Part 2 /Sunken Chest/ Pectus Excavatum/ MVP &/ Spectrum conditions

[Guest guest]

Part 2... from Sue,

Below has info on the type of condition that can be associated with pectus...as MY husband has the "PAC" = Premature ATRIAL contraction version = not ventricle...TYPE. ( Doc said PAC is not usually serious.)

Mitral Valve Prolapse (MVP) is believed to be inherited, with a greater expression of the MVP gene in females. Although people with MVP come in all shapes and sizes, there are physical features commonly associated with MVP. These include: PECTUS EXCAVATUM depression of the BREAST bone, scoliosis curvature of the spine, abnormally straight thoracic spine straight back, arm span greater than height, unusual joint flexibility, and LOW body weight.

Mitral valve prolapse has been around for a long time. In fact, symptoms similar to MVP syndrome were traced to the sixteen hundreds. MVP has been known by a variety of names. These include: irritable heart, soldier's heart, the effort syndrome, Barlow's Syndrome and DaCosta's Syndrome. British solders during the mid eighteen hundreds noted symptoms of fatigue, palpitations, shortness of breath, chest pain and were unable to perform demanding physical tasks. This was a major cause of medical disability. Similar findings were noted during the Civil War, World War I and World War II.

Osler, an eminent physician, noted the similarity between symptoms associated with irritable heart mentioned by others and those occurring in the general population, particularly in women. Some physicians believed the problem was not the heart, but one of a PYSCHICATRIC in nature. As technology advanced, so did the understanding of mitral valve prolapse. The 1980's saw the development of the classification of mitral valve prolapse into: Anatomic MVP and the MVP Syndrome.

Normal Mitral Valve

Anatomic Mitral Valve Prolapse

Anatomic mitral valve prolapse is an abnormality of the mitral valve leaflets, or supporting chords, or both. These structures allow the leaflet(s) to prolapse--buckle back into the left atrium during the heart's contraction--ventricular systole. Anatomic mitral valve prolapse is usually associated with structural changes whereby: the valve can be described as floppy; the chords--supporting structure--may thin, thicken, or lengthen. The exact cause of these structural changes is theoretical and not clearly understood.

Prolapse of the Mitral Valve

Several mechanisms can produce MVP. When the cause of the prolapse cannot be identified, it is described as primary mitral valve prolapse. When MVP is a consequence of other conditions, it is known as secondary mitral valve prolapse. One example of Secondary mitral valve prolapse is prolapse caused by endocarditis--a BACTERIAL INFECTION of the valve. Please note that this book will discuss primary mitral valve prolapse.

Mitral Valve Prolapse Syndrome

Primary anatomic mitral valve prolapse is frequently associated with a constellation of symptoms. These symptoms are listed below. Individuals with one or more of these symptoms are referred to as having the mitral valve prolapse syndrome MVPS. The term MVP syndrome refers to the occurrence of, or coexistence of, symptoms unexplainable on the basis of the valvular abnormality. Thus, the symptoms associated with MVPS are not due to the valve itself. They are believed to be based on various physiological changes. These are discussed later.

MITRAL VALVE PROLAPSE SYNDROME

COMMON SYMPTOMS

•Chest pain•Fatigue•Palpitations, extra heart beat•Lightheadedness, dizziness•Shortness of breath•Anxiety and/or panic attacks•Headaches•Low exercise tolerance•Mood swings

Characteristics of the Symptoms

Chest Pain

The chest pain associated with MVP presents itself in many ways. The pain may be brief in duration, or persist for hours. People describe the pain as sharp, heavy, shooting, sticking, or as pressure. At times it can be incapacitating, occurring repeatedly. Often the chest pain is atypical of angina pain caused by narrowing or constriction in the coronary arteries. Sometimes, however, the pain MIMIC's angina.

Many MVPers believe chest pains signal a heart attack. MVPS is NOT known to cause a heart attack. In general, severe narrowing and blockage of a coronary artery that supplies an area of heart muscle with blood causes a heart attack. This may lead to permanent damage of a portion of the heart muscle. MVPS neither narrows nor blocks coronary arteries, nor causes permanent damage to the heart muscle.

You ask, "How can I be sure the chest pain is not from coronary artery disease?" The answer to this relates to your original diagnosis. To first determine if heart disease is present, your physician considers your cardiovascular risk factors such as: age, sex, family history, blood lipid profile, smoking history, as well as your symptoms and results of diagnostic testing. Periodically, he follows up with testing such as an exercise stress test to reassure you the chest pain is not caused by coronary artery disease.

Fatigue

Fatigue is usually present to some degree. It may be episodic and severe, or relatively constant. Usually fatigue begets more fatigue the less you do, the less you feel like doing. The cause of the fatigue may relate to blood volume changes noted with exercise, to a high resting heart rate, or to other physiological factors to be discussed shortly.

Palpitations, Extra Heart Beats, Forceful Heart Beat, Pounding Heart, Heart Flutter

People describe palpitations EXTRA BEATS as a POUNDING sensation in their chest. Others say they feel a flipflop or fluttering. Arrhythmias disturbances in the heart rhythm such as ATRIAL extra beats (PACs), or premature ventricular extra systoles (PVCs) can cause palpitations. While some people feel each beat, others do not notice them. Often, after extra beats, people have a sensation that their heart stopped for a few seconds.

Skipped or extra beats are very COMMON among MVPers and the general public. Sometimes they occur following the use of caffeine, alcohol, tobacco, or certain medications. Other times, emotional stress may cause extra beats. Sometimes they happen for no apparent reason. In any case, these beats are relatively common, and should not be a cause for alarm. An explanation of the heart's electrical system may help to understand extra beats.

(For further information about extra beats and various arrhythmias, see Taking Control: Living with the Mitral Valve Prolapse Syndrome.)

Lightheadedness, Dizziness

Lightheadedness, dizziness, or both can occur when first standing up. This feeling is usually associated with a sensation of a forceful heart beat or palpitations. These symptoms may be related to decreased intravascular volume and metabolic neuroendocrine abnormalities.

Shortness of Breath

This is usually described as the inability to take in a deep breath. It may occur at rest or with activity. The shortness of breath has not been found to be related to cardiac heart, or pulmonary lung abnormalities.

Anxiety and/or Panic Attacks

Although the relationship is not clear, many MVPers suffer from anxiety or panic attacks. The symptoms described are more consistent with panic disorder, the anxiety disorder studied most often in MVP patients. People have recurrent, spontaneous anxiety attacks that consist of various combinations of symptoms similar to some MVPS symptoms. These symptoms include: fatigue, fainting, dizziness, chest pain, lightheadedness, rapid heartbeat, heart palpitations, and shortness of breath.

The degree and mechanism of association between MVPS and anxiety disorders remains unclear. While some believe the symptoms cause anxiety attacks, others believe extraneous factors trigger attacks. They may occur anywhere, at anytime, even in the middle of the night. Whenever anxiety attacks do occur, they are frightening.

Headaches

Headaches sometimes occur in the form of migraines and are accompanied by nausea and blurred vision. Some people describe their headaches as nagging or dull.

Other Symptoms

MVPers report other symptoms. Common ones include:

•chronically cold hands and feet•gastrointestinal stomach disturbances•problems with memory or a feeling of fogginess•inability to concentrate•mood swings•problems sleeping•numbness or tingling of the arms or legs•arm, back, or shoulder discomfort•difficulty swallowing•lump in the throat

Frequently, these symptoms are frightening, discomforting, frustrating, annoying and incapacitating. Certainly, they affect one's life style.

Expect symptoms to be more intense during emotional stress, when you are overly tired, after unaccustomed physical activities, during menopause, or during menstruation. It is not unusual for the symptoms to disappear spontaneously for months--even years and reappear again.

The following table lists factors that increase the intensity or frequency of MVPS symptoms. Data collected at the Mitral Valve Prolapse Program of Cincinnati (MVPPC), along with responses to the questionnaire in the first edition of Taking Control were used to compile the list.

FACTORS THAT CAN INCREASE THE INTENSITY OR FREQUENCY OF MVPS SYMPTOMS:

•Emotional stress•Excessive fatigue•Unaccustomed physical activity•Being anxious or nervous•Caffeine •Medicines with stimulants•Sweets•Being in a hot, dry environment•Dehydration•Flu, cold, or other illnesses•Lack of sleep•Alcohol•Smoking•Skipping meals•Rushing around•Lying on the left or right side•Menses•Menopause

Symptoms begin at any age. Most people, however, notice symptoms between the ages of 20 to 30. The exact cause likely relates to several factors and remains unclear. Often, MVPers who have been without symptoms, become symptomatic after an illness, injury, pregnancy, or emotional stress such as a divorce. While symptoms occur more in females, many also occur in male MVPers. Frequently, chest pain, palpitations, fatigue or anxiety attacks initially prompt them to seek medical help.

Many people with MVPS believe the more symptoms they have, the more severe is the prolapse buckling back of the valve. This is not the case. In the mitral valve prolapse syndrome, there is no correlation between the degree of prolapse and the severity of the symptoms.

METABOLIC NEUROENDOCRINE ABNORMALITIES IN MVPS

Research studies support the belief that certain physiological abnormalities may be responsible for MVPS symptoms. Not everyone's symptoms, however, are explained by these physiological alterations. The presence, degree, and type of involvement of the various physiological systems sometimes vary.

These physiological abnormalities include: autonomic nervous system dysfunction, decreased intravascular blood volume, and renin-aldosterone regulation abnormality. These systems are interrelated but separately discussed.

For further information, see Taking control: Living with the mitral valve prolapse syndrome.

SUMMARY

MVPSa common clinical condition affects millions of people. Only within the past few years have researchers identified a physiological basis for its symptoms.

Previously letters from MVPers show many endured one misdiagnosis after another till some truly believed, "It's all in my head."

Although definitive words on methods for long-term treatment of MVPS await further research, don't give up. Follow the recommendations discussed in this book. Use this knowledge to change the quality of your life. TAKE CONTROL.

SELECTED REFERENCES (Chapter 1)

Bashore, T., Grines , C., Utlak, D., Boudoulas, J., & Wooley, C. (1985). Mitral valve prolapse: Postural exercise response reflects a volume disorder. Journal of the American College of Cardiology, 5, 504 (abstr).

Boudoulas, J. (1992). Mitral valve prolapse: Etiology, clinical presentation and neuroendocrinefunction. Journal Heart Valve Disease, 1, 175188.

Boudoulas, J., & Wooley, C. (1988). Mitral valve prolapse: Clinical presentation and diagnostic evaluation. In, H. Boudoulas & C. Wooley (Eds.), Mitral valve prolapse and the mitral valve prolapse syndrome. (pp. 299330). New York: Futura Publishing Co., Inc.

Coghlan, H. & Natello, G. (1991). Erythrocyte magnesium in symptomatic patients with primary mitral valve prolapse: Relationship to symptoms, mitral leaflet thickness, joint hypermobility and autonomic regulation. Magnesium Trace Element, 92, 205214.

Coghlan, H., Phares, P., Cowley, M., Copley, D. & , T. (1979). Dysautonomia in mitral valve prolapse. American Journal of Medicine, 67, 236244.

Elin, R. (1988). Magnesium metabolism in health and disease. Disease of the Month, 34, 161219.

Ewing, D. (1988). Recent advances in the noninvasive investigation of diabetic autonomic neuropathy. In, R. Bannister (Ed.), Autonomic failure: A textbook of clinical disorders of the autonomic nervous system (pp. 667689). Oxford: Oxford University Press.

Fontana, M., Wooley, C., Leighton, R., & , R. (1975). Postural changes in left ventricular and mitral valvular dynamics in the systolic clicklate systolic murmur syndrome. Circulation, 51, 165173.

Gaffney, F., & Blomqvist, C. (1988). Mitral valve prolapse and autonomic nervous system dysfunction: A Pathophysiological Link. In, H. Boudoulas & C. Wooley (Eds.), Mitral valve prolapse and the mitral valve prolapse syndrome. (pp. 427443). New York: Futura Publishing Co., Inc.

Galland, L., Baker, S. & McLellan, R. (1986). Magnesium deficiency in the pathogenesis of mitral valve prolapse. Magnesium, 5, 165174.

Halpern, M, & Durlach, J. (eds.) (1985). Magnesium deficiency: Physiopathology and treatment implications. First European congress on Magnesium, Lisbon, October 68, 1983. New York: Karger.

Jeresaty, R. (1979). Mitral valve prolapse. New York: Raven Press.

Kolibash, A. (1988). Natural history of mitral valve prolapse. In, H. Boudoulas & C. Wooley (Eds.), Mitral valve prolapse and the mitral valve prolapse syndrome. (pp. 257274). New York: Futura Publishing Co., Inc.

Rude, R. (1989). Physiology of magnesium metabolism and the important role of magnesium in potassium deficiency. American Journal of Cardiology, 63, 31G43G.

Seeing, M. (1989). Cardiovascular consequences of magnesium deficiency and loss: Pathogenesis, prevalence and manifestations of magnesium and chloride loss in refractory potassium repletion. The American Journal of Cardiology, 63, 4G22G.

Page accessed times since September 21st, 1998Last Updated September 28, 2000

[ Academic Programs ] [ Dean's Message ] [ Student Life ][ What's New ] [ Faculty ] [ Alumni ] [ Nursing Web Resources ][ Topics in Nursing Practice ] [ Center for Nursing and Health Research ]

Back toCollege of Nursing and HealthHome Page

Back to State UniversityHome Page

Last updated Monday, November 05, 2001