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Forum Name: Cardiology Symptoms

Question: SVT AFTER GALLBLADDER SURGERY MISDIAGNOSIS?


 RebeccaSunnybrook - Fri Apr 11, 2008 10:11 pm

Hi. I am a very healthy twenty six year old. In shape, non-smoker, rare social drinker. It was recently found that I had billary dyskpenia. After months of untolerable stomach pain, I agreed to surgery. During my pre-op, I expressed again what had been my only concern for many years, frequent heart irregularities, skipping beats and racing sometimes causing chest pain or shortness of breath. I was again told that my heart "clicks". An EKG was done and found borderline results. This was followed by an ECHO. My final report read trace tricuspid regurgitation. I told my primary and surgeon this. During surgery, I had what the recovery room nurse described as an almost uncontrolable SVT with a drop in pressure. I was given the proper meds and stablized. But, was forced to stay in the hospital days after for heart monitoring. A follow up echo done in the hospital stated, mitral regurgitation with defined mitral valve prolapse. My question is, had my doctors known this was my diagnosis could my SVT and aftereffects, that I am still experiencing three weeks later been prevented? (Of note: My first echo done three weeks before my surgery was done in a completely different facility than the hospital that did the second. They are not affiliated.)
Thank you for taking the time to read my post.
 John Kenyon, CNA - Wed Jul 23, 2008 11:06 pm

User avatar Hi RebeccaSunnybrook -

Well, you do have MVP. The fact that it was missed during the first echocardiogram could be due to one of two factors. One, the really interesting one, is that it is not always clearly present during every echo. Due to many different factors (including the fact that it can virtually disappear at times), it isn't always caught on echo the first time. The "click" murmur is a classic sign of MVP, though, and with a triad of click murmur, billowy or redundant mitral leaflet on echo, and certain mild, nonspecific EKG changes, the diagnosis is certain. It is frequently missed, and it is also somewhat controversial among some doctors as to what constitutes MVP absent the classic triad, so it could have simply not shown up on the day of the first echo, or it could have been mild enough that the doctor who read that echo didn't feel there was sufficient cause to call it MVP. Now it's been caught. It is almost always benign (rare instances of progression to "flail" valve are the product of a different process), but it is associated with a whole host of symptoms, some of which seem almost crazy. For instance, a small subset of MVPers will also have migraine headaches or optical migraine (odd lights in the corner of the field of vision usually).

SVT is also frequently seen in MVP patients, and it can be a one-time thing or occasional. If it becomes a problem (it is difficult to function during a prolonged episode, if only because of the distraction), it can be eliminated, but if you have so far ony had it during a surgery, and this is sometimes a reaction to anesthesia in people with MVP, you may not have it again. As for your question: Could it have been prevented? I have to say that since your first exam showed both the nonspecific EKG changes and the classic click murmur, two out of three should have at least warranted a notation on your chart and this probably should have been forwarded to the surgical facility. It may not have prevented the episode, but at least the team at that facility wouldn't have been caught off-guard and could have dealt with it more readily. Unfortunately, it is a doctor's call as to whether or not to do this, and as I say, it probably wouldn't have prevented the SVT during surgery. This is one of those "no harm, no foul" situations.

All that being said, you can probably expect to experience more than the average frequency of palpitations, skipped beats, arrhythmias, etc., than the average person, because of the confirmed MVP, but it all doesn't really mean much in that this is almost never life-threatening, just really annoying. There are also, as I said earlier, a lot of other seemingly unrelated potential symptoms which also are mostly annoying ones, and it's not clear what the relationship is to the prolapsed mitral valve, but there is statistically a clear connection, so that people who have this cluster of symptoms are said to suffer "MVP syndrome" or dysautonomia, or malfunction of the autonomic nervous system. Occasional fatigue, lightheadedness, the aforementioned migraine symptoms, occasional shortness of breath, and similar symptoms, can all occur with no rhyme or reason, or not at all.

Much of this, if it becomes a more or less regular feature of life, is usually then treated with a beta blocking drug such as metaprolol. This, when necessary, is usually very effective.

Good luck to you, so sorry you had to have this experience, but thankfully it is not actually dangerous and that there are ways of managing it. Hopefully by now you are feeling much better. Please stay in touch here.

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