Articles of interest for MVPS/D patients, taken from past issues of "And The Beat Goes On"
Check this page often, as articles will be updated and changed.
Last Date Edited, January 11, 2017
PHILLIP WATKINS MD
Fatigue is the most common symptom reported by a large number of patients. A study of almost 2,000 patients revealed that 92 percent reported fatigue as the most common complaint; The fatigue is nonspecific and not necessarily related to exercise or even activity. At times it is quite difficult to differentiate from depression, and, indeed, associated depression can be present. A patient related that, "I am simply tired all the time and don't feel like doing anything." Whereas many of the patients are deconditioned, the level of conditioning or aerobic fitness is not necessarily correlated with symptoms.
ONE OF THE MOST FREQUENT CARDIAC SYMPTOMS MENTIONED BY PATIENTS IS THAT OF INCREASED CARDIAC AWARENESS. THESE PATIENTS MAY BE CONSCIOUS OF EVERY HEART BEAT AND PERCEIVE THE HEART AS POUNDING OR BEATING MOREFORCEFULLY. THIS CAN OCCUR WITH EVEN A FAIRLY NORMAL PULSE RATE. THEY DESCRIBE A FEELNG OF CARDIAC AWARENESS THAT ONE WOULD EXPECT TO EXPERIENCE AFTER VGOROUS EXERCISE, BUT THESE PATIENTS EXPERIENCE THI S AT REST, LYING DOWN, OR WHILE TRYING TO SLEEP. ANOTHER COMMON SYMPTOMS IS THAT OF A POUNDING OR IRREGULAR HEARTBEAT AT NIGHT, PAARTICULARLY WHEN LYING ON THE LEFT SIDE (TREPOPNEA.)
THESE PATIENTS TYPICALLY HAVE TO CHANGE POSITIONS BECAUSE OF THE CARDIAC AWARENESS EXPERIENCED IN THIS POSITION. ALSO FREQUENTLY NOTED IS AN IRREGULARITY IN THE HEARTBEAT THAT MAY BE PREMATURE VENTRICULAR CONTRACTIONS AND, AT OTHER TIMES, PREMATURE ATRIAL CONTRACTIONS. THE PATIENT ALSO FREQUENTLY EXPERIENCES NOCTURNAL SYMPTOMS AND MAY AWAKEN AT NIGHT WITH A RACING, POUNDING HEARTBEAT ASSCIATED WITH FEELINGS OF MARKED ANXIETY.
TAKE A STAND
When 20 year old Sue Smith left her home in Caifornia to attend college in Wisconsin, she had visions of freedom and fraternity parties. Those dreams evaporated in November of her freshman year when she was hospitalzed with the flu. A few weeks later, after watching a movie in her friend's dorm room, she stood up and promptly passed out.
"I thought it was a fluke, but a couple of days later, it happened again." By January, I was fainting up to 10 times a day, says Sue, a busy college student who was active in campus government and worked as an intern for a counseling service.
Sue visited dozens of physicians and spent weeks hospitalized with various ailments, yet no one could identify the cause of her symptoms. Some doctors even claimed she was makng it up. Nearly two years passed before an official diagnosis: postural orthostatic tachycardiaa syndrome, or POTS.
Sue's fainting spells are one of the hallmarks of POTS. Another is trouble standing up, primarily because not enough blood returns to the heart upon standing, which causes a rapid increase in heart rate called tachycardia. In fact, the diagnostic criteria for this syndrome include an incease in heart rate of more than 30 beats per minute (40 beats per minutes for children) or a heart rate of 120 beats per minute within 10 minutes of standing. Other symptoms include chronic fatigue, "brain fog," and pain.
To confrim her diagnosis, doctos monitored Sue's heart rate and blood pressure while moving her from a horizontal to a vertical position on a special tilting table. Unfortunately once Sue tested positive during this "tilit table test," doctors" still didn't know how to treat her.
Even though Mayo Clinic researchers coined the term "POTS" in 1993, many physicians have never seen the condition in their practice, or at least have not identified it accurately, in part because there are so many accompanying symptoms that can be mistaken for something else.
for most people, standing up is simple. Blood pools in the lower body and pelvic area as we rise to our feet and our heart rate increaes slightly as part of a reflexive adjustment.
In people wit POTS, however, this regulatory system is out of whack. Blood doesn't flow where it should, forcng the heart to work harder. Since the heart isn't getting enough blood patients feel light-headed, dizzzy, and out of breath.
Why are we writing about POTS in a web site about MVPS? Let's look at the symptoms of POTS:
Change in perspration
Temperature control problems
Difficulty concentrating "brain fog."
Sound familiar? Many people with POTS also have a mitral valve prolapse. Just another type of dysautonomia.
The majoriety of people with MVPS who actually faint is small. If you are one of the few that does faint talk to your doctor about it.
Many people with MVPS/d go to their doctors hoping for help with their fatigue and exercise intolerance.
However, when these indivduals seek medical advice, the responces are seen as abnormal, and frequently, pharmacological treatments are prescribed.
This is not surprising. Physicians are presented with symptoms and use tools they are most familiar with, often drugs, to address them.
Unfortunately, most physicians are simply unfamiliar with the complex physiological responses to acute exercise, and, more importantly, the adaptations associated with exercise training.
MVPS/d patients can be in a severe deconditioned state. This can cause excessive rise in heart rate, cardiac atrophy, reduced exercise capacity, low blood volume, muscle atrophy, and any other wide-ranging structural and metabolic changes.
This brings up the question, should deconditioning become medicalized? In this context there are a number of other chronic medial conditions, most notably fibromyalgia, chronic fatigue syndrome, and POTS, that are associated with poor exercsie capacity, and the patient narratives and physician responses are frequently similar to those outlined above for MVPS/d
MVPS/d is a syndrome that is diagnosed far more frequently in young-and middle-aged women than men, and by the time of definitive diagnosis patients have typically spent several years seeking expert advice.
While dealing with unpleasant symptoms during this time, there may be a period of inactivity, followed by more inactivity. Thus, a downward spiral of inactivity and deconditioning occurs. This downward spiral can be made worse by related perceptual issues, including somatic hyper vigilance* and fatigue, that can be improved with exercise training.
There is hope for these deconditioned patients in exercise traning in a supportive environment. If deconditioning were a more mainstream medical diagnosis, perhaps the awareness of the average physician treating the average patient would increase more formal therapeutic rehab programs that include congnitive and behavioral therapy. In cases like MVPD/d, deconditioning could be diagnosed and treated.
Physical inactivity and lack of exercise, deconditioning, is one of the most common, preventable causes of morbidity and mortality known for an impressive array of diseases. It also appears to be a final common pathway for conditions like fibromyalggia, POTS, and chronic fatigue syndrome.
If deconditioning were a recognized syndrome or diagnosis like hypertension or diabetes, it would be easier to educate the general public and medical community aboout the one universally effective treatment for it - exercise training.
Despite years of trying, it has been difficult to identify a limited set of causative agents or factos that account for these conditions and devise effective drug-based therapeutic protocols. This leads to frustrated patients, frustrated physicians, and people seeking all sorts of explanations for these conditions.
Journal of Physiology
* Enhanced state of sensory sensitivity accompanied by an exaggerated intensity of behavior whose purpose is to detect threats.
Phillip C. Watkins, M.D., Director of the MVP Center, Birmingham, Alabama
A common problem in patients with Mitral Valve Prolapse Syndrome is the presence of mood swings. These mood swings are particularly noticeable in the months from November through March. During this period of time many patients experience marked changes in mood, particularly the onset of depression. In the past this has been termed the "holiday blues" but also is known as "seasonal affective disorder or S.A.D." It is very puzzling to understand why this occurs especially in with MVP Syndrome.
If this sounds like you, it is time to get help now before the really short and dark days of winter. Talk to your doctor. The SSRIs, prozac, zoloft, paxil, etc, are used for SAD. If you don't want to take medication, look into "light therapy". Exercise can also help, as can getting out side in the sun for a while everyday.
YOUR FLUID IS TOO LOW
Temporary low blood pressure commonly happens when standing up. It is called orthostatic hypotention. It can also happen after eating, especially after eating, expecially a large meal, and that is called postprandial hypotention. This can cause symptoms of dizziness, confusion problems, chest pain, fainting, and falling.
Diseases that affect the nervous system, dyautonomia being one of them, interfere with blood pressure regulation. Dehydration, some medications, and lack of physical activity can also contribute to problems with low blood presure.
To understand postural hypotention, imagine your body as a tube of fluid. When you stretch out on your bed, the fluid distributes itself fairly evenly from head to toe. Stand up, and gravity tugs it downward. A quart or so of blood pools in the legs, reducing the amount that's returned to the heart. The next few heartbeats deliver less blood than usual, so blood pressure pluments. Standing after sitting has much the same effect.
A similar event happens after eating, as the body directs extra blood toward the stomach and intestines to aid digestion.
Feeling faint or lightheaded?
People with MVPS/D often feel dizzy and/or lightheaded. While they usually don't actually faint, they often feel like they might.
Dr. van Dijk led a study in which 223 patients with a history of syncope (fainting) pre-syncope were given education on lifestyle changes or were trained in "physical counterpressure" exercises.
The three exercises are leg crossing, hand-gripping, and arm-tensing. The participants were instructed to use the muscle-tensing techniques in situations known to provoke fainting and/or lightheadedness, such as fear, pain, stress, fatigue, dehydration, straining, low blood pressure as a side effect of medications, and prolonged severe coughing. During the 14-month follow-up, use of the exercise technique reduced the risk of fainting by more than one-third. Thoses in the exercise group also reported using the exercises to cut short episodes of ightheadedness. The study presented at a recent meeting of the American College of Cardiology is believed to be the first to assess the effectivness of physical counterpressure techniques in daily life.
These exrcises are "tonic" contraction, that is sustained contraction of a muscle, not multiple contractions, as used to maintain posture. "The treatment is very simple, inexpensive, noninvasive, and has no long-term side effects" Dr van
The three maneuvers increase venous blood flow to the heart so it can be pumped to the brain to prevent blood pressure from dropping to very low levels. However, to see if you are doing them correctly you should talk to your doctor.
BETA-BLOCKERS FOR MVPS
When we think of beta-blockers, we think of treating high blood pressure. While that is true, beta-blockers do a lot more than lower blood pressure.
Usually , the first medication prescribed for MVPS/D patients is beta-blockers, also known as beta-adrenergic blocking agents.
Beta-blockers block norepinephrine and epinephrine (adrenaline) from binding to beta reciptors on nerves. There are three functions, based on their location in the body:
Beta 1 receptors are located in the heart, eyes, kidneys.
Beta 2 receptors are found in the lungs, gastrointestinal tract, liver, uterus, blood vessels, and skeletal muscle.
Beta 3 receptors are located in fat cells.
By blocking the effect of norepinehrine and epinephrine, beta-blockers reduce heart rate, reduce blood pressure by dilating blood vessels, and may constrict air passages by stimulating the muscles that surround the air passages.
Beta-blockers are also used for abnormal heart rhythms, migraines, and anxiety. Some people take beta-blockers before they do public speaking. Beta-blockers are even used to treat glaucoma.
Beta-blockers differ in their effects and in the type of beta receptors they block. Your doctor will decide which one is best for you.
Non-selective beta-blockers, for example, propranolol (Inderal), block B1 and B2 receptors and, therefore, affect the heart, blood vessels, and air passages.
Selective beta-blockers, like metoprolol (Lopressor, Toprol XL), primarily block B1 receptors and, therefore, mostly affect the heart and do not affect air passages.
Some beta-blockers, for example, pindolol (Visken), have intrinsic sympathomimetic activity (ISA), which mens they mimic the effects of epinephrine and norepinephrine in blood pressure and heart rate. Beta-blockers with ISA have smaller effects on heart rate than agents that do not have ISA.
Labetald, Trandate, and carvedilol (Coreg) block beta and alpha-1 receptors. Blocking alpha receptors adds to the blood vessel dilating effect of labetalol (Normodyne, Trandate) and carvedilol (Coreg).
To try and simplify all this, beta-blockers prevent irregular heart beats by making your heart beat more slowly and with less force. They also help blood vessels relax and open up to improve blood flow.
For people with MVPS/D one of the most important things beta-blockers do is to block the effects of adrenaline and to reduce symptoms of anxiety. Many people with MVPS/D seem to have a disorder of adrenaline regulation
Beta-blockers blodk the effects of epinephrine and norepinephrine released by the autonomic nervous system. Beta-blockers also reduce sympathetic activity by blocking sympathtic impulses.
Many time MVPS/D patients are afraid to take beta-blockers for fear it will lower their blood pressure too much. This usually doesn't happen, because we need a very small dose.
Editors note: I take on-half of 25 mgs. of Tenormin. I was startaed originally on a low dose of Inderal. It did lower my blood pressure too mucn, As a result I becamse very dizzy all the time. When this happen you can always try another beta-blocker, as I did. There are many to try.
Mitral Valve Prolapse Syndrome and Physical Activity.
People with MVP and MVPS/D are interested in how much, and what kind of activity they can safely participate in. Most of the time they can do anything anyone else can do. In most individuals MVP and MVPS/D are benign and cause few if any symptoms. And, in fact, aerobic exercise is encouraged for all patients with MVP and/or MVPS/D.
One study demonstrated that a 12-week aerobic exercise program improved the symptoms and functional capacity of women with documented MVPS/D. Compred with the contol group showed a significant decrease in anxiety, as well as an increase in general well-being functional capacity, and a decline in symptoms such as chest pain, dizziness, and mood swings.
Two groups of patients with documented prolapsea emerge from the literature: Those whose symptoms are directly related to their valvular disease, and those whose symptoms cannot be explained on the basis of their valvular disease alone. The first group has been referred to as MVPS-anatomic, and the second group as having MVPS/D.
Those with MVPS/D have a constellation of systemic symptoms. The pathogenesis of these saymptoms is not well understood but is thought to be multifactorial, including adrenergic hyper-responsiveness, autonomic dysfunction, and abnormal renin aldosterone response to volume. Hypotension is thought to contribute to the dizziness or synocope that some patients who have MVPS/D experience. This is of particular importance to athletes with MVPS/D because they may be more sensitive to dehydration induced by vigorous physical activity, and thus, at higher risk for exercise induced syncope.
Other symptoms reported by those with both MVP and MVPS/D include chest pain fatigue, dyspnea, exercise intolerance, headaches, sleep disorders, anxiety and panic attacks, irritable bowl symnptoms, and vascular symptoms such as flushing and cold extremities.
Most athletes who have either MVP or MVPS/D can safely participate in all activities. Those who show no evidence of mitral thickening or redundancy are at lowest risk for any complications.The 26th Bethesda Conference addressed the topic of exercise for athletes who have either MVPS or mitral regurgitation. The recommendations:
Athlets with MVP (having structurally abnormal valve manifested by by leaflet thickening and longation) and without any of the following creiteria can engage in all competitive sports:
History of syncope documented to be arrhythmogenic in origin
Repetitive form of sustained and nonsustained supraventricular arrhythmias, particularly if exaggerated by exercise
Moderate-to-marked mitral regurgitation
Prior embolic event
Athletes with MVP and one or more of the aforementioned criteria can participate in only low intensity competitive sports. For athletes who suffer from moderate-to-severe mitral regurgitation every effort should be made to reduce factors that increase regurgitation. In addition to reducing weight and controling blood pressure static exercise such as weihgt lifting should be avoided because it can result in dramatic increases in blood pressure, thereby worsening mitral regurgitation. It is important to remember that MVP rarely results in serious complications.
Nonetheless, people who have MVP must be identified and their risk level accessed for optimal managment of symptoms and risk. Pursuing the appropriate workup and proceeding with targeted therapy will allow patients to lead safe, healthy active lives.
Most of you have had an echocardiogram, which can help classify patients as having low, mild, moderate, or high risk of complications. Doppler echocardiogram is useful in evaluating the size and intensity of the mitral regurgitant flow or jet.
Other tests to consider in the patient with mvp include electrocardiography to screen for conduction disturbance, 24-Holter monitoring to evaluate those with palpitations, graded exrecise stress testing to monitor exercise tolerance, and stress echocardiography. The stress echo may prove helpful in determining if there is exercise induced regurgitation.
We want to repeat this again:
Most patients who have MVP or MVPS/D will have a benign form with no significant complications. If your physician has told you that you can participate in competitive sports or just your own exercise program, and he/she has taken the proper tests to ensure your safety GO FOR IT!! You can be in the best physical shape you have ever been in, and your heart and MVPS/D symptoms will improve greatly.
Exercise and Leaking Valves
"An echocadiogram showed a small leak in my mitral valve. About a year later in a follow-up echocariogram, some leakage in my tricuspid valve was also found. The valves are not causing me any problems, but I wonder if it's okay for me to exercise and lift light weights?"
This is a familiar question to doctors treating patients with MVPS/D.
For three of the four cardiac valves, the mitral, tricuspid, and pulmonic, a little bit of leakage is completely normal. In fact, for the mitral and tricuspid valves, the backflow of blood occurs well before the valve closes.
Modern echocardiography equipment is so sensitive that virtually everyone's echocardiogram shows some leakage of the mitral and tricuspid valves, provided the images are techinically reasonable. So, if your doctor tells you that you have a little mitral and/or tricuspid regurgitation, but you don't need to worry about it, don't let it interfere with your exercise program.
The aortic valve, in contrast, doesn't normally leak, not even a little. It acts like a door between the heart and the main artery of the body (the aorta). Nature probably sculpted this valve to close early,before blood can rush back towardthe heart, as a way to direct blood into the coronary arteries.These arteries, which nourish the heart muscle, originate just beyond the aortic valve. If the valve closes early more blood pressure is available to fill the needy coronary arteries.
In fact, a healthy lifestyle and regular exercise are the mainstays of management of mitral valve prolapse/dysautonomia.
When you exercise you increase the tone of the autonomic nervous system, which causes a decrease in heart rate and a decrease in blood pressure. Exercise is the most potent medication we have for improving autonomic function. It is essential to lowering your resting heart rate.
Aerobic exercise, including walking, jogging, swimming, or cycling at a moderate pace for 30 minutes at a time is the safest way to begin exercise.
Light weights are usually tolerated, but heavier ones can trigger symptoms. Many times it is better to first get yourself aerobically fit and then start using light weights to tone up.
If you are not used to exercising, start out slowly and build up over time. Of course you should aks your doctor's advice before starting an exercise program. If you exercise with others in an aerobic class for instance, that cute little instructor may say, "Let's take our heart rates." Don't be surprised if your pulse is a lot faster than others in the class that don't have MVPS. As you get more fit, your heart rate should go down.
Your heart is a muscle and, like any muscle, it gets stronger with exercise. Aerobic exercise strengthens the heart and makes it more efficient and is generally recommended for those with MVPS
"Treatment of Symptomatic Mitral Valve Prolapse Syndrome and Dysautonomia"
Phillip Candler Watkins, MC, FACC
The patient with symptomatic mitral valve prolapse and dysautonomia can present with multiple symptoms including fatigue, chest pain, increased cardiac awareness, and mood changes. Many of these symptoms are mistaken for other disorders, and the diagnosis is not easily made. The patient should be evaluated carefully with a complete history, as well as a physical exam and appropriate testing, including treadmill testing and echocardiography (echo). Treatment should consist of complete education of the patient, stressing the importance of life style changes, such as avoiding caffeine and a prescription for regular exercise. Appropriate medication may include a beta-blocker if the patient is hyperadrenergic, and a tricyclic, benzodiazepine, or a serotonin reuptake inhibitor (SSRI) if the patient experiences mood swings. The patient who experiences syncope and marked hypotension may require fluorohydrocortisone. Carefully following these life-style changes and appropriate use of medication should produce marked improvement of the patient's symptomatology.
Strong Association of Thyroid Disease Linked to MVP James Lowrance Some medical research articles state that MVP is a common finding in thyroid patients, which could mean that tryroid disease may be one of several possible triggers for this syndrome, or it may aggraviate the condition in people who already had MVP prior to the onset of their tryroid disease. I have done extyensive search and research on this connection and have found no less than five highly reputable research groups reporting on this association. What does this mean for thyroid patients?
The medical reports themselves state that this fact demonstrates the importance for thyroid patients in being tested for this murmur/click. some of the research states the possibility that MVP also has an autoimmune component to it, or that it may be an autoimmune disease itself. While many patients with this heart abnormality do not experience symptoms, those who do are termed as having mitral valve prolapse syndrome (MVPS) as previously mentioned, the syndrome aspect being a reference to the array of symptoms it can cause.
Some of the symptoms related to this heart murmur/click are the results of dysautonomia, meaning the involuntary nervous system becomes slightly imbalanced, causing a failure in blood pressure regulation and an imbalance in other involuntry bodily functions.
It is possible that people who already have MVP but who also experience the onset of an autoimmune thryroid disease (Graves' disease or Hoshimoto's thyroidits), see the MVP/MVPS worsen in symptom manifestations. It is also possible that thyroid autoimmunity it self serves as a trigger for causing MVPS. These must be considered as possibilities because medical research studies have shown the condition to be very common in thryroid patients, as opposed to control groups (non-thyroid disease participants).
Professor Bell, director of the endocrine clinic at the University of Alabama School of Medicine in Birmingham AL, has reported finding MVP present in 41 percent of patients with Hashimoto's tryroditis and in 51 percent of Graves' disease patients who were studied. (Source WebMD)
Professor M.E. Evangelopoulou and colleagues from Alexandra Hospital Athens University School of Medicine reported and average of 1 in 4 patients with Graves' and Hashimoto's as having a co-morbid (associated) MVP. None of the healthy people in the conteol group without thyroid disease were found to have MVP. Study titled "Heart Valve in Patients With Thyroid Disease".
The american Journal Of Psychiatry published a study in 1987 that states there is a strongly confirmed association between panic attacks, mitral valve prolapse, and autoimmune thyroid disorders. (Study title: "Mitral valve prolapse and thyroid abnormalties in patients with panic attacks."
Several studies are also published on the U.S. National Library of Medicine research website. One of the studies states that the prevalence of mitral valve prolapse is significantly increased in patients with autoimmune disorders of the thyroid gland, when compared to normals and nonautoimmune conditions. Study title" "Prevalence of mitral valve prolapse in chronic lympohocytic thyrodits ad- nongoitrous hypothyroidism."
Another important aspect to this subject is the fact that thyroid patients who have MVP/MVPS may, in fact, confuse the symptoms of the heart murmur/click with unresolved thyroid disease symptoms. Some medical sources out there also state that people with MVPS may sometimes be diagnosed as having Chronic Fatigue Syndrome. Another connection regarding CFS is the fact that people suffering the condition often have dysautonomia, which is also common in MVPS.
I personally see in this subject of MVP being strongly associated with autoimmune thyroid disease, the importance in recognizing how commonly co-morbid some conditions are, and the importance in considering these connections when thyroid patients are not experiencing the expected symptom relief from their treatment. Doctors should recognize the need in testing for MVPS in these patients whose unresolved symptoms match those for the common heart murmur/click.
Mitral Valve Prolapse, Panic Disorder, and Chest Pain Division of Cardilogy, University of South Alabana College of Medicine.
Panic disorder is a specific type of anxiety disorder characterized by at least three panic attacks within a 3-week period, or one panic attack followed by fear of subsequent panic attacks for at least one month. It too is a common condition with a prevalence and age and gender distribution similiar to that of mitral valve prolapse. Panic disorder and MVP share many nonspecific symptoms including chest pain or discomfort, palpitations, dyspnea, effort intolerance, and presyncope. Chest pain in patients with MVP is highly variable, possibly reflecting multiple etiologies. Chest pain in panic disorder is usually characterized as atypical angina pectoris and as such bears resemblance to the chest pain commonly described by patients with MVPS. Multiple investgative attempts to elucidate the mechanism of chest pain in both conditions have failed to identify a unifying cause. Review of the literature leaves little doubt that MVPS and panic disorder frequently co-occur. Given the similarities in their symptomatology, a high rate of co-occurance is, in fact entirely predictable. There is, however, no convincing evidence of a cause-effect relationship between the two common conditions. Until specific biologic markers for these disorders are identified it may be impossible to prove. The lack of a proven cause-and-effect relationship between MVP and panic disorder and the absence of a unifying mechanism does not diminish the clinical significance of the high rate of co-occurance between the two conditions. Primary care physicians and cardiologists frequently encounter patients with MVP and nonspecific symptoms with no discernible objective cause who fail to respond to beta-blockers. Panic disorder should be considered as a possible explanation for symptoms in such patients.
"When Panic Attacks" Lyn Frederickson, M.S. N.
For quite some time it has been documented that there is an association between mitral valve prolapse and panic attacks. Published studies indicate that 15 percent of all mitral valve prolaspe patients experience these attacks.
At the center in Birmingham, Alabama, we kept very careful records in our computerized database of the symptoms reported by our first 1,500 patients. We found the incidence of panic attacks to be 50 percent. This figure is staggering. I really believe that my patients have always had panic attacks, but I didn't know the proper questions to ask to solicit this information. I still have patients that don't tell me they have this symptom until they are carefully questioned. Many patients deny "panic attacks" but admit to "sudden, frightening smothering spells" that make them think they are dying.
The symptoms of panic attacks are: Shortness of breath, rapid heartbeat, sweating , chest pain, intense anxiety accompanied by the urge to flee, and sometimes feeling out of touch with reality. Attacks occur at various times and places, but most commonly while shopping in a grocery store, driving on the freeway, or during sleep, causing the person to awaken with a feeling of smothering; this is known as a nocturnal panic attack.
Panic attacks usually occur spontaneously. They are extremely frightening, and some patients immediately adopt new behaviors in an attempt to lessen the likelihood of having another attack. Such behaviors may include avoiding grocery stores, not driving, or developing a fear of sleep and, thus, insomnia. When this avoidance behavior becomes severe it is known as agoraphobia, or fear of the marketplace.
It is now widely accepted that panic attacks are triggered by certain biochemical imbalances in the central nervous system. Patients are treated with medication which tends to stabilize these biochemical imbalances. Because the avoidance behaviors may be well established, it is sometimes very helpful to seek the services of a good clinical psychologist in addition to your medical doctor in order to control the behavioral consequences of the chemical imbalances.
Panic attacks are not life-threatening, but can be very devastating to the life style, as well as the self-confidence, of the individual experiencing panic. The families of these people often have a difficult time understanding the individual's behavior, and prolonged problems can be very stressful to relationships both at home and on the job.
There are a number of good books about panic attacks that can help patients and their families understand panic attacks and provide support and information on controlling this common and very uncomfortable problem.
"Stress Management and he Treatment of MVPS/D" Patricia Rippetoe, Ph.D
Stress management plays a more pivotal role in the treatment of mitral valve prolapse syndrome than you might think. If you have ever suffered from any of the myriad symptoms common in people with MVP and dysautonomia, you are probably a rather perfectionistic, high-achiever who hates to make a mistake. You probably care a great deal about making other people happy, sometimes at your own expense. More than likely you also have a bit more trouble than most people n expressing negative emotions, particularly anger, for fear of hurting or offending other people.
When we feel we can't cope with the stress in our lives, negative emotions such as hurt, anger, frustration, etc., are likely to arise. If we are unable to express these emotions to productively solve our stressful problems, feelings build up like items stuffed in a too-full closet. Eventually the "closet" bursts with a multitude of symptoms which may be all too familiar. Someone else without dysautonomia might get an ulcer or high blood pressure. Our physical vulnerability when under stress is our autonomic nervous system. So how do we manage stress better to avoid a closet too full of emotions and, thereby, control the symptoms of MVPS/D?
Much has been written about stress management; far too much to relate here. However, my experience with MVPS/D and MVP patients leads me to believe there are two primary areas of stress to be aware of and to work on. The first is to set better limits. If your sense of worth comes from other peoples' approval, you are going to strive to please these people. When you put all of your energy into pleasing people, you have very little left over to help you be who you really are. You lose yourself. This typically leads to resentment, anxiety, feelings of helplessness, and a sense of loss of control. It, therefore, becomes important to recognize the limits of what you can give to others before you are depleted and out of control. This means learning to say "no," learning that you are still lovable even if you say no, and learning that you can protect yourself from exploitive, controlling people who might take advantage of your lack of boundaries.
The second area of stress we can understand and control better is our difficulity in directly expressing our feelings. When we fear hurting others with our negative emotions, we absorb these emotions. The only way to "unstuff the closet" is to be more direct in appropriately expressing feelings to certain individuals. Anger, for example, can turn into depression when it has no place to go. When we constructively tell people how we feel, we have a greater chance of solving problems and moving on. Learning how to be angry and still feel valuable and lovable becomes crucial in controlling stress. Learning how to tell someone that you are hurt and need support becomes essential.
Setting limits on others who would inadvertently ask for more than you are willing or able to give, and telling people how you feel and what you need from them are two fundamental ways to prevent the build up of stress. Of course, these are not the only ways. There are wonderful relaxation tapes that are also very useful in helping to learn to control stress in your life. There are many qualified professionals experienced with whom you can work.
"MVP and mitral regurgitation"
Even though MVPS/D is primarily a benign condition that does NOT tend to degenerate over time, we are still questioned about mitral valve regurgitation, "leaking" of the valve, and how often one should be checked to see if the regurgitation is progressing.
"What is mitral valve regurgitation?"
Regurgitation is a condition in which blood leaks in the wrong direction because one or moreof the heart's valves is closing improperly. Valvular regurgitation may occur in any of the four valves of the heart: The aortic valve, the mitral valve, the tricuspid valve, and the pulmonic valve. When not leaking improperly, these valves function to allow blood to pass in only one direction and only at the right time during a heartbeat.
"How is valvular regurgitation diagnosed?"
This begins with the physician obtaining the patient's full medical history and giving the patient a physical. The physician will listen to the patient's heart through a stethoscope. The physician will also listen to the patient's pulse. Certain murmurs and telltale pulse motion characteristics can help physicians determine whether a valve defect is present and, if so, pinpoint its cause and severity.
*Midsystolic click and late systolic murmur are the hallmarks of mitral valve prolapse on clinical examination. However, auscultatory findings are highly variable from one physical examination to another and include fluctuations in the intensity of both the click and murmur.
The next diagnostic step would be an electrocardiogram (EKG). This recording of the heart's electrical activity is highly sensitive. It helps detect heart irregularities, disease, and damage by measuring the heart's rhythms and electrical impulses. This test can indicate if any of the heart's chambers are enlarged (the left ventricle in particular) and if arrhythmias are occurring.
If the patient's history, physical exam, and EKG suggest presence of valvular regurgitation, then additional tests will be ordered. Echocardiogram uses sound waves to visualize the structures and function of the heart. The physician can study and measure the heart's thickness, size, and functions. The image also shows the motion patterns and structure of the four heart valves, revealing any potential leakage (regurgitation). During this test a color flow Doppler ultrasound is required to assess the severity of the regurgitation.
A chest x-ray offers the physician a picture of the general size, shape, and structure of the heart and lungs. An enlarged heart can indicate damage or dysfunction. If these noninvasive tests do not offer enough information, then an invasive procedure called a catheterization may need to be done. During the catheterization pressure will be measured by catheters to determine the severity of the leakage and whether the coronary anatomy is normal. Some doctors are now ordering the newer noninvasive angiogram (CT). Cardiac catheterization is not a common procedure for people with MVPS/D.
"Treatment of valvular regurgitation"
Mitral valve prolapse with mild regurgitation usually requires no treatment. Antibiotics are no longer recommended by The American Heart Association for surgical and dental procedures, as they have been in the past. More severe regurgitation may require cardiac medications or surgery.
"Keep in mind that only about two percent of the population will ever need surgery"
"Symptoms of mitral regurgitation"
Fatigue,especially during time of increased activity Heavy coughing,sometimes with blood-tinged sputum Syncope;fainting spells Cyanosis(a bluish tint of the lips, skin, and other areas of the body)
"Suggestions for monitoring chronic mitral valve regurgitation" Mild regurgitation See a doctor annually for a checkup. Let your doctor know if you develop symptoms in between visits. Have an electrocardiogram every two to three years. Moderate regurgitation See a doctor annually. Let your doctor know if you develop symptoms in between visits. Have an echocardiogram once a year. Severe regurgitation Have a physical examination and echocardiogram once every six to twelve months.
*Systolic murmurs are typically benign and diastolic murmurs are always pathological. MVP is classified as a systolic murmur.
"You Are What You Eat" Lyn Frederickson, RN, MSN Co-founder of The Mitral Valve Prolapse Center, Birmingham, Alabama Contributing writer to "And The Beat Goes On"
Good nutrition is a sensible first step in a comprehensive program of total well-being for all of us, but especially for those with MVPS/D and low energy levels. When dealing with MVPS/D we look for a sensible balance between diet, exercise, fluidloading, and sometimes, medications. This is is a good first step.
People with MVPS/D tend to have certain predictable dietary shortcomings. Just like deconditioning, poor nutrition is also a vicious cycle. People with very low energy levels may not feel like going the extra effort to prepare a balanced meal. They tend to surround themselves with the simplest foods, which are most often loaded with fat, sugar, and have very little nutritional valve. This will produce very little useful energy. The body requires good fuel to perform at maximum efficiency.
We also have an attitude problem with food. In our culture, food is love. It comforts us when we feel poorly. We believe it gives us energy when we feel tired or acts as a tranquilizer when we feel anxious. The first step we ask our patients to take is to remove the emotional impact from food. Remember that food is fuel for the body. It makes sense to put the highest quality fuel in the system for our bodies to function properly.
Caffeine is a stimulant, a drug. A legal drug, to be sure, but still a drug. It is the only truly socially-acceptable drug in our society. Your autonomic nervous system is extremely sensitive to everything, including stimulants such as caffeine. The immediate effect of this drug is to give a sudden boost to the system, but it is invariably followed by a plunge.
Caffeine stimulates the release of adrenaline, which gives a temporary energy boost, but then the plunge starts; what we call the roller coaster effect. It is very destabilizing to the system. Caffeine also has a very powerful diuretic effect and tends to further deplete the body of fluids required to have energy.
People who regularly consume caffeine and try to suddenly eliminate it from the diet may notice a headache; sometimes quite severe and lasting for several days. This can be avoided by gradually tapering your caffeine intake over a period of weeks.
One substance that is absolutely poison to people with MVPS/D is sugar. The average American consumes a tremendous amount of sugar each year. Remember that sugar contains virtually no nutritional value. It is pure calories, and the results of consumption for people with MVPS/D are severe.
Sugar triggers the autonomic nervous system and, just like caffeine, gives a temporary boost in energy. With the release of insulin from the body in order to burn the sugar, there is a sudden drop in blood sugar that is quick and often results in a shaky sensation, rapid heartbeat, and sometimes even panic attacks.
Many patients report that they are sugar junkies, particularly chocolate, and don't believe that they can kick the habit.
Have you ever tried to eliminate sugar? It is tough! You are irritable and shaky and often have difficulty sleeping for the first few days. It is believed that sugar is truly an addicting substance, and this response represents a type of withdrawal.
After several days there will be an increase in energy and a calming effect. This makes the effort to kick the sugar habit worthwhile.
Cutting out sugar doesn't mean that from now on for the rest of your life you can never consume anything with sugar in it. You can dramatically limit the number and amount of goodies that you consume and save sweets for very special occasions. Most of our patients report that they lose their taste for sweets and feel so much better when they skip them that they don't mind leaving them behind.
For the majority of people with MVPS/D salt is not a concern. Many have low blood pressure and find that cutting back salt in their diet makes them feel worse. Salt is needed to maintain fluid volume. Some of you will feel better if you consume a sensible amount of salt. If you have high blood pressure, consult your doctor about the need to limit salt.
Another piece to the MVPS/D puzzle is the importance of high fluid intake. People with MVPS/D seem to have a faulty thirst mechanism that makes them even less thirsty than the average person. Do you go all morning without drinking anything?
The healthy approach is to sip liquids all day. Try a sport bottle with a straw. Keep it full and drink all day. If this is not convenient, drink a large glass of water with breakfast, at midmorning, lunch, midafternoon, dinner, and after dinner.
Vitamins are often the source of questions by patients seeking to feel their best. Our general philosophy is that if you eat a well-balanced diet, you probably have no need for additional vitamins. There is some evidence, however, that because our daily diet often consists of refined foods with attention to weight control, there my be some nutrients that are lacking. A good multvitamin supplement won't hurt, and may help. We discourage megadoses of any vitamin. If in doubt, check with you physician.
REMEMBER: You are what you eat! Put only high-quality fuel in your system, and you will feel and look your best. Good luck, Lyn