Questions posted in the Heart Forum have been answered by doctors from The Cleveland Clinic Foundation.

Question Title: dramatic change in irregular beats

Forum: The Heart Forum
Topic: Mitral Valve


I am 27 years old and was diagnosed with MVP three years ago after fainting from an irregular heartbeat. I was placed on 25 mg/day of the beta blocker atenolol, which stopped the fainting, but I still had the occasional irregular heartbeats (about one noticeable episode per day).
Two days ago, I began noticing the irregular beats (manifesting themselves as a short flutter in the chest then a "BOOM" beat) were occurring every 10 minutes on average. Could the atenolol be losing its effectiveness and should I up the dosage to 50 mg? Could the MVP have suddenly gotten worse like it did?
While writing this, I've had two irregular beat episodes. I've read all the literature about these flutters being harmless, but for them to pick up in frequency that dramatically is startling and, by all indications, not common.
Basically, I need some advice as to what I should do.


Dear Jeff, thank you for your question. Mitral valve prolapse (MVP) is associated with various rhythm disturbances of the heart which most commonly are premature beats from the atria (PACs) or the ventricles (PVCs). It sounds like you may have had prolonged runs of these premature beats to cause your fainting spell in the past and your recent palpitations. Beta blockers decrease the severity and frequency of these premature beats and your current dose of atenolol is on the low side, so it certainly could be increased. It's doubtful that the MVP has worsened to cause these symptoms since this disorder is usually stable with time. Common precipitants of premature beats are tobacco, alcohol, caffeine, and stress. One of these precipitants may be the cause of your recent palpitations, so you should try to avoid these precipitants. Notwithstanding that advice, I also wanted to assure you that premature beats are indeed benign and don't portend a bad prognosis. For you to reduce the nuisance that these premature beats cause, it may help to increase your dose of atenolol. However, you would need to see your own physician to determine whether this is the best course of action for you.

I hope you find this information useful. Information provided in the heart forum is for general purposes only. Only your physician can provide specific diagnoses and therapies. Please feel free to write back with additional questions.

If you would like to make an appointment at the Cleveland Clinic Heart Center, please call 1-800-CCF-CARE or inquire online by using the Heart Center website at www.ccf.org/heartcenter. The Heart Center website contains a directory of the cardiology staff that can be used to select the physician best suited to address your cardiac problem.

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