Mitral valve with overwhelming fatigue

  I was diagnosed with MVP 1991 secondary to chest pain & fatigue. Following an 2-D echo which showed MVP & Holter monitor that was unremarkable except for a heart range of 40 to 130 bpm in that 24 hour period I was placed on Tenormin for the CP.Due to the side effects of the tenormin I opted to live with the chest pain which has been minimal to severe @ times. I have had approximately 4 episodes of PAT which have resolved on their own after 30 min or so when a cough seemed to snap me out of that rhythmn but have frequent occassions of a large thump in the Left chest that almost always produces a cough with chest pain.
  I have went on my own to see one of the best cardiac Dr in our area & have had a stress test that showed me as in excellent health. I continue to have this overwhelming fatigue & have been diagnosed with depression as the cause. I feel that some jump to the conclusion fatigue results from depression & think medication will cure it. After 1 year on Wellbutrin SR 150 mg I feel there is no change in the fatigue. I just want to feel normal & energetic not drug down & breathless. These sx seem better when I walk 2 miles per day but still continue when I am @ rest, no reason for the fatigue.
  My question is I guess is how can you distinguish when a MVP is possibly getting worse or you really have a problem with depression. Being an RN I have listened & feel there is a slight murmur & audible click where there wasn't one before. I want to know for sure if there is something further developing or I'm just paranoid & reading into things too much. Should I have a new 2-d echo to compare with the old to R/O any further deterriorating changes or just observe for a while longer to see if things resolve themselves?
  I would appreciate it very much if you have time to reply & understand if you are busy otherwise. Thanks so much.

[CCF Cardio MD-SGM]

Dear Robin,
MVP can be associated with a variety of symptoms including chest pain.  Severe fatigue, however, is not a feature of the Mitral Valve Prolapse syndrome.  Simple prolapse without regurgitation or significant thickening of the mitral valve leaflets is a fairly benign condition.  It appears that the risk of more serious complications of MVP increases when these other associated findings are present.  Thus, it is reasonable to periodically undergo a physical examination to listen for mitral regurgitation.  Should
this be present, an echocardiogram is indicated to assess the degree of regurgitation.  Regurgitation can cause fatigue, but would need to be fairly significant to produce this symptom.  Mitral regurgitation typically produces shortness of breath upon exertion.  Thus,  I recommend that you periodically see a cardiologist regarding the follow-up of your MVP, discuss the need for prophylactic antibiotics prior to dental or other procedures, and possibly investigate other causes for the profound fatigue.
Depression can certainly cause fatigue, as can disorders of the thyroid gland, for example. If the Wellbutrin hasn't improved your symptoms, you may want to consider seeing a mental health professional to undergo another evaluation and consider other diagnoses or medications.
Best of luck with this problem.  Information in the Heart Forum is for general purposes.  Specific diagnoses and therapies can only be provided by your physician.