MVPS - article given me by my cardioloigist 1993 / Pre - EDS diagnosis

[Guest guest]

MITRAL VALVE PROLAPSE SYNDROME

By W. Glenn P. Friesen

SKELETAL FEATURES COMMONLY SEEN

FAINT SPELLS

PSYCHOLOGICAL FACTORS

PALPITATIONS

FATIGUE

BLOOD CLOTS

THYROID PROBLEMS

SUMMARY

At least 7.5% of men and women are found to have floppy mitral valve

leaflets. Clinically, we see about five times as many women as men, but

this probably just reflects the fact that women see their doctors more

frequently. Symptoms are not primarily related to floppiness of the mitral

valve leaflets, but the diagnosis is based upon finding this feature at

echocardiography. In a syndrome there are many symptoms in common and

certain physical finding in common.

This particular syndrome is not a disease. When you came through the

factory (were born) the features were already there. In some families up to

50% of the relatives have this disorder, but there can be skipped

generations. We would like you to know what the medical profession has

found out about this syndrome and we as cardiologists have found to be

helpful advice.

Skeletal Features Commonly Seen:

Frequently a straight backbone between the shoulder blades (like a poker) is

noted. This produces stiffness of the adjacent muscles and also neck

muscles, and there can be tender areas in the muscles which pinch on nerves

and cause sharp pains through the chest at times, even into the front of the

chest or at the breast region or down the arm. These symptoms can mimic

heart attack pain, but are due to nerve root irritation from muscle spasm.

It is common after stress and tension. There may be a dent in the centre of

the breast bone (pectus excavatum). It is more obvious in some people than

others. Also, there may be lax ligaments - for example, the fingers may be

bent back easily or there may be double joints. This must be due to a

variation of normal and not a disease. While later on in life there may be

stiffness and aching in these regions, there is no increase in the incidence

of arthritis and there will be no deformity later on, although morning

stiffness is frequently seen. Massage or physiotherapy treatments with

stretching exercises bringing the shoulders up, and extension and rotation

of the neck for five or ten minutes in the morning and evening will help to

loosen up these stiff areas. There may be occasional need for some anti

inflammatory or pain medication.

Faint Spells:

While some faint spells may be due to arrhythmia, people with mitral

prolapse often have simple fainting. This means that suddenly the blood

pressure gets too low to support the brain functioning and a person gets

white and faints.

This is usually associated with standing up in one position for too long or

being in an enclosed space with warm weather, etc. Shifting your weight

from one leg to the other will help if you are standing in line and you feel

faint.

It is important to drink four or five glasses of water per day to help keep

your pump system filled with fluid and thus avoid this postural low blood

pressure effect.

Psychological Factors:

All of the symptoms of anxiety are magnified in people with this syndrome.

The mind seems to be very alert, very sensitive to what's happening, and

often we note feelings of paranoia, questioning motives of other people in

relationship to yourself. You should be aware that you are much more

sensitive to the behaviour of other people around you than the average

person. When things aren't going right in your world it's more likely to

result in headaches, heart irregularities, pounding in the heart, aches and

pains in a variety of areas, stiff muscles, insomnia and occasional vivid

dreams.

Irritable bowel with flatulence is often associated; sometimes constipation

or looseness of the bowels is associated, as well as occasional hesitancy or

urgency in urination. While alcohol may cause these symptoms to subside for

a few hours, they return four to twenty-four hours after drinking too much

alcohol, and the symptoms become worse at that time; therefore, alcohol is

not recommended. It is better to get a mild sedative to help you through a

crisis, do more physical exertion, go for a half to one hour walk, learn

meditation or self-hypnosis techniques, and improve communication skills

with your loved ones. By expecting too much from other people you set

yourself up for great disappointments. Realize that you are much more

sensitive than the average person about issues.

Palpitations:

Heart rhythm disorders are frequent, with the most common being

palpitations. Some people feel a racing of the heart and this is called PAT

(paroxysmal atrial tachycardia, sometimes paroxysmal atrial fibrillation).

This is a nuisance type situation that can generally be managed by reduction

in stress, increasing physical activity and zero caffeine intake - no

coffee, tea, cocoa, chocolate, etc., and avoidance of stimulant drugs and

limiting alcohol intake to no more than two or three drinks per day.

Oftentimes palpitations are noted at rest, in the evenings and upon lying

down on the left side. Simply turning over to the right side will often

help you to overcome these feelings - it's best to try not to panic. Try to

get your mind on something else, perhaps read a book or go for a walk.

Occasionally rapid beating of the heart will require treatment and a common

form of treatment is a beta blocker (these block the adrenaline in your body

which stimulate these automatic extra beats).

Quinidine and other medications can also be used. Sometimes mild sedatives

will help considerably. Other types of non-medical treatment can be used

such as meditation, or obtaining peace of mind through a variety of means

such as psychological, religious, etc. Avoidance of hypoglycemia by eating

properly and avoiding fasting is recommended. This means avoidance of blood

sugar swings, either too high or too low, and generally sweets are

discouraged. Complex carbohydrates with fibre (potato, cereal, cantaloupe)

and protein (lean meat, low-fat milk products) should be eaten with each

meal. Perhaps an apple or a bran muffin or a slice of cheese between meals

could be eaten in addition.

Generally, one should not worry unless there is fainting or feelings of

sudden faintness in the sitting or lying down position. In that case, you

should see your doctor or go to the emergency room, particularly if there

has been a complete faint or blackout or if the heart continues to race

after half an hour. We have noticed an increased incidence of slow heart

rate in older people (70's age group) with this syndrome and a pacemaker may

then be required; however, this probably represents a small percentage of

the total number of people with mitral valve prolapse.

Fatigue:

Fatigue ability is not related to heart weakness but to an imbalance in

autonomic controls of the veins and circulation to the muscles, etc.

Increase your water intake to four glasses plus per day, and do the

equivalent of half an hour walk per day, and try to reduce stress factors.

Get a good night's sleep.

Blood Clots:

Platelets are small elements in the blood, smaller than red blood cells,

which when they become too adherent form small clots in the arteries and,

for example, could cause small strokes. This is more common in people with

mitral valve prolapse - that is, the platelets are stickier and occasionally

medications are used such as Aspirin (Entrophen), Persantine (Dipyridamole),

Anturan (Sulfinpyrazone), or actual anticoagulants such as Warfarin or

Coumadin. Only a small percentage of people require this treatment however.

Generally, as long as good health habits are maintained and active exercises

continued, this should be no problem and in most cases medications are not

required.

Thyroid Problems:

Approximately 50% of people with hyperthyroidism (overactive enlarged

thyroid gland) have mitral valve prolapse. However, only a small percentage

of the large population with mitral prolapse have hyperthyroidism. It's

likely the increased association is related to high stress, more keenly felt

by mitral prolapse patients. Some investigators feel there is more

adrenaline or adrenaline-like substances in the blood of people with mitral

prolapse. Situations that would ordinarily be mild anxiety producing in the

average person cause considerably more anxiety, either because of the

greater adrenaline amount or because of increased reactivity of the

receptors to adrenaline.

Summary:

The long-term outlook is very good - people with mistral prolapse live as

long if not longer than the average person. It is advised that antibiotics

be taken prior to any dental surgery or any potentially infectious surgery

to prevent a bloodstream infection. Bacteria can settle on the floppy

leaflet and case flu-like illness with low-grade fever and night sweats

called sub-acute bacterial endocarditis (SBE). This illness requires four

to six weeks hospitalization and IV antibiotics to overcome, and can lead to

valve damage.

Keep as active physically as possible and try to reduce stress in your life!

The good thing about having mitral valve prolapse is that you are much more

alert than average, very sensitive and aware, and tend to avoid bad habits

because you are very sensitive to body changes. Because of this sensitivity

and avoidance of bad habits, a long life can usually be anticipated.