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Heart & Cardiology/Arrythmia and Mitral Valve Prolapse

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QUESTION: Hello Dr. Ahmed,
I’ve been diagnosed with mitral valve prolapse by my internist last November 2013. An echocardiogram lists my regurgitation as trivial. My ECGs aren’t normal but he always waves them off as “normal” and that “I shouldn’t worry” about them, saying so far as “your valve prolapse is cute.” However, here are the following questions I’d like to ask:
1.   I’ve experienced a time when my heart went crazy (like the feeling that it was struggling for 1.75 seconds or so and my vision tunnelled), I’ve several times in the past where my heart makes this large THUMP that wakes me up at night (hasn’t happened now that I’m taking Nebivolol HCL, a beta blocker), and I still experience moments where my heart feels like it makes this “squirting” sound once and then everything’s okay. Nobody ever told me what I felt. Were those atrial fibrillations, PVCs, SVTs? What’s the nearest approximation you can make from all three sensations I mentioned above?
2.   He keeps waving all these off as “normal.” I went to a cardiologist, he saw all my erratic ECGs, took blood pressure from both arms, checked my chest and back with a stethoscope and said the same thing. However, why is it that every time I have this palpitations (they’re just one-time thumps and “squirts”) I feel like I’m going to die?

I haven’t fainted though (except in high school where we had this citizen’s army training and I didn’t move one bit to impress our sergeant even though everyone was moving this way and that).

So why do I’ve the feeling that I’m going to die? Is this apprehension normal? Or is my anxiety well-founded?

3.   I sometimes wake up and find both my arms feeling tingly and numb, especially my little fingers. Once I move around though, they become normal again. Is this normal?
4.   I’ve made a myriad ECGs (about five these past 11 months) and all the time (even though the results have this “abnormal” tag on them), attending physicians in the ER (and even my internist and cardiologist say the results are “fine.” So why do they have the “abnormal” tag on them?
5.   I’m not worried about my mitral valve progressing (that’s too far off and worrying won’t make things better), I worry THOUGH about arrhythmias and sudden death caused by these erratic beats. My doc says they won’t happen to me as I don’t have CAD or rheumatic heart disease.  Is this true? And what are the chances of a person having an MVP with trivial mitral valve regurgitation getting these life-threatening arrhythmias? Do I have a higher chance than the general population?


I really hope you can answer all these Dr Ahmed. People say my condition is normal yet I suffer from palpitations almost every day (0-4 “squirts” in a day) and I feel like death is knocking at my door every time these occur. As much as possible please be honest. Sooth me if indeed I should have nothing to worry about but don’t sugarcoat stuff if the hospital has somehow erred on the side of complacency. I need to prepare my family if indeed my time is coming. Thanks! 

ANSWER: Hi, ive attached a number of links you may find useful. http://blog.myheart.net/category/the-heart/the-valves/



Let me try answer these questions point by point

1) I think that the most likely occurrence here would be a PVC or a PAC. The good news is that these are relatively benign and more of an annoyance , and not generally clinically significant. If these were to continue to recur then its reasonable to wear a short term heart monitor to see what they are and reassure you. It sounds like you have had an excellent response to a beta blocker, which would generally be a first line medical therapy for these if symptomatic.

2) The reason your cardiologist wasn't worried by these is as these PVC's and PVC's are generally benign, especially in the setting of normal pumping function of the heart. These beats are very dependent on the person, some people feel like they are going to die and others can have them literally all day long and never notice them. It sounds like they are very anxiety provoking to you. Hopefully reassurance as to the benign nature of these will help to settle that.

3) These tingling sensations are almost certainly nothing to do with the heart, they sound more neurological and are likely related to sleeping position.

4) EKG autoreads are notorious for being too sensitive. This means that although they pick up many abnormalities, they also call many normal studies abnormal when infact they are normal. It is for this reason that EKG's are over read and corrected by specialists.

5) Minor arrhythmias like PAC's and PVC's are very common. They are not likely related to the mitral valve specifically. The presence of trivial mitral regurgitation is essentially a normal finding. In general, studies of patients with MVP demonstrate that survival is not significantly different than that of the normal population unless multiple risk factors are present, so in that sense, your cardiologist is correct.

Hope that was helpful,


---------- FOLLOW-UP ----------

QUESTION: Thank you Dr. Ahmed! Thank you so much for answering my questions point by point.
I know you’re busy but some follow up questions (please bear with me):
1.   “If these were to continue to recur then its reasonable to wear a short term heart monitor to see what they are and reassure you.”

But aside from the reassurance thing, it’s not necessary right? My internist and my cardiologist didn’t say I need a Holter monitor.

2.   “These tingling sensations are almost certainly nothing to do with the heart, they sound more neurological and are likely related to sleeping position.”

Ah so it’s not about low blood pressure or the heart being unable to supply oxygen-carrying blood to my extremities?

3.   Additional question: Does taking electrolyte drinks (Gatorade, etc) help when we have palps? I heard palpitations are sometimes caused by lack of sodium and potassium. Should I stock up on these? Or is it dangerous if I regularly drink a bottle of Gatorade? I regularly eat a tiny, tiny pinch of salt and sugar before I go to bed. Is this safe?

Answer
Hi,

No the monitor is not necessary, you should be ok without it if your physicians dont feel your symptoms warrant it.

The symptoms are very unlikely related to circulation or blood supply, Low blood pressure may result in symptoms from a sitting to standing position, light headedness and maybe fatigue. Tingling sensations related to hypoxia are unlikely.

Electrolyte drinks are not known to be effective in preventing palpitations. In people who have recurrent palpitations its reasonable to obtain simple blood tests. if levels of electrolytes such as potassium are low then it may be useful to take supplements. Its not dangerous to the best of my knowledge to drink gatorade regularly however read this viewpoint for an interesting opinion http://blog.myheart.net/2014/01/15/sports-drinks-the-billion-dollar-lie/. A pinch of salt and sugar before bedtime is not harmful to the best of my knowledge.

Hope that was helpful,  

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Mustafa Ahmed MD

Expertise

Cardiology, Interventional Cardiology, Cardiac Surgery, Hypertension, Pulmonary Embolism, Structural and Valve Disease

Experience

Board Certification Internal Medicine and Cardiology Interventional and Structural Cardiology

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http://blog.myheart.net

Publications
Multiple Publications In High Quality Peer Reviewed Journals. Internationally Recognized.

Education/Credentials
MD from The Royal Victoria University of Manchester, England Medicine, Cardiology, Interventional Cardiology, Research Training - University of Alabama

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