Changes in Mitral Valve

[NBCT]

I have a concern regarding a diagnosis of Mitral Valve Prolapse due to myxomatous changes with mild to moderate MR. I understand some of the symptoms noted by patients are explained by MVP syndrome(chest pain, fatigue, palpitations etc.) due to autonomic system sensitivity, and that many have no symptoms at all. I experienced all of the above with relentless irregular beats, orthostatic tachycardia, dizziness etc. been taking Toprol XL for four years now which has helped.
My concern is how is one to differentiate between those labeled benign symptoms when they occur verses a true  cardiac ischemic event(the reported subtle symptoms women feel while in the midst of a heart attack)?
I am a female, 42, non-smoking, normal weight, with a strong family history of heart disease. I do not practice what I preach(nurse) about when in doubt get checked out, but the incidents of chest pain with papitations lately have me unnerved. Is there a loop monitor that will show EKG changes(ischemic) during an episode that can be used at home? I have used an event recorder years ago and last had a stress test a year ago which was borderline. Thanks for any input you may have.

[CCF-M.D.-MJM]

Hello,

Good question that I am commonly asked in clinic.

There is not a loop recorder that evaluates for ischemic changes and there probably should not be.  EKG monitoring during stress tests (exercise stress tests or exercise echocardiograms/thaliums) look for ischemic changes.  If you have a good exercise tolerance and a negative stress test, then that is sufficient.  If you have a negative stress and don't experience the symptoms of chest dyscomfort, fatigue, palpitations, then the symptoms are not from ischemia.  All the loop recorder would do is remind you that you are having the symptoms and perhaps make it easier to obsess about them.

It is very common for women in their late 30's to early 50's to have boarderline stress tests.  There may be nonspecific EKG changes or nonspecific changes on the nuclear or echo imaging modality.  At that point it is up to clinic judgement to decide if you want to persue a catheterization.  Almost all patients with these findings have a normal heart cath.  The purpose of the cath serves to rule out disease but more importantly reassure the patient.

Regarding the symptoms--once you know you don't have coronary disease by a catheterization or stress test, you know that when you have the symptoms it is not your heart.  If you have a change in the symptoms, that should raise an eyebrow.  Meaning  the chest pain doesn't occur at rest, now it happens with activity or you start to get short of breath with exertion, arm pain, jaw pain or ache with exertion.  I have to admit it is a bit tricky, but keep you doctor informed if your symptoms ever change is the best thing to do.

I hope this helps.

[Erik36]

Is there anyone here with any type of arrhythmia like PVC's, PAC's or A-Fib that also takes Lipitor? I have been on Zocor for two years and am about to switch to Lipitor. I read in the PDR that Lipitor can cause Palpitations and Arryhthmias. Lipitor is the only Statin that lists Arrhythmias as a potential side-effect. If anyone has any thoughts on this subject it would be greatfully appreciated!

Thanks!


Erik

[Carolina03]

"Regarding the symptoms--once you know you don't have coronary disease by a catheterization or stress test, you know that when you have the symptoms it is not your heart. If you have a change in the symptoms, that should raise an eyebrow. Meaning the chest pain doesn't occur at rest, now it happens with activity or you start to get short of breath with exertion, arm pain, jaw pain or ache with exertion. I have to admit it is a bit tricky, but keep you doctor informed if your symptoms ever change is the best thing to do."

I don't mean to raise anxiety, but what about microvascular angina?

Research from the WISE study provides data that many females with normal coronary arterties and borderline stress tests experience chest pain due to microvascular spasms.

Ischemia from this type of disease may cause cardiomyopathy over time, according to my cardio. Patients benefit from taking calcium channel blockers and nitrates.

Is MA an early indication of heart disease or a disease in itself? Can any current diagnostics "prove" such an etiology?

Thanks.

[hankstar]

Hi Erik,

     I have heard several persons complain of an increase in PVCs while taking Lipitor, some never experienced a PVC til after taking Liptor, after stopping Lipitor the PVCs disappeared, of course others don't experience any at or are not aware of them if they are occuring while on Lipitor.
     Please note this apparently occurs in small minority of persons on Lipitor and some only contribute it to coincidence, not a direct side effect and nothing else, anyhow my personal opinion on this drug being a PVC sufferer myself, though only occuring in episodes, I would take it with caution after already being predisposed to experiecing PVCs.

    Talk with your doctor and see what advice he might have to offer.

[Gaspipe]

IF you were to look thru a PDR you would note many many meds list arrthymia as a possible side effect. So it does not surprise me Lipitor does as well.Heck a possible side effect of beta blockers and all anti-arrthymic meds are arrthymias!!! Oh well....

[eileneee]

eric,
i am in chronic a-fib and have been for almost 10 years.  i have been taking lipitor for about 5 years without any problems or additional arrithymias.  maybe i am one of the lucky ones.  i agree with gaspipe that there are many, many meds that list arrithymias as a side effect.  i guess we have to weight the good and bad and then decide.  good luck
eilene