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MVP, Palpitations and Stress - help quickly please


  Im really looking for some insight here. Ive been chasing some problems
  around for a couple years and fell stuck in a chicken and egg type
  situation.
  Here is some rather lengthy background:
  Male age 32 about 6' tall about 160lbs.
  2 years ago went to Doctor for skipped beats. They were occasional but
  really worried me.  
  Echocardiogram showed 'minor' MVP.  Dr said I didnt even need to take
  antibiotics at dentist. But this could cause the skipped beats.
  Started having non descript chest pains over next 6 months.  
  Dr perscribed Inderal (20mg twice daily).  Seemed to help and also
  had a general calming effect on me.  Which is good because Im pretty
  high strung.
  Had numberous EKGs and Holter monitor.  All returned normal over next
  year or so.
  Have also had number of dizzy spells and near fainting the last year
  or so. (Been taking inderal about 13 months)
  Had a glucose and thyroid test that came back fine.
  Tilt table test revealed 'neuro cardiogenic syncope' after less than
  20 minutes into the test.  
  In the process of following up with a cardiologist on this.
  Meanwhile doctor said that he believe I have an anxiety problem that
  is adding the this mix of symptoms.  ( including a GIRD and hiatal hernia)
  I have to agree with him on this one.
  Additional information that may be superfluous:
  Trouble sleeping ( staying asleep not falling asleep )
  Markedly less tolerant of heat.  (I seem to get wiped out easily in hot weather even if Im not active)
  Sensitive to light ( I now wear sunglasses even on overcast days and
  leave the lights off in my office when I work on my computer which is
  pretty much all the time)
  
  ---------end background
  This whole thing has had me very worried over the last couple years.
  Im even a bit afraid to excersize or overexert myself because sometimes that starts the palpitations up.  
  The inderal (propranolol) keeps my heart rate down in the 55-65 range
  often around 58 beats per minute.  Could this be contributing to my
  near fainting spells and or a weak feeling??  
  Is this 'bradycardia' induced by the propranolol??
  This morning I was quite fatigued and my pulse was down to 52 according
  to my blood pressure monitor. ( Blood pressure was 131/84)
  Should I discuss changing the inderal dose?  
  At one point a doctor had me try 20mg propranolol 3 times a day and
  I found myself exhausted and noticed my pulse was occasionally <50.
  Could the propranolo have any effect on my results from the tilt table
  test or is this unrelated??
  
  I also take prilosec daily for hiatal hernia.  And my doctor perscribed
  diazepam on an as needed basis for anxiety and what I just recently found
  out were possible panic attacks.
  Could chronic stress and anxiety be the root of all these symptoms or
  just an additive result of worring??  ( My job is quite stressful and
  these first symptoms (skipped beats) started not long after our first
  child was born and my father was diagnosed with cancer which only added
  to the already high stress level).
  I would appreciate any insight and possible areas for discussion with
  the cardiologist to which Ive been refered. Im supposed to see him
  for the first time tomorrow and Id really appreciate a reply ASAP if
  possible.
  Thanks In Advance
  PCR

-------------------------------------------------------------------------------------------------------------
Dear Paul
I personally feel that mitral valve prolapse is overdiagnosed. Even if it is present, it is a rare cause of palpitations.
The inderal is probably causing your pulse to be in the 50's. A pulse in the 50's is unlikely to cause any symptoms, especially since you write that your blood pressure is normal with this low heart rate. Inderal can contribute to feeling fatigued.
If you are having dizzy spells and almost fainting, you need to mention these serious symptoms to your doctor.
I hope this is useful. Feel free to write back. I wish you the best of luck.
If you would like to set up an appointment with one of our cardiologists here at the Cleveland Clinic please feel free to call 1-800-CCF-CARE.
Information provided in the Heart Forum is intended for general medical informational purposes only. Actual diagnosis and treatment of any particular medical condition can only be made by your physician(s).




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