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- Tue Mar 31, 2009 12:59 pm
I am a 36 year old female. I was diagnosed with mitral valve prolapse almost 20 years ago. I have had "skipped beats" or Pvc's off and on since then. Last year I had several days in a row where my heart was constantly "off". My holter monitor showed I was "throwing pvc's". My cardiologist said hormones, anxiety and prescribed klonopin. I did not take the meds, because I knew it was not anxiety. Two weeks ago, my heart started skipping regularly and I passed out. The nurse who was with me at the time said I was in "Afib". My heart felt like it was vibrating it was beating so fast and very irregular.
Echo showed enlarged heart, bicuspid and tricuspid valve regurg, and pulmonary hypertension. Echo stress - walked 2 minutes, heart rate was 168 and bp was 168/100. They stopped me, prescribed Digoxin, and sent me home until my follow up. It has now been almost 2 weeks and the symptoms are the same, but I haven't passed out again. Rapid heart rate with any movement at all, skipped beats, etc.
Blood test show low potassium, low vitamin d, low calcium. Thyroid level is normal. My question is - what does all this mean? The cardiologist spent less than 5 minutes in the room with me before prescribing a drug and walking out - i tried to ask him more questions, but he was "busy". What questions do I need to ask to find the right way to treat whatever it is that I have wrong? Is there anything you suggest I do? I am scared and really need to know what the next step should be.
| John Kenyon, CNA
- Fri Apr 17, 2009 8:17 pm
Hi there --
Wow, there's a lot that deserves addressing, and I have to admit to being pretty disappointed with the doctor in question. This isn't funny stuff, even when it's not life-threatening. Some of the symptoms are even normal, or at least minor (PVCs are extremely common and not diagnostic of anything, but they can at least draw attention to things that are not right). But it's awful to have to deal with when you have no information to work with. I'll try and help by going down the list and maybe you can make a list and go back and smack it down on his desk -- or do something to get his attention for a few minutes. Here goes:
Mitral valve prolapse (MVP) is commonly associated with a lot of the symptoms you've experienced. Usually this is coincidental, but it also sometimes becomes a catch-all, as does anxiety, something also often associated with MVP for reasons that are unclear. (By the way, the Klonopin, in this case, might actually help things work a little better, even though you are right, there's structural stuff going on and it's not caused by anxiety but probably the cause of it). Still, there's a lot left to know: First, how severe is the mitral regurge, if there's any (and it would seem there is). Second, what degree of regurge is present in the other valves? Next: does the doctor feel Digoxyn is effective against your A-fib? (We know it often is in general). And with that, should you be on an anticoagulant or is the A-fib just intermittent? Why is your potassium low, and should you be prescribed a supplement to help control the arrhythmias? (This is often a big contributor to this stuff, and at best it's not helping). What is the degree of heart enlargment and what can you expect from that in the future?
Most of this is fairly common stuff, but deserves an explanation in context of the findings. You deserve an analysis. But the one thing that especially deserves attention is the finding of pulomnaary hypertension, which can be quite serious and absolutely deserves further exploration and/or a very clear explanation. This is not something one mentions in passing then walks out of the room.
If you're unable to get a satisfactory response from this cardiologist then you absolutely are warranted in seeking a second opinion. The stress test (the heartreate and BP) seems normal, so I'm wondering why the test was interrupted. You may be in realtively good shape, but if these things are not carefully examined and explained, you have very good reason to be concerned. It's time to be aggressive about this. If it turns out to be less than serious it's still going to be a huge nuisance and will deserve medical management. I hope this will be helpful to you. Good luck and please follow up with us here as needed.