Which Specialist Should You See for Mitral Valve Prolapse and Anxiety?

Which specialty should I consult for mitral valve prolapse and autonomic nervous system dysfunction?

Dear Doctor: I have been experiencing issues with sleep quality for a long time.
As a single parent of two children, I often struggle to get enough rest, which leads to frequent outbursts of anger towards my kids.
Coupled with physical exhaustion, family stress, and unhappiness, I have been feeling unwell for the past six months.
I experience headaches, dizziness, tightness in my shoulders and neck, widespread body aches, loss of appetite, and I easily feel down or irritable.

About two to three months ago, I suddenly felt chest tightness and had difficulty breathing, almost like asthma, along with unexplained coughing and frequent shortness of breath.
I visited a cardiologist who diagnosed me with mitral valve prolapse and autonomic nervous system dysfunction.
The doctor prescribed Inderal for heart rhythm and muscle relaxants, and now I am on Inderal along with anxiety medication, taking it twice a day.

I would like to know if this treatment will help improve my condition.
Am I on too high of a dosage? I am still young; how can I effectively treat this condition? Will it get better? Whenever I feel fatigued, have poor sleep, or experience tension, I become uncomfortable.
It feels like my life is being affected.
What should I do? What type of exercise is suitable for me right now? Should I continue treatment with the cardiologist, or do I need to see other specialists or undergo additional tests?

Wo yao jiankang, 30~39 year old female. Ask Date: 2015/09/09

Dr. Ding Shuyan reply Psychiatry

Hello, the cardiologist who prescribed these medications should have explained to you that there may not be any issues with your heart itself, but rather problems related to the autonomic nervous system or emotional stress.
These medications are effective and you should feel temporary relief after taking them; however, they primarily address the symptoms rather than the underlying causes.
If you are open to it, I personally recommend seeing a psychiatrist or psychologist, as they specialize in these areas.

Exercise is definitely effective for stress relief.
When choosing an activity, the first principle is to select something that interests you, as you will be more likely to engage in it.
The second principle is to choose an activity that matches your current physical ability and time availability, which will help ensure sustainability.
In the worst-case scenario, even brisk walking near your home can be beneficial.
Symptoms of anxiety and stress are generally well-treatable in psychiatry, but unlike a cold that resolves in two to three days, treatment may take some time.
For long-term maintenance, practices such as muscle relaxation exercises and diaphragmatic breathing are excellent and can help prevent frequent recurrences.
Many women find yoga to be more acceptable; if there are classes nearby, it could be a great option to consider.
Wishing you all the best,
Dr.
Ding Shuo-Yan

Reply Date: 2015/09/09

More Info

Mitral valve prolapse (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. Given your situation, it’s understandable that you are feeling overwhelmed, especially with the added stress of caring for two children and dealing with sleep deprivation.
First, it’s important to recognize that MVP itself is often benign and may not require aggressive treatment unless it leads to significant complications. However, the symptoms you are experiencing, such as chest tightness, shortness of breath, and anxiety, can be distressing and may require a multidisciplinary approach to management.

Which Specialist Should You See?
1. Cardiologist: Since you have already been diagnosed with MVP and have seen a cardiologist, it is essential to continue follow-ups with them. They can monitor your heart condition and adjust medications like Inderal (propranolol), which is often prescribed for anxiety and to manage palpitations associated with MVP. Regular check-ups will help ensure that your heart health is stable.

2. Psychiatrist or Psychologist: Given your symptoms of anxiety, depression, and the impact of stress on your physical health, consulting a mental health professional is crucial. A psychiatrist can evaluate your mental health and prescribe medications if necessary, while a psychologist can provide therapy to help you develop coping strategies for stress and anxiety. Cognitive-behavioral therapy (CBT) is particularly effective for anxiety disorders.

3. Primary Care Physician (PCP): Your PCP can coordinate your overall care, ensuring that both your physical and mental health needs are addressed. They can also help manage any medications you are taking and refer you to specialists as needed.

Medication Management
You mentioned that you are currently on Inderal and medication for anxiety. It’s essential to have regular follow-ups with your prescribing doctor to assess the effectiveness of these medications and to monitor for any side effects. The dosage should be tailored to your specific needs, and it’s crucial to communicate any concerns about feeling overmedicated or under-medicated.

Lifestyle Modifications
1. Stress Management: Incorporating stress-reducing techniques such as mindfulness, meditation, or yoga can be beneficial. These practices can help you manage anxiety and improve your overall well-being.

2. Exercise: Regular physical activity can significantly improve both physical and mental health. Low-impact exercises such as walking, swimming, or cycling can be suitable, especially if you start slowly and gradually increase intensity. Always consult your cardiologist before starting any new exercise regimen to ensure it is safe for your condition.

3. Sleep Hygiene: Improving your sleep quality is vital. Establishing a regular sleep schedule, creating a restful environment, and avoiding stimulants before bedtime can help enhance your sleep quality.

4. Nutrition: Eating a balanced diet rich in fruits, vegetables, whole grains, and lean proteins can support your overall health and help manage anxiety.

Conclusion
In summary, you should continue to see your cardiologist for your mitral valve prolapse while also seeking support from a mental health professional to address your anxiety and stress. It’s essential to communicate openly with your healthcare providers about your symptoms and concerns. With the right combination of medical care, lifestyle changes, and support, it is possible to manage your symptoms effectively and improve your quality of life. Remember, you are not alone in this journey, and seeking help is a significant step towards feeling better.

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