From: segall@pepper.rutgers.edu (Ed Segall)
Newsgroups: sci.med
Subject: Re: Mitral Valve Prolapse
Date: 31 Jul 92 20:18:36 GMT
Organization: Rutgers Univ., New Brunswick, N.J.
To: John.Willis@p123.f349.n109.z1.fidonet.org

In article <712414811.F00002@blkcat.UUCP> John.Willis@p123.f349.n109.z1.fidonet.org (John Willis) writes:

> What I wonder is two things:
> 
>     1. Will an echocardiogram detect MVP when the chest pains only occur
> occasionally and not during testing? (if not, how similar are the symptoms of a
> hiatal hernia?); and
> 
>     2. Is there is any known, or suspected, association between caffeine intake
> and MVP?
> 
> Thanks,
> 
> John (gasp)


This is based in what I understand from my doctor and reading up on
the subject:

Aural MVP symptoms (click or murmer) may come and go, and can vary due
to position.  But if the valve is actually prolapsed, echo will detect
MVP at any time.  (I don't know whether certain situations, such as
temporarily elevated blood pressure, will make the prolapse more
evident sometimes than others.  I suspect so.).

Chest pain in MVP does not behave like the typical stress-related
chest pain one hears about associated with coronary artery disease.
In coronary artery disease, the heart's blood supply is restricted,
causing pain or other discomfort.  In MVP, chest pain tends to come
and go more slowly, and (I'm not certain about this part), is due to
hyperkinetic activity of the heart - it has to work harder, since it
pumps less efficiently.  So basically, the muscle gets "tired".  

Caffiene stimulates the heart, and so avoiding it is likely to reduce
the incidence of pain.  Also, there is a complex of symptoms, often
associated with MVP (but not necessarily causally related) that
relates to how the body processes catcholamines (spelling is probably
wrong).  Now we're getting into an area I'm fuzzy on - corrections are
requested.  But I believe that adrenalin is a catcholamine.  Anyway,
the upshot is that getting yourself in a "stimulated" state is not
going to help you.  More empirically, cutting down on caffiene tends
to make some MVP patients with bothersome symptoms feel better, at
least with regard to their symptoms :-). 

It is my personal opinion that it is prudent to avoid things that
cause chest pain.  One potential long-term hazard of MVP is an
enlarged heart, and associated problems, such as arhythmias.  I don't
know that chest pain is a sign that some "threshold" has been passed
that may contribute to the development of this problem, but it seems
clear that reducing the workload on the heart so that chest pain is
not experienced is a step in the right direction.  On the other hand,
those who experience no symptoms probably have nothing to worry about.

--Ed

PS I am not a doctor. 

PPS I think that if you are having symptoms that you think may be
caused by a hiatal hernia, then you should try taking antacids to see
if that helps.

PPPS Also watch out for muscular tension that can cause chest
discomfort. Stress/anxiety can cause chest discomfort, and focusing on
it can worsen it significantly.  This has caused at least one person
with MVP (me) become overly concerned about my condition in the past.
-- 

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