Your questions are answered by Phillip C. Watkins, M.D., director and co-founder of:
The Autonomic Disorders and Mitral Valve Prolapse Center
880 Montclair Road, Suite 370
Birmingham, Alabama 35213
1-800-541-8602
Disclaimer:
The answers to these questions are not intended to give personal medical advice. That should be obtained from your own physician. There is no substitute for a complete medical evaluation by a competent doctor. Only he/she knows your personal medical history.
Q. Does an MVPS/D patient have a compromised immune system?
A. Patients who have MVPS/dysautonomia may well have a compromised immune system in some cases. The prolonged stress hormone production that patients may have with dysautonomia can supress the immune system. We also see patients quite frequently who have compromised immunoglobulins. They may have low levels of either igG, igA, or igM* They generally respond to immunoglobulin infusions. the chronic stress associaed with dysautonomia probably plays a great role in compromising the immune system.
*igG, igA, and igM are antibodies made by the body's immune system in response to bacteria.
Q. I have been having problems with my memory, forgetting things and not thinking clearly all the time. My doctor ran a cat scan and MRI of my head, which was normal. He wanted me to ask you if this could be what happens sometimes if the autonomic system is off.
A. Our patients do quite frequently have problems with memory, concentration and focusing, and at times are easily distracted. In some cases this may represent ADD-type problems, which would be treated appropriately. In some cases the dysautonomia itself increases sensory input to a degree where memory and focusing can be affected. It is certainly responsible to evaluate for those other problems, but it is not at all unusual to see this, and it generally responds to the usual treatment to for their dysautonomia.
Q. I was wondering if the first medication you try on an MVPS/D patient suffering from a lot of PVCs and anxiety is a beta-blocker?
A. The patient we see, after a full evaluation, usually will have more than just one medication to start with. We have found that it does not work very well just to partially treat the symptoms without treating all of the sauses that are causing those symptoms. In many cases a beta-blocker is one of the medications, but we may also use and SSRI, or perhaps clonazepam in some of the patients. This all depends on the evaluation and what appears to be proper treatment for that particular patient.
Q. I am starting menopause, and my doctor has suggested progesterone for heavy bleeding and extremely sensitive breasts. Is progesterone, either cream or oral, okay for woemn with MVPS/D?
A. Patients with dysautonomia and mitral valve prolapse commonly have hormone imbalances and problems. It is important to see a physician who is very knowledgeable in adjusting hormones. Progesterone, in either cream or oral form, is certainly acceptable in the proper circumstances.
Q. Since I got older my very low blood pressure, 90/58, has gone up to 120/70. I must say that I feel better than I used to. I have less fatigue, dizziness, and fewer palpitations. Is this common in MVPS patients?
A. As patients with dysautonomia and mitral valve prolapse get older their symptoms definitely change. The marked fluctuations in blood volume probably also improve as well. It is not at all unusual to see more normal blood pressure as patients get older, particularly into their 40's and 50's. This would lead one to bellive that these symptoms such as some of the fatigue, the dizziness, and the orthostatic changes would also improve.
Q. I have been to three cardiologists. I'm beginning to belive that they are the worst doctors to see, maybe because they usually deal with life-or-death situations. None of them recognize MVPS/D. Do you have any suggestions as to what kind of doctor one should seek out?
A. It is important to find a physician who is knowledgeable about dysautonomia. The patient with prolapse who is developing symptoms has a disorder of the autonomic nervous system. In many cases a competent internist, family doctor, general practictioner, or gynecologist can diagnose and treat these problems. It is quite helpful to ask some friends who also have dysautonomia and mitral valve prolapse what doctor they go to, who they feel has been able to help them.
Q. Is there anything other than medications that will help keep heart rate down?
A. In general, regular aerobic exercise will help to keep heart rate down. This is due to conditioning and training. However, in patients who have mitral valve prolapse/dysautonomia this is not always true. If the patient is very aware of an increased heart rate and a forceful heartbeat, in general it will take medication to control the heart rate. Medications may include either beta-blockers or calcium channel blockers. Often a combination of a beta-blocker plus regular exercise will eventually lead to a more normal heart rate, which can then lead to taking medication only on an as-needed basis.
Q. Are medications for thyroid that doctors prescribe such as Armour thyroid and/or T-3 therapy okay for an MVPS/D patient?
A. The thyroid medications are definitely okay for MVPS/D patients to take. There is actually an increased incidence of hypothyroidism, or low thyroid function in patients who have MVPS/D. This is caused by an autoimmune disorder called thyroiditis. It is very important for these patients to have thyroid function checked every 12 to 24 months, as thyroiditis can occur and lead to a decrease in metabolism over a period of time. The medications can then be carefully regulated by the physician. Symptoms of low thyroid function would include fatigue, hair loss, weight gain, etc. These symptoms, of course, also occur in patients who do not have low thyroid. It is important to have this checked at periodic intervals by your physician.
Q. Can thousands of daily untreated PVCs harm one's heart?
A. Patients who have PVCs may well have thousands of them daily. The average number of heartbeats per day is around 100,000 or so. Certainly several thousand of those may be PVCs. It will not harm the heart per se, although you may experience symptoms of an irregular heartbeat. Of course, if this develops into a more dangerous type of rhythm problem, that would be a different situation.
Q. I always have a fast heartbeat. Even the slightest movement can cause me to have tachycardia. Will this eventually wear my heart out?
A. This will not damage or "wear out" your heart. It is uncomfortable and very unpleasant to have this occurring. This is generally due to increased adrenaline from the dysautonomia. A beta-blocker or similar type of medication should control this and help the symptoms. You probably would be experiencing a lot of fatigue unless this was treated with a beta-blocker.
Q. I have come across articles by nutritionists and natural health "experts" who say MVP is caused from over-calcification of the heart valves due to poor diet and from taking calcium supplements. Any comment?
A. Mitral Valve Prolapse is not caused by calcification of the heart valves and certainly diet has nothing to do with it. There is no data that confirms this.
Q. Can beta-blockers make the symptoms of cold hands and feet worse?
A. Beta-blockers can, in some cases, worsen the condition of cold hands and feet. In general, this is due to low blood volume and constriction of blood vessels in hands and feet from the dysautonomia itself. Some beta-blockers tend to cause more constriction in the hands and feet, which makes this much more noticeable. The best treatment, however, is increasing fluid intake and exercising regularly. This increases blood flow and quite often alleviates the problem. There are also some patients who have this symptom due to a disorder called Raynaud's, which is an autoimmune disorder that affects peripheral blood vessels, causing cold hands and feet.
Q. A year ago I tried taking a beta-blocker, but my blood pressure dropped so low that I felt I would pass out when standing. Also, changing positions from sitting to standing, bending over, and getting out of bed, caused severe lightheadedness. I would like to try a beta-blocker again. Are there any that cause less of a blood pressure drop than others?
A. The type of beta-blocker chosen is, of course, important; however, making sure that you have adequate fluid intake is more important. So too is finding out if low blood volume is contributing to the blood pressure drop. These symptoms are very common in patients with MVPS, whether they are on a beta-blocker or not. In general, lower doses, of course, would prevent having more of a blood pressure drop. In many cases the blood pressure is actually more normal when a beta-blocker is given. If this continues to be a problem, I would definitely choose one of the very mild beta-blockers, such as a 5 mgs. of betaxolol. You could also add Florinef in the morning to stabilize blood pressure, so that an adequate dose of beta-blocker can be given.
Q. Is Wolff-Parkinson White Syndrome in any way related to MVPS?
A. Wolff-Parkinson White Syndrome is an abnormality seen on an EKG where the heartbeat takes a shortcut through the heart and occurs earlier than it should. This, in some cases, leads to bouts of tachycardia. It does not seem to be related as far as its frequency of occurrence.
Q. I notice a difference in my heart rate when I first get out of bed in the morning. I've been trying to get up slowly, but it seems to take about 20 minutes. Are there any suggestions you can give me? I also notice a rapid heartbeat which changes when I change position, such as when I am lying down at night, and then I get up to go to the bathroom. Is this normal with MVP? I was on Tenormin for years but recently have come off of it with my doctor's okay. I'm trying to follow your advice by exercising five days per week and watching my diet, but sometimes I get so frustrated when my symptoms act up.
A. What you're describing is the typical changes seen in patients with MVPS due to low blood volume. As you stand up and change position, blood tends to pool in the lower extremities, and the heart has to pump harder and faster to compensate for this. The typical patient with MVPS has a blood volume lower than it should be. To solve your problem, you should increase your fluid intake with our recommendation of one ounce of fluid per degree of temperature outside, for a minimum of 64 ounces per day. As warm weather approaches you should be drinking 10 to 12 glasses of fluid a day. In addition, stopping the Tenormin has allowed the increased adrenaline that occurs with patients with MVPS to take hold, and you're experiencing the rapid heart rate from that also. Our suggestion would be to continue your exercise, increase your fluid intake, and consider going back on at least a small dose of Tenormin, even if it's every other day.
Q. I have been taking Zoloft (25 mgs. twice a day) for three years to help combat my symptoms. Is it possible to stay on an antidepressant indefinitely to help control the symptoms of dysautonomia?
A. You certainly may take any of the serotonin medications indefinitely to control symptoms of dysautonomia. In some cases patients do not need as much of the medication in the summer months, as the body produces more serotonin in the summer months compared to the winter months. Again, the need for medicine tends to change. We have also seen in our practice that at times the patient seems to start producing more serotonin on their own, and the need for medication drops to the point where they can either take it perhaps intermittently or get off the medicine entirely. Each case is somewhat different. I am not aware of any long-term effects from these medications.
Q. I am on a softball team. Is this considered aerobic exercise?
A. No, aerobic exercise is continuous exercise that utilizes large muscle groups in the body for a period of time of at least 20 minutes with substantial elevation of the heart rate. Since most of the time spent during a softball game is either standing on a base or sitting on a bench, your body is not is an aerobic state at all.
Be aware that extreme upper body motion (such as swinging a bat or throwing a ball) may induce chest wall soreness.
Q. I frequently have sharp, stabbing pain in the left side of my chest. I am afraid it is my heart, but my physician assures me that it is costochondritis. What is costochondritis, and is it due to my MVP?
A. Costochondritis is an inflammation of the cartilages of the ribs in the anterior chest wall. It may follow trauma, be associated with arthritic-type disorders, and is a frequent cause of chest pain in MVP. It is usually described as a sharp, stabbing or sticking type of pain that may radiate widely throughout the chest. Palpation over the area of pain often exhibits marked tenderness.
Although aggravating, it is not serious and usually responds well to the use of aspirin or ibuprofen (Advil).
Q. My son has been diagnosed with ADD. His doctors want to put him on Ritalin. For a long time now I have thought that he inherited my MVPS. He has many of the symptoms I have. If he does have MVPS would Ritalin be a safe drug for him to take?
A. Your question does not state the age of your son, but I assume that he is a teenager or, perhaps, younger. We certainly have seen quite a few patients diagnosed with ADD and ADHD who also have MVP syndrome/dysautonomia. In our experience the medications currently used for this disorder have not been a major problem in increasing symptoms of MVPS/D. If he, indeed, does have this condition, I would see no problem with at least trying the Ritalin. If he still has other symptoms perhaps not due to ADD, then consideration should be given to perhaps MVPS/D causing some of these symptoms.
Q. I have recently been feeling tired and run down, so my doctor took blood tests and said my cortisol levels were the highest he had ever seen, 36.6, and my thyroid was 0.84. He put me on Synthroid, 0.24 mgs. I took one pill and started feeling panicky. My doctor said not to take any more and is sending me to an endocrinologist. I should tell you that I am already on Celexa, 12.5 mgs. and 1/2 tablet of Buspar every day. My questions are: Is it common for people with MVPS to have very high cortisol levels, to be sensitive to Synthroid, and to have thyroid problems?
A. There is definitely an increased incidence of thyroid dysfunction in patients who have mitral valve prolapse syndrome/dysautonomia. We see an incidence as high as perhaps 20 percent of our patients who have had what appears to be thyrioditis, which leaves them with an underactive thyroid gland. This is easily tested by a thyroid profile and, in particular, an ultra-sensitive TSH test. I am not aware of any studies that show an increased incidence of high cortisol in patients with MVPS.
We occasionally do check these levels, but rarely find them to be elevated. Certainly the thyroid abnormality is more common. An evaluation by an endocrinologist would be appropriate in this situation.
Q. I had a stress test, and my heart rate was 220 after 12 minutes on the treadmill. A cardiologist told me this was normal for an active, healthy 25 year old. Do you agree with this? I do wear a heart monitor when I work out in the gym, and my heart rate does get near 220.
A. A heart rate of 220 bpm after exercise would be considered excessive. We quite frequently do see heart rates in the 180 to 200 range, particularly in younger persons during exercise. In many cases they do become symptomatic. Quite often this is due to a form of dysautonomia called postural orthostatic tachycardia syndrome (POTS). In some cases the patient has excessive stimulation from adrenaline. Many patients are very symptomatic in this situation and tend to eventually become fatigued. Quite often it is easy to simply add a beta-blocker to control the heart rate; the patient becomes asymptomatic and, thus, the fatigue improves.
Q. I am a 60-year-old female who has smoked cigarettes for 40 years. I tried unsuccessfully to quit numerous times. My question is: Can a person with mild MVP, also diagnosed with depression, anxiety, ADD, and OCD, who is afraid to take strong medicine, use Zyban or Wellbutrin, with or without the nicotine patch?
A. We indeed do use Zyban and Wellbutrin, which chemically are the exact same medications, in patients who either wish to quit smoking or lose weight. This medicine is very effective in controlling the craving of the brain for nicotine, carbohydrates, etc. We do not use the nicotine patch, as you are simply feeding more nicotine into the body at a time when you are trying to withdraw from it. One of the most important things is to continue the medication for a period of two to three months after you have quit smoking. Whether a patient should do this who also had ADD or OCD should be discussed with your physician before starting it, however.
Q. In the past I have been asked many times if mitral valve prolapse is the same thing as a leaky valve or mitral regurgitation? Lyn Frederickson, R.N., MSN
A. A leaky valve, or regurgitation, implies a backflow of blood into the heart and is not the same as mitral valve prolapse. MVP patients, however often have a very small, insignificant murmur that represents a very small backflow. Mitral regurgitation can result from other conditions, such as cononary heart disease and even rheumatic heart disease. These conditions are quite different from MVP and have a much different significance.