Articles of Interest for Mitral Valve Prolapse Dysautonomia Patients
Taken from past issues of our bimonthly newsletter
"And The Beat Goes On"
Check this page often as articles will be updated and changed


Treatment of Symptomatic Mitral Valve Prolapse Syndrome and Dysautonomia
Phillip Candler Watkins, MC, FACC
Director of The Mitral Valve Prolapse Center, Birmingham, Alabama
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 echocardiogrphy (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. Approprite medications may include a beta-blocker if the patient is hyperadrenergic, and a tricyclic, benzodiazepine, or a serotonin reuptke inhibitor (SSRIs) if the patient experences 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.

Symptoms Associated MVP Syndrome
By: Richard O. Russell, Jr.,M.D., F.A.C.C.
Mitral valve prolapse is no named because a very slight posterior motion is seen as the mitral valve closes. The mitral valve is designed to undergo significant movement as it opens and closes during cardiac action, or flexibility, of the mitral valve itself, is not harmful and causes no damage to the heart or to the body. The array of troublesome and often frightening symptoms which may be seen from time to time in people with t his valve movement is not due to this extra motion, or prolapse, of the valve. The associated symptoms which might include dizziness, numbness, chest pain or pressure, palpitations, anxiety, sleeplessness, gaseousness, bowel symptoms or actual diarrhea, and mood swings have been called the Mitral Valve Prolapse Syndrome.
These symptoms are not due to the prolapse of the valve itself.
Many individuals have come to recognize that the prolapse of the mitral valve (the other valve of the heart can similarly prolapse as well) is actually just a marker or an identifier for a person with this complex of symptoms and not the prime cause of the symptoms.

Most often, these and other symptoms are clearly related to the excessive drive or hyperfunction of the autonomic nervous system, which can be thought of as the "automatic" nervous system. This system controls functions of our body like pulse rate, blood pressure, breathing, digestion, blood sugar, the size of our pupils in dark and light, and the dilatation of our peripheral blood vessels under hot conditions and contraction in cold conditions. It also is related to our state of anxiety and sleep/wake conditions. It is both the stress nervous system and the digestive nervous system, having tow states which are normally finely tuned and balanced.

We are quite familiar with what our body does under stress, such as before giving a talk, a performance, an examination, an important interview or before an anticipated stressful event. We often have sweaty, yet cool hands, hard pounding of the heart, slight breathlessness, dryness of the mouth, increasingly frequency of urination, loosness of bowels, and if measured, some increase in blood pressure. This familiar pattern of behavior of our body is due to adrenaline and similar hormones from the autonomic nervous system as a result of the stress. This anticipated event has "gotten our juices flowing." This is the response of our body to acute stress. After the acute event is over through sensations experienced prior to it generally subside. We have met the stress and dealt with it, diffusing and halting the stress hormones responsible for it.

However, certain individuals with perhaps lower or more moderate levels of stress continue to experience bodily sensations of the stress syndrome, though on a more chronic basis. It is as if the stress hormones remain turned up or our bodies respond to these hormones with continuing stress symptoms. These individuals seem to have a more reactive or hypersensitive autonomic (stress) nervous system. This had led some researchers to call the syndrome"DYSAUTONOMIA." It is of interest that many patients with mitral valve prolapse have (or are subject at some point over the tears to have) symptoms o dysautonomia. Similarly, a certain percentage of patients with dysautonomia or mitral valve prolapse syndrome have other related findings, such as scoliosis curvature of the spine, usually mild) or bony chest abnormalities (such as pectus excavatum). Many women have fibrocystic breast problems and excessive premenstrual symptoms (PMS) and even temporomandibular joint problems, or TMJ.

Thus it seems clear that the tiny movement of the heart's mitral valve is not causing all these varied manifestation of a syndrome encompassing many body systems. Perhaps there is good reason, then to call this complex of symptoms DYSAUTONOMIA OR THE MITRAL VALVE PROlAPSE SYNDROME to indicate our understanding of the fact that there is far more involved here than a small amount of prolapse of the mitral valve leaflet.

Stress Management and the Treatment of MVPS/D
Patricia Rippetoe, Ph.D
Retired consulting psychologist to The Autonomic Disorders & MVP Center, Birmingham, Alabama

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 in 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 close 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 people's approval, you are going to strive to please these people. When you put all 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 difficulty 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 expressing feelings appropriately to the appropriate individuals. Anger, for example, can turn into depression when it has no place to go. When we constructive 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 as 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 on the market now 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.

You are what you eat
Lyn Frederickson, RN, MSN
Author of "Confronting Mitral Valve Prolaspe Syndrome"
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, fluid loading, and sometimes, medications. Diet 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 and most often those are loaded with fat, sugar, and have very little nutritional value. 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 it invariably followed by a plunge.

Caffeine stimulates the rlease of adrenaline, which gives a temporary energy boost, but then the plunge starts what we call the roller coater effect. It is very destablizing to the system. Caffeine also has a very poweful diuretic effect and tends to further deplete the body of the 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 comsumes a trememdous 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 temporay 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 elimate 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 comsume 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 approch 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, midmorning, lunch, mid-afternoon, dinner, and after dinner.
When this becomes a habit you will notice that you feel better and come to crave the fluids. Drink primarily water, some fruit juices, decaf tea, or other decaf beverages. Avoid caffeine like the plague!

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 ofthen consists of refined foods with attention to weight control, there may be some nutrients that are lacking. A good multivtamin supplement won't hurt and may help. We discourage megadoses of any vitamin. If in doubt check with your 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


When Panic Attacks
by: 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. Publisned studies indicate that 15 percent of all mitral valve prolapse patients experience these attacks.

At the MVP Center onf Birmingham Alabama, we kept very careful records in our computerized data base of the symptoms reported by our first 1,500 patients. We found the inci dence 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 symsptoms of panic attacks are: shortness of breath, rapid heartbeat, sweating, chest pain, intense anxiety accompaniend 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 knwon as a nocturnal panic attack.

Panic attacks usually occur spontaneously. They are extremely frightening and some patiaents immediataely 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 well 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 lifestyle 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 thier families understand panic attacks and provide support and information on controlling this common and very uncomfortable problem.


MVP and 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?
Regurgitaion is a condition in which blood leaks in the wrong direction because one or more of the heart's valve is closing imporperly. 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 will be an elctrocardiogram (EKG). This recording of the heart's electrical activity is highly sensitive. It helps detect heart irregulariteis, 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 catherterization may need to be done. During the catherterization, pressure will be measured by catheters to determine the severity of the leakage, and a coronary anatomy is normal. Some doctor's are now ordering the newer non-invave angiogram (CT). Cardiac catherterization is not a common procedure fore people with MVPS/D.
Treatment of valvular regurgitation
Mitral valve prolapse with mild regurgitation usually requires no treatment, except for taking antibiotics before dental, medical, or surgical prodecures. More severe abnormalities may require cardiac medication and/or valve surgery.

Keep in mind that only about two percent of the population will ever need surgery.
Symptoms of mitral regurgitation.
Mild forms tend to produce no symptoms. More severe forms may cause symptoms such as :
Shortness of breath, sometimes severe, sometimes in the middle of the night while lying down.

Fatigue, especially during times 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 checkkup. Let your doctor know if you develop symptoms in between visits. Have an echocardiogram every two to three years.
Moderate Regurgitation
See a doctor annually. Let your doctor know if you develop symptoms in between visites. 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 diastolilc murmurs are always pathological. MVP is classified as a ststolic murmur..


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