Question Title: MVP or Panic Attacks?

My 23-year-old daughter has been diagnosed with POSSIBLE MVP. She had an EKG in the doctor's office which was normal and there was no 'click' when her heart was checked with a stethascope. She has a history of anxiety stress disorder and panic attacks and has been off Prozac for over two years. The echocardiogram is a very expensive test for someone with no insurance. (She is a student and has just been dropped from my policy.) Are there other tests she can take beforehand that are cheaper that could give us a lead on whether she really has this problem? There is a great deal of stress in her life right now and with her history, I am more apt to think she is suffering through her panic attacks again, but also feel she needs reassurance. One hospital recommended the Holter Monitor. Is this going to show anything? Should the EKG have shown something abnormal or was this another unnecessary test?

---

___

---

Dear Jo,
Although this is not a diagnosis or treatment forum, there are two things that
strike me as important in what you say: 1. If there is no murmur heard on examination
of the heart and no click, it is HIGHLY unlikely that there is MVP and an echocardiogram
would then only be indicated if there were some reason other than 'to rule-out MVP'
to do the echo(say for instance that your daughter has significant shortness of breath or
some new symptom that might be due to an abnormality of the heart.) Also you should know
that there is NO THERAPY for MVP other than for those who have concomitant mitral regurgitation
which would be heard on serial if not one physical examination of the heart. For those who have
MVP and the regurgitation(leaky valve) we recommend antibiotic prophylaxis for the with all dental visits
and such. The best way to handle whether or not to get an expensive test is to ask the physician ordering
it these questions: 1.What are you looking for on this test and what in your opinion is the likelihood we will find anything of significance?
IN your daughter's case will finding MVP change anything?
2.Will it change the therapy, and if not how will this information be of value to you?
3. What are the risks of not having the test?

The second thing that strikes me in your description is the fact that you are considering as a good possibility that the problems your
daughter is having are simply a return of her panic attacks. IN college there is a tremendous amount of stress and unless there were some
new and concerning symptom with these current episodes it is very likely that you are right and it simply represents just that-more panic attacks.

Since I do not know the whole history and do not know the indication for the ECG, surely I can not comment on whether or not it was indicated.
It is however a fairly cheap test that gives quite a bit of information if it is abnormal. You need to ask the questions I suggest and discuss
with your daughters doctor the possibility or likelihood of this being a return of panic attacks- and if he does not agree, you simply ask why?
Good Luck and write back with further questions if they arise.
Information provided in the heart forum is intended for general medical informational purposes only,
actual diagnosis and treatment can only be made by your physician(s).

---