Doubts and Frustrations

  I am a 42 year old female who would be grateful for any answers you can give me. First, my history: I have had chest pains since a child when I'd run and exercise real hard, however I never told anyone because I thought it was normal. These continued into adulthood. I complained about them to doctors as an adult in my mid-30's but was told I was too young for heart problems and thus these were due to stress. About 9 years ago, I mentioned one severe episode after running intervals in the park to my psychiatrist who ordered an EKG. There was a delay in conduction time which the cardiologist attributed to an antidepressant I was on (Elavil). He said that was the cause of the chest pains and to stop running intervals or anything that caused the pains. He also thought he heard the clicks of a mitral valve prolapse but an echo was negative. 5 years later I was off the antidepressant and out of therapy. My EKG returned to normal.
  Last summer, my chest pains were becoming worse in intensity and frequency. I was continuing to ignore them until, by accident, I discovered that my pulse was in the 40-50's. I am not an athlete. My resting EKG was still normal. A stress test was ordered and it was abnormal. It was established that when I am having chest pains that my EKG is abnormal. A heart catherization was done next. My heart showed no signs of abnormalities other than a mitral valve prolapse. During Doppler tests, there is quite a bit of reguritation when my cardiologist has me squeeze his hand. He says a valve replacement is in my future but the valve isn't bad enough yet.
  We have tried 7 different medications to try to get the chest pains into a tolerable level. Beta blocker (specific, non-specific, combo alpha and beta) either cause severe depression or bottom out my blood pressure. Currently I am on Posicor, a calcium channel blocker, and a small dose of Zoloft. My cardiologist says there is no evidence of depression but that the Zoloft helps in the orthostatic hypotension I sometimes experience.
  I am still troubled by chest pains--especially when I am tired or overdo. I have learned to grin and bear them....even when short of breath and have difficulty moving my legs. What bothers me the most is that my life before this heart cath and diagnosis was a pretty normal life. And the chest pains are much worse in frequency and intensity than before the heart cath as well. I can't help but wonder if something was damaged during the cath as I tried to get off the table 4 times during the procedure while the catheter was in my heart. My cardiologist has told me not to worry about it but I suspect he might be more worried about malpractice or something. I don't care if something went wrong or a mistake was made...I just want the truth so I can understand what is going on. I wish I had never had the procedure done and never gotten the diagnosis. My life suddenly has many limitations and when I try to buck them, I am almost incapacitated by chest pains. Laying down seems to be the best way to deal with them, although when I get up they hit me real hard again.
  Now I read about the Mitral Valve Prolapse Syndrome....and I am told by an ER doctor that my chest pains are not coming from my heart...that I am having a panic attack. I am confused and filled with doubts about who is crazy here. These pains are very real and they are exhausting. In frustration, I have sworn off appearing at an ER again. If there is nothing in my heart to kill me, as I have been told, then I'd just as soon forget all of this and never see another doctor again. I understand now patients who say that they just want to be left alone. And I'd appreciate getting my life back.
  Any comments or suggestions you can give me would be much appreciated.
  Respectfully,
  Nina
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Dear Nina:
The heart catheterization almost certainly had no effect on making your chest pains worse.  I have never seen a case where it has, other than for psychological reasons.  While there are serious complications associated with heart catheterizations, what you describe sounds different.
It seems as though you may have a leaky mitral valve.  This can be a problem if the amount of leak is severe.  You should be followed regularly by a cardiologist to make sure the amount of leak is not getting worse.  In addition, you should have regular cardiac ultrasounds, so that your heart valve can be assessed objectively.  If the heart function appears to be deteriorating, you may need surgery.  If the valve is leaking only a bit at rest, it may be worthwhile to do an exercise stress test with simultaneous cardiac ultrasound imaging to see if the leakiness gets worse with exercise.  If the valve really does leak significantly, surgery is an excellent treatment, provided it is done in a timely fashion [before the heart gets too weak].  Therefore, do not ignore the condition.
However, even if testing shows that you have significant mitral valve regurgitation, I cannot say that the numerous long-standing symptoms that you describe are all due to the valve.  You should make sure that your doctors evaluate whether you have any heart rate or rhythm problems, or other medical conditions.  Also, Zoloft is a medicine for depression, and I suspect that your doctors are in fact treating you for depression.  I would suggest formal evaluation by a psychiatrist.
I hope this has been useful.  Good luck.
Information provided here is of a general nature.  Specific diagnoses and treatments can only be made by your doctor.  If you would like to be seen at the Cleveland Clinic, please call 1-800-CCF-CARE for an appointment with a cardiologist who specializes in heart valves at Desk F15.