| Articles of interest for MVPS/D patients, taken from past issues of "And The Beat Goes On" |
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Check this page often, as articles will be updated and changed.
Last Date Edited, Nov.20, 2011
"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 sill 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 more of 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
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