Mitral valve will it get worse and can I exercise?

[MDAVEY]

My story is long but I wll condense it down. I am male 39 years old and it started when I was 7 or so had tonsill problems and then had them out. Somewhere in the process I picked up strep, then for months I was going to the doctor and taking medications. The doctors kept saying I had the germ that started Rhuematic fever and I took meds for months but no one ever said for sure if I had rhuematic. Every since then I have had chest pains sometimes dizzy spells especially when I was a teenager at different points in my life it has been ok and been bad. Doctors always said my heart sounded fine no problem no click if you will. I can remember in high school having what now looking back must have been anxiety and still do on occasion. Afew years back it was very bad for awhile. The doctor just told me it was anxiety and gave me pills for it,since my mother has anxiety too. Also I still always took antibiotics b-4 the dentist since no one was ever sure that I had or hadn't had rhuematic fever and they wern't sure if any valve damage. In the past few years the big problem has been skipping beats sometimes cold hands/feet and usually a rapid heartbeat,tired for no reason. So after years of wondering in Jan 04 I demanded my doctor do a fullset of tests to check out my heart once and for all. Had echo, stress test,halter moniter bloodgas,thyroid etc... All tests came back ok but the echo showed slight MVP with no signifigant regurgitation. Went back for follow up 4-5 and he gave me Toprol-xl 25 mg and said to take just when I have high heartrate.Will this get worse?  Thanks,Mike

[Dr. Erik]

I think it's ok to try the Toprol. Your heart rate and blood pressure should compensate. If you can't tolerate the Toprol you can discontinue it. As far as the anxiety, that's a pain right in the neck isn't it? I went through Psychotherapy along with taking Prozac, Xanax and now have replaced Prozac with Paxil.
My anxiety has been under control now for years. It's amazing, once your anxiety is under control, you find out how much of your problem was anxiety the whole time. I think you can relieve your anxiety and drastically improve your quality of life. Good luck!

[Mieke]

Thanks Tony, just clicked on Post a question and got through! It must be 8am in America and I was just lucky to log on at that time.
Will see what the Doc says about the Aspirin treatment.

Mieke

[va_tony]

Mieke,

Though some claim that they can tell the difference between PVCs and PACs based on the sensations they experience, there is a wide range of symptoms that overlap both cases making it really difficult.  The only practical way to tell is with an ekg.  If you've been diagnosed with PVCs in the past, that's probably what they are now.

I've been incredibly lucky getting to post questions (2 successes out of about a half dozen tries). It appears they start taking questions precisely at 8:00 am (and ,of course, by 8:01 the two question slots are filled).  CCF advertises that they rotate the time zones daily, but I suspect this is limited to US time zones. So, you may wish to try at a local (Australian) time corresponding to 8:00 am US EDT, CDT, MDT, and PDT.

Good luck,

Tony

[Mieke]

Thanks for the information, I will continue to try and post the question to see what the Doctors opinion is.  I think all my palpitations are PVC's, its been a while since I had a holter monitor.  Do PAC's feel any different from PVC's? my heart does some peculiar things sometimes and I have to stop momentarily and think what is going to happen next, and I can hear it beating in my ears, and a sort of pressure in my head when that happens.

[va_tony]

Mieke,

My last post to you was about 7 am EDT.  It's now 10 am. So, if you posted on-the hour, it was 8 am somewhere in the US. Congratulations!

Tony

[rw21]

Understanding you are on Paxil, how addictive is it.  My mom has been on Paxil for about 3 yrs.  Still interested in calcium-magnesium supplement before I go with the std. drugs for anxiety/depression.  I have notice in the last few weeks a difficult time in trying to sleep. I usually can fall asleep anytime I want with no problem.  My GP gave me Ambien 10mg but it only works for about 4 hrs. and then I'm awake and can't get back to sleep.  My calves have been hurting for the last few days and I think I really need a few nights of good sleep.  Any thoughts???   With the Toprol, is this something that you need to take regularly or only when you have a spell especially since my resting HR is low.  Each time I had the AF was about 4 or 5am when I awoke to go to the bathroom.  Never had AF from the work place or excercise.  AF would last anywhere from several minutes to about 8 hours.

[MDAVEY]

Paule, thanks for the reply but the Cardiologist is the one who told me to take only when I need it ...I wouldn't think you would just take a drug whenever thats why I am confused is he a quack or on the right track...wasn't trying to make a rhyme! Thanks, Mike

[Paule]

Wow.  I'm glad the board placed the disclaimer.  I have to strongly disagree with many comments from the last post. 1)Toprol XL SHOULD NOT be used "as needed." Any advice that it should and is followed can be dangerous. One must carefully taper when using beta blockers & WITH their doctors knowledge/care.  Readers pls remember, the dislaimer up above.

2) Xanax is NOT a sleep aid & these drugs (as with all drugs) have risks, even when used as directed.  Xanax carries with it high physical/psy. dependence risk, esp used every nite for sleep. An earlier post regarding valium (a similar benzodiazepine) use over 7 years and 12 months of horrible withdrawl is not unusal (actually person was lucky) and can happen with xanax.  
I hate to also say this but being at the "young" age of 36 and on xanax should be of concern.  As you even stated, you have many years ahead of you. Do you expect to stay on xanax for sleep for 20-30-40 or 50 years?  I don't mean any alarm but you may be a bit too carefree about the regimens your discussing in your post.

SSRIs(Paxil) have a discontinuation syndrome associated with their use but there are many that discontinue without the "withdrawls" some experience. Paxil is not considered addictive.  I have seen both "withdrawls" of paxil and xanax--I wouldn't want either but if I had to choose....

Individuals with MVP more often have anxiety conditions--there are several books, one that comes to mind is by Dr Ronald Hoffmann (spell?).

Cognitive Therapy (CBT)--with antidepressants if needed--offer the best outcome if one is anxious or anxious/preoccupied about their health.  A good book (in my opinion) is a very old book called THE ANXIETY DISEASE (Dr.Sheehan spell).  Its old but its principles still apply.  It takes the reader through a real (but fictional account) of the "doctor" shopping that accompanies the "spells" of anxiety.  The lump in the throat (globus hysterectus), and the thousands of dollars of unneccesary but defensive workup that accompanies these spells.  EKGs, echos, etc.

Good luck.

[MDAVEY]

rw, the doc just told me to start taking toprol-xl to and most of the time my heartrate is around 68 to low 70's but when I get an episode like after a big meal or drinking etc.. then it goes to 85-100 the doc said oh that that wasn't bad and was pretty normal I should only be concerned if it was like 155 he said but to me 100 is high if I am just doing nothing so he gave me the toprol and said only to use if I had an episode. So if 90-100 is in the normal range should I even be taking meds? or if I don't take them am I hurting my heart even though he said I was in the normal range? ....very confusing...hope we all find the answers   Mike

[Mieke]

I too have MVP with mild regurgitation, lots of PVC's for 20years now, I was put on valium for my anxiety, because lets face it PVC's especially on a regular basis do make us very anxious.  I think a lot of the time doctors think we have the PVC's because we are anxious people when in most cases its the other way around. I became physically dependant on valium although I only took a small dose occassionally,but it was over a 7 year period.  I had a shocking time coming off the pills and was sick for 12months, much worse than my heart problems! I suppose eventually we learn to live with the PVC's and cherish the times our hearts are quiet.

Anyway, I was just wondering if anyone knows if peope with MVP, PVC's and regurgitation are at a higher risk of developing clots? I have heard that this is the case and I have been trying to post the question but can't get in. If this is the case should we be on a small daily dose of Aspirin?  Then I have just heard that people on daily Aspirin are at a greater risk of cerebral haemorrhage! Very confusing, has anyone heard anything similar?

I appreciate this site so much, we don't have anything like this in Australia, I log on regularly to read what you all have to say to each other, its wonderful support thank you all of you.

[Dr. Erik]

The Toprol can be used as an "as-needed" drug. Usually people do take it regularly. Paxil is not addicting, although once on it for a while you would have to taper it when discontinuing. Maybe you need a higher dose of the Ambien to last through the night. I take Xanax at bedtime for my night time anxiety and I sleep like a baby all night. You have come to a point where you don't want to be on meds but at the same time you don't want to suffer anymore. When I reached this point I decided that quality of life was more important than worrying about taking medicine. Actually, the medicines we are talking about are all very safe and have no long-term adverse effects when use as directed. I am only 36 years old and have been taking them since I was 23. I am still healthy and I exercise and lead an active lifestyle. Go ahead and take some Calcium and Magnesium supplements. They won't hurt you. I take Magnesium Oxide and it has done wonders for my A-Fib and PVC's and PAC's. But it won't help your anxiety. Good luck!!!

[va_tony]

Mieke,

   You asked if people with MVP or MVR are at greater risk of developing blood clots. I don't believe so.  I just performed a google search and couldn't find any sites that imply that. They do say that anticoagulants are recomended if you have both MVP/MVR AND atrial fibrillation or, if you've had a mechanical valve replacement. I'm on coumadin myself because of mild MVR and AFIB.  But for many years, I had only MVR and my doctor never once mentioned taking an anticoagulant for it (he did write a prescription for antibotics to be used prior to dental work though). I also have an enlarged atrium, which is another clotting risk.  Atrial enlargement, in fact, is often caused by MVR. Do you know for sure your palps are PVCs and not PACs? One common route to AFIB is having both PACs and MVR (which leads to atrial enlargement).  The probability of getting AFIB for those having both an enlarged atrium and PACs is 100%.

    I imagine aspirin does carry with it a higher risk of cerebral hemorrhage. One of the side-effects of all anticoagulants/antiplatlets is bleeding, including in the brain. But I'm sure the benefits of taking aspirin daily far outweigh the very small risks.

    I spent about a month in Australia a few years back.  I really loved your country.  Great place!  I just wish it were a bit closer geographically to the US.

Tony

[pms_barbie]

Thanks I sure hope so.  I am like the biggest worry wart.  Do you have reg with yours?

[Dr. Erik]

Yes I too have mitral Valve Prolapse. The fact that you have mild regurgitation is a good sign. You'll probably never have to have your valve repaired although no one can say for sure. I'm sure your next echo will turn out just fine.

[rw21]

Erik

[Dr. Erik]

Yes, I have mild regurgitation.

[pms_barbie]

I assume you have mitral valve prolapse also?  I know the palps cause me a great deal of anxiety and stress.  I have moderate to severe prolapse but only mild reg.  That was my last echo.  I am awaiting the results of my most recent echo.  I hope it isnt worse.

[Dr. Erik]

I'm sorry you have had to go through this whole ordeal. The bottom line is that you are fine. Lots of people have Mitral Valve Prolapse. It does not shorten your lifespan. You have an anxiety problem and you have a hard time coping with these skipped beats (probably PVC's and PAC's). You need counseling and possibly medication to help control your anxiety. I have had PVC's and PAC's and A-Fib for years and I have an anxiety problem. I got help for the anixety finally and I've been fine ever since. The skips don't bother me a bit. Good luck to you!

Erik

[MDAVEY]

Sorry 1 more comment I went to the dentist today and I took my antibiotics 1 hour before like I should. My question is even though I floss and brush regularly I still bleed quite a bit and the dentist said I should have blood work done but I told him a month ago had full bloodwork done and a thyroid panel done and it was ok my ldl was 80 and my total cholesterol was 171 but my tryglecerydes were high at 250..can this cause the bleeding or can it be related to the MVP? Thanks, Mike

[Cleveland Clinic]

MDAVEY,

thanks for the post.

I can't really tell you if what you have will progress without seeing your echos and exactly what is the mechanism and amount of your prolapse, or if it's even there. The term prolapse tends to be overused in the echocardiographic world.  

Most likely, if you have prolapse, your course will be benign, and a serial echocardiogram could confirm non progression.

good luck