described—where your heart rate decreases significantly when lying down and increases when standing—are not uncommon and can be attributed to several factors, including the body's autonomic nervous system response and the effects of MVP.

1. Heart Rate Variability: It's normal for heart rate to vary with posture due to the autonomic nervous system's regulation of blood flow and heart function. When you stand, your heart rate increases to maintain blood pressure and blood flow to the brain. Conversely, lying down can reduce the heart's workload, leading to a lower heart rate. The heart rate changes you observed (e.g., 58 bpm when lying down and 101 bpm when standing) are within a physiological range, but the symptoms of discomfort you experience are significant.

2. Symptoms and MVP: The symptoms you describe, such as feeling weak, shaky, and experiencing difficulty standing, can be related to MVP, especially if you have anxiety or panic attacks. MVP can sometimes lead to arrhythmias (irregular heartbeats), which can cause palpitations or a feeling of the heart racing. However, the fact that your heart rate is significantly lower when lying down suggests that your heart is functioning normally in that position.

3. Need for Further Evaluation: Given your symptoms and the history of feeling faint and weak, it would be prudent to discuss these concerns with your healthcare provider. They may recommend further evaluation, such as a Holter monitor (a portable ECG device that records your heart's rhythm for 24-48 hours) to assess for any arrhythmias that may occur during your daily activities or at night. Additionally, an echocardiogram can help evaluate the severity of the mitral regurgitation and any potential impact on heart function.

4. Management and Lifestyle: In many cases, MVP does not require treatment unless symptoms are severe or complications arise. Lifestyle modifications, such as managing stress, regular exercise, and avoiding stimulants (like caffeine), can help alleviate symptoms. If anxiety is a significant factor, cognitive behavioral therapy or relaxation techniques may be beneficial.

5. When to Seek Help: If you experience worsening symptoms, such as increased chest pain, shortness of breath, or severe dizziness, it is essential to seek medical attention promptly. Additionally, if you notice any new symptoms or significant changes in your condition, it is advisable to consult your healthcare provider sooner than your scheduled follow-up.

In summary, while the heart rate changes you experience with posture are not necessarily indicative of a serious problem, the associated symptoms warrant further evaluation to ensure that there are no underlying issues related to your mitral valve prolapse or other cardiac conditions. Regular follow-ups with your cardiologist will be crucial in managing your condition effectively.

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