Mitral Valve Prolapse: Symptoms, Diagnosis, and Management

Mitral valve prolapse

Six months ago, I frequently experienced chest pain, so I visited a cardiologist and was diagnosed with mitral valve prolapse.
At that time, both the electrocardiogram (ECG) and the 24-hour Holter monitor showed no abnormalities.
Over the past few months, I have been troubled by frequent palpitations, especially at night.
The chest pain has decreased compared to before.
During my follow-up appointment, I reported the palpitations to my doctor, who arranged for another ECG and a 24-hour Holter monitor, which identified a problem.
The doctor said it was benign arrhythmia.
I was originally prescribed Concor 1.25 mg to take one tablet every morning.
However, during yesterday's follow-up, the doctor adjusted the dosage to Concor 5 mg, taking half a tablet every morning.

I would like to ask why many doctors believe that benign arrhythmias do not require treatment and that lifestyle adjustments are sufficient, yet my doctor increased the dosage.
2.
I experience palpitations mostly at night; is it sufficient to take the medication only in the morning? 3.
What should I pay attention to regarding benign arrhythmias?

Anglela, 20~29 year old female. Ask Date: 2016/02/02

Dr. He Dongjin reply Cardiology

Hello, most benign arrhythmias do not require treatment and can be managed by adjusting your lifestyle.
However, if you are experiencing symptoms, it is advisable to take some medication to alleviate the worsening symptoms.
Since your symptoms are still causing you distress, you might consider adjusting the timing of your medication to take it before bedtime instead of increasing the dosage.
Changhua Hospital cares about your well-being.

Reply Date: 2016/02/02

More Info

Mitral Valve Prolapse (MVP) is a common condition where the mitral valve does not close properly, which can lead to various symptoms, including chest pain and palpitations. Your experience of chest pain and palpitations, particularly at night, is not uncommon among individuals diagnosed with MVP. Let's delve into the symptoms, diagnosis, and management of this condition, as well as address your specific concerns regarding your treatment.

Symptoms of Mitral Valve Prolapse
MVP can present with a range of symptoms, though many individuals may remain asymptomatic. Common symptoms include:
1. Palpitations: Many patients report feeling their heart racing or fluttering, especially during periods of stress or anxiety.

2. Chest Pain: This can vary in intensity and may be sharp or dull. It is often not related to exertion and can occur at rest.

3. Fatigue: Some individuals may experience unusual tiredness.

4. Dizziness or Lightheadedness: This can occur, particularly if there are associated arrhythmias.

5. Anxiety: The awareness of palpitations can lead to increased anxiety, which may exacerbate symptoms.

Diagnosis
The diagnosis of MVP typically involves:
1. Physical Examination: A healthcare provider may hear a characteristic "click" sound during a heartbeat, which is indicative of MVP.

2. Echocardiogram: This ultrasound of the heart is the gold standard for diagnosing MVP, allowing visualization of the valve's structure and function.

3. Electrocardiogram (ECG): This test records the electrical activity of the heart and can help identify any arrhythmias.

4. Holter Monitor: A 24-hour ECG can capture intermittent arrhythmias that may not be present during a standard ECG.

Management
Management of MVP often depends on the severity of symptoms and the presence of any complications, such as significant mitral regurgitation or arrhythmias. In many cases, especially when symptoms are mild, lifestyle modifications and reassurance are sufficient. However, in your case, where palpitations are frequent and bothersome, medication may be warranted.

1. Lifestyle Modifications: Reducing caffeine intake, managing stress, and ensuring adequate sleep can help alleviate symptoms.

2. Medications: Beta-blockers are commonly prescribed to help manage palpitations and anxiety associated with MVP. Your doctor’s decision to adjust your medication dosage may be based on your reported symptoms and the need for better control of your heart rate and rhythm.

3. Regular Follow-Up: Continuous monitoring through follow-up visits and possibly repeat echocardiograms or Holter monitoring may be necessary to assess the progression of the condition.

Addressing Your Concerns
1. Medication Adjustment: The increase in your medication dosage may be aimed at providing better control over your symptoms, particularly if your palpitations are frequent and disruptive. It is essential to communicate openly with your healthcare provider about your symptoms and any side effects you experience.

2. Timing of Medication: While you are currently taking your medication in the morning, it may be beneficial to discuss with your doctor the possibility of adjusting the timing if your symptoms predominantly occur at night. Some medications may be more effective when taken at specific times, depending on the nature of your symptoms.

3. Monitoring Benign Arrhythmias: While benign arrhythmias often do not require treatment, it is crucial to monitor their frequency and severity. Keeping a symptom diary can help you and your healthcare provider identify patterns and triggers. Additionally, staying informed about your condition and maintaining regular check-ups can help manage any potential complications.

In conclusion, MVP is a manageable condition, and with appropriate lifestyle adjustments and medical management, many individuals lead normal, active lives. It is essential to maintain open communication with your healthcare provider to ensure that your treatment plan aligns with your symptoms and lifestyle. If you have further concerns or if your symptoms change, do not hesitate to reach out to your doctor for guidance.

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