Mitral valve prolapse and palpitations

Hi, I am a 33 year old female who was diagnosed with mitral valve prolpase via echocardiogram about 3 months ago.  The diagnosis was mild mvp, with myxomatous changes of the valve.  I believe the regurgitation is "trace".  My physician said that the valve is "floppy".  I am supposed to have yearly echos to track it.

I have been troubled with occasional palpitations since puberty.  They feel like "flip-flops" or "pauses".  They were relatively infrequent, noticed mostly during stress, or too much caffiene, etc.  My mother and grandmother also experienced them, and my brother had one episode of extended atrial fib.

Since the diagnosis, I have been having daily palpitations and have basically become terrified.  I had a normal EKG after going to the the emergency room for them. They were not able to capture them at the time though.  I have had Holter studies done as a teenager and young adult (prior to the MVP diagnosis) and as far as I know they came back unconcerning.

My questions are:

1.) Are these palpitations likely caused by stress related to my diagnosis or are they directly related to the mitral valve prolapsing.  I've heard MVP called an "arrhythmia".  Is that really accurate?

2.) Am I really at greater risk for "sudden death"?  There seems to be conflicting information out there about it.  I have lost a lot of sleep over this!

3.)  Is there any advantage in this case, of going on beta blockers.  My GP prescribed them, to be used as needed, but I hated how I felt on them.  Would being on the beta blockers help prevent mitral valve prolapse related complications?

Any clarifiying information would be helpful!

[Michael J. McWilliams, M.D.]

1. MVP is not an arrhythmia.  It is when the mitral valve extends further back into the atrium than normal.  While it does require monitoring, it is usually not a problem.  There are a host of seemingly strange symptoms attached to MVP -- chest pain, palpation, anxiety, etc.  I don't know why MVP causes these symptoms but it does seem that people with MVP have these symptoms more often.

As for "are the these symptoms causes by stress...." -- that is an interesting observation.  Anecdotely, it is common for people to say their symptoms got worse after the diagnosis or as soon as they become aware that there could be a problem.  Palpitations in general are worse during times of stress.  Adrenaline and possible other stress related hormones make your heart beat harder.  During times of stress these hormones are released even though you don't feel "stressed" or "anxious."  It some people I believe this contributes.

2.  That is a difficult question.  The answer is not clear.  I found one reference that said the incidence of sudden death in MVP with no significant MR is 1.9 per 10,000 per year.  That is a pretty low risk.

3. I have not seen data to suggest that beta blockers decrease complications related to MVP.  Beta blockers are used to decrease the sensation of palpitations but not specifically for MVP.

I hope this helps.

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