Add salt to your diet, unless you have high blood pressure
Exercise on a regular basis
SAMe has been a help to some patients
St Johns Wort has helped some (do NOT take with an antidepressant)
Magnesium is of help to some patients who are low in magnesium.
Remember "natural" does not mean safe. Always tak to your physician if you want to try something other than prescriptoin drugs. Patients with MVPS/D are usually very sensitive to many things.
MEDICATIONS, By Phillip Watkins MD, "Cardiology in Review"
Medications are generally indicated for the patient who has symptoms that warrant a visit to the physician. The type of medication prescribed depends on what symptoms are present. In general, beta-blockers are quite helpful for the patient who has very hyperadrenergic symptoms. If the patient is anxious or has panic attcks, the use of a beta-blocker will help clear these symptoms more quickly. Other advantages of a beta-blocker are decreased cardiac awareness, a tendency to alleviate the pounding racing heart rate, and in general, creating less awareness of the cardiovascular system. There are many beta-blockers to choose from. Usually we avoid the use of propranolol, because it tends to cause more fatigue, sleep disruptions, and side effects that are not well-tolerated by some patients.
Usually small doses of beta-blockers are needed. With atenolol, 25 mgs. once or twice a day is generally helpful. In the person with severe panic inceasing the dose of the beta-blocker will often yield better results. It is important to look specifically for the patient who appears to be hypervagal, as these patients do not tolerate beta-blockers and it tends to worsen their symptoms
The increasing ability of the serotonin reuptake inhibitors has made it much easier to treat mood swings in the mitral valve prolapse/dysautonomia patient. They are beneficial not only for the depressive symptoms that occur particularly during the winter months, but also for the anti-panic effects. The anti-panic effects of serotonin inhibitors are benficial particularly when combined with the appropriate beta-blocker. In general, the longer-acting serotonin reuptake inhibitor medications appear to work best. Fluoxetine in dosages of 10 to20 mgs per day, sertraline 25 to100 mgs per day, or paroxetine 10 to 20 mgs per day. (There are many more antidepressants for the physician to choose from depending on your symptoms)
Some of the side effects asociated with SSRIs, such as nausea, can be minimized by taking them with food.
Some patients may not tolerate the use of SSRIs, as they tend to have more anxiety and panic symptoms. If this is the case, they generally will benefit more from the use of a tricyclic rather than the SSRI. Occasionally, the patient who is treated with an SSRI will complain of sexual dysfunction. Sometimes simply reducing the doseage can help the problem, but in general the SSRIs tend to cause this to some degree. In our experience, the medicaions that require twice daily dosage are not as effective as those that can be taken once a day. Those with the longer half-life tend to be more effective. Also, because of the longer half-life, it is important to realize that when the physician prescribes an SSRI, he or she must be very patient and not simply advance the dosage of the medication. It can take as long as 3 weeks or more to see maximsl improvements. If a patient has increased the dosage during that time, he or she may actually reach a dose that is causing side efects or toxicity 3 or 4 weeks later.
Patients who do not tolerate SSRIs quite often do nicely with the use of imipramine or nortriptyline. Imipramine appears to be effacious in patients with chest pain. At times the chest pain may be somewhat alleviated by a beta-blocker, but at other times it has no effect. Whether this is because the chest pain is a manifestation of panic is not clear, but in the patient who continues to have chest pain, this is somethng that might be considered. In general, imipramine should be started in very small doses of 10 to 20 mgs at night. Patients who experience panic and cannot tolerate SSRIs may benefit from long-lasting benzodiazepines, in particular if they also have associated nocturnal myoclonus. Clonazepam generally can be started in quite small doses, such as 0.25, 0.5 at night, and occasionally an extra 0.25 can be added once or twice during the day depending on symptoms. The use of the short-and-medium acting benzodiazepines tend to be a problem because of their short action and also their predilection to addiction. However, in the occasional patient the use of alprazolam may be useful in the short term to alleviate the symptoms until other medicaions become effective.
The patient who experiences rather marked hypotension and syncope will benefit from the use of fludrocortizone. It is generally started in the dosage of 0.1 mgs per day for a couple of weeks and then can be reduced gradually and stopped after a few weeks. It is important for the patient to have their blood pressure checked, seated and standing, several times per week to determine how well it is working. Fludrocortizone also had been reported to be effective in patients who experience chronic fatigue. This is thought to be due to the fact that chronic fatigue patients also have been reported to have positive tilt studies resulting from the decreased central blood volume.
In summary, the appropriate treatment of the patient with MVPS and dysautonomia begins with a high degree of suspicion of the clinical presentation in making the diagnosis. This should be followed up by education and reassurance, with particular emphasis on fluid-loading, aerobic exercise, and avoidance of caffeine and sugar. Appropriate medications are then prescribed for the symtomatic patients, with subsequent follow-up to adjust medications. Later, as the patient becomes asymptomatic, the physician can gradually reduce their medications.