The Most Misunderstood Cardiac Condition

Mitral valve prolapse is an often misdiagnosed heart condition that occurs when the mitral valve, which lets blood drain from the top to the bottom chamber of the heart, buckles back during the heart's contraction.

Mitral valve prolapse syndrome (MVPS) refers to a cluster of symptoms that often occur when the heart has this abnormality.

• Find it on eBay! Go to eBay now and search over 1 million items for sale at incredible prices.

Common symptoms: Heart palpitations, chest pain, dizziness, fatigue, anxiety or panic attacks, headaches, mood swings. Symptoms may be made worse by physical or emotional stress, caffeine, dehydration, skipping meals or being in a hot, dry environment.

MVPS affects 4% to 18% of Americans-as many as 40+ million people. It afflicts about three times as many women as men.

The physical abnormality is believed to be inherited.

Whether it actually causes the symptoms associated with it-and if so, how-is unknown.

Other physiological changes associated with mitral valve prolapse include:

• High sensitivity to catecholamines, the adrenaline-like substances released by the nervous system to help the body deal with emergencies.

• Problems with the body's salt-regulating mechanism.

• Decreased intravascular volume-the amount of blood circulating through the body.

• In some people, the buckling back of the valve is accompanied by a murmur, during which a small amount of blood flows back into the top chamber of the heart. (The blood doesn't stay there, but gets pumped out on the next beat.)

Not all physicians are familiar with MVPS. Too often, symptoms are not taken seriously by doctors, or are wrongly attributed to other conditions-usually hypoglycemia, chronic fatigue syndrome, an inner ear problem or anxiety disorder.

Many people with the condition go from doctor to doctor, terrified they're on the brink of a heart attack-only to be told there's nothing wrong with them or that the problem is psychological.

The good news:

Despite being classified as a heart condition, mitral valve prolapse does not cause heart attacks, and it's believed that the majority of people with MVPS have a normal life span.

Sometimes, just learning that the condition has a name-and that it's not life-threatening -is enough to make the syndrome manageable.

However, patients with mitral valve prolapse are advised to use antibiotics when undergoing "dirty surgery"-procedures, such as root canal work, during which bacteria could be released into the blood, making the valve more vulnerable to infection.

Diagnosing MVPS:

In addition to noting the presence of symptoms, a physician can usually diagnose MVPS by listening to the patient's heartbeat for a click (made by the buckling back of the valve)-or murmur (the swooshing sound caused by the flow of blood back into the top chamber). These sounds, though, aren't always detectable. The diagnosis may be confirmed with an echocardiogram, or ultrasound examination.

Living with MVPS: There is no cure for mitral valve prolapse. Fortunately, the symptoms can usually be controlled through changes in diet, exercise and other life-style habits.

Nutrition management:

• Avoid caffeine and other stimulants. Because MVPS patients are sensitive to adrenaline-like substances, stimulants can aggravate symptoms. Cut out coffee, tea, chocolate, caffeinated soft drinks and over-the-counter drugs containing caffeine, such as Anacin and Vivarin. Also avoid drugs that contain the stimulants ephedrine and pseudoephedrine, including Actifed, Benadryl, Chlor-Trimeton, Sudafed and many other antihistamines.

• Increase salt and fluid intake, especially if you feel dizzy when you stand up. People tend to think heart problem-cut down on salt, but the opposite is true of MVPS. The condition is often accompanied by problems with salt regulation and circulating blood volume, so taking in enough salt and fluids-at least eight glasses of water or juice a day-is important.

Exception: People with high blood pressure should not add salt to their diet.

• Eat a well-balanced diet, not too high in calories-or sweets. A high caloric intake-and the metabolization of simple carbohydrates and fats-can greatly increase the activity of the sympathetic nervous system, the body's "accelerator," making symptoms worse. Never go on crash or fad diets. Not only are they ineffective over the long term, but most of the weight loss achieved is through water depletion-just the opposite of what someone with MVPS needs.

• If you suffer from migraine headaches, avoid tyramine. Tyramine is a food component that has been associated with migraines. It is found in chocolate, citrus fruit, avocados, raspberries, pickled herring and some foods that have undergone fermentation, such as cheese and wine.

Exercise management:

My research has shown that many MVPS sufferers experience a dramatic improvement in symptoms simply by following an exercise program. For best results, workouts should be:

• Aerobic (brisk walking, bicycling, swimming, etc.).

• Done a minimum of three times a week, preferably on alternate days.

• Twenty to 45 minutes long, plus time to warm-up and cool down muscles.

• Performed at a level where work load feels somewhat difficult but not too intense. Taking pulse rate to measure workout intensity is not recommended for people with MVPS. If you feel out of breath, overexerted or dizzy, you're exercising too hard.

Very important: Start slow. If you're out of shape, begin with a 10-minute session and add a few more minutes each time. And don't expect symptoms to vanish overnight. Our research subjects didn't begin to show improvement until they'd been exercising regularly for six weeks or more.

Coping with panic attacks:

A number of people with MVPS have recurrent anxiety attacks accompanied by heart palpitations, light-headedness, shortness of breath, extreme apprehension or fear, chest pain and/or the feeling that they're about to pass out.

For many, the unexplained presence of frightening symptoms, such as a pounding heart, triggers an outflow of anxiety. The person may think, I'm having a heart attack, and these kinds of thoughts further intensify the physical symptoms.

Panic attacks rarely come from nowhere. If you think about it, you may be able to identify a source of anxiety-or remember eating a type of food you're sensitive to-preceding the attack.

Helpful: Cognitive therapy, as described in books by Dr. David Burns of the University of Pennsylvania.* You can change the way you react to events by altering how you perceive them.

Key steps:

1. Be aware of automatic thoughts-there is a clutching in my chest.. I'm about to die.
2. Identify the cognitive distortions, or irrational patterns of thinking, that lead to anxiety and depression.

Examples:

• Catastrophizing - I'm going to pass out in the middle of the supermarket. I'll be humiliated.

• Overgeneralization - This panic attack will make me late for work and ruin my whole week... and my boss will probably fire me.

• Should statements.

• Focusing on negative information and discounting the positive.

• Expecting the worst-This must be a heart attack.

• All-or-nothing thinking - I can't take control of my health. I must be a total failure.

3. Challenge your irrational thoughts with rational, contradictory evidence. Write your argument down if you have to.

Unfortunately, it's hard to think clearly enough to use cognitive therapy techniques when you're in the middle of a panic attack.

Good on-the-spot measures:

• Get up and move around. By lying in the dark worrying, you'll only make it worse. Focus your attention on something else, such as housework or an absorbing book. Call a friend and touch base with reality.

• Breathe. Pursed-lip breathing is very effective in combating shortness of breath. Don't worry about taking a deep breath-just breathe in, then slowly exhale through your mouth with your lips pursed, as though blowing out a candle. Repeat three or four times until you can breathe comfortably. Medications: The non-drug interventions just described can bring about great improvement for the vast majority of people with MVPS. However, if excessive symptoms continue to interfere with the activities of daily life, medication may be helpful.

Most commonly prescribed: Beta-blockers and anti-anxiety drugs. Both have side effects, so discuss them with your doctor and make sure he/she carefully monitors their effects.