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Forum Name: Valvular Heart Diseases

Question: Mitral Valve Regurgitation in a Teenager


 nanio - Tue Mar 31, 2009 9:33 pm

Hi, I'm new here. I'm glad I've found a place where I can post a question and someone would be able to answer it for me.
I have a 16 years old daughter who was diagnosed with a mitral valve prolapse when she was 9. Later, when she was 11 her doctor discovered she had a "mild" regurgitation at that time and ask her to avoid sodas with caffeine and chocolate, which she did for sometime. As soon as she was 13 o 14, she started drinking coke all the time and usually hide the chocolates from me so I'd not find out she was eating them. My daughter has not seen her doctor for more than a year because he retired and she was doing "fine". Two weeks ago she had was seemed like the flu and did not feel well. The thing is that that day, she told me she's been having palpitations even when resting and in fact we were having lunch at the time she told me and her heart was racing. Later that day, she was at school and sat down outside, trying to get warmer (she was wearing a jacket) because she felt "really cold". But we live in a tropical island in the Caribbean (Puerto Rico) and the climate here is not cold. Anyways, she sat there for about 15 or 20 minutes, in the sun and then felt somehow dizzy and went inside the building. She got a tan in the part of her body that weren't covered, but she did not feel the sun over her skin. When she got inside, she faint and fell into the floor and was unconscious for a couple of minutes so I rushed her to the ER and they did some blood and urine tests, an CTScan to find out if she hurt herself when she fall on the floor and everything came back ok, except the blood test that revealed she had a virus (cold) and the doctor at the ER told us we should make an appointment with a pediatric cardiologist which I've been trying to do ever since without any success. What concerns me the most is that my daughter gets really tired even from walking from the couch to the kitchen, and she feels fatigue when she have to speak with someone for more than a couple of minutes. She has to walk from one building to another at school and this make her really tired. Last Saturday she went to a restaurant with her boyfriend and afterward they try to take a walk inside the mall where the restaurant is but couldn't do it because as soon as they got out of the restaurant, she fell nausea, dizzyness and tiredness. They came right back home. Another thing is that lately she can't feel heat or pain very well, especially in her hands. The other day she touched a pan containing hot cheese for nachos and she felt like surface of the pan was cold (I touched it and it was really hot) instead of hot. Yesterday she was moving her pedestal fan from a place to another and one of her fingers got into the fan and got hit. She was bleeding from the cut (a small one), but did not feel any pain until a few minutes later. Her brother had to tell her she was bleeding. I'm concern about my daughter and I'd appreciate any feedback. Thanks for yours
 John Kenyon, CNA - Thu Apr 23, 2009 9:00 pm

User avatar Hello --

We may be talking about two different problems with your daughter, but then again maybe not. I'll explain.

First, about mitral valve prolapse (MVP): it sounds as though this is fine and as near normal as it can get. Some doctors see it as a variant of normal and it is extremely common, almost always benign, and rarely causes any serious problems.
Trivial mitral regurgitation is commonly seen whether MVP is noted or not. This in itself is not a problem.

Now then, MVP is also often associated with a distinctive syndrome, a benign but often psychologically troublesome one, involving palpitations, shortness of breath, anxiety and sometimes panic disorder, fatigue, etc. Usually these people test normal in all aspects for their hearts. The reason this happens with some MVP people is unclear. Also, MVPers are more likely to have bothersome palpitations more often than others (though this is difficult to ascertain), which is the reason they are told to avoid chocolate and caffeine. The doctor figures this will reduce the frequency of palpitations and so the patient will be less anxious. Those substances will trigger palpitations in many people, even those without MVP. Your daughter decided she didn't want to give up the caffeine and chocolate, and eventually began to have more palpitations, which can feel pretty unpleasant but won't do any actual harm. If she understood the caffeine and chocolate were making this problem much worse, perhaps she'd stop or cut back. The alternative is to keep consuming them and know they will probably cause these sensations. It's as simple as that.

People with MVP syndrome often also have what's called neurocardiac syncope, in which the blood pressure becomes abnormally low, fainting sometimes occurs, but again it's not life-threatening. Cold extremities may also be a feature.

So then comes the issue of lack of sensation in her hands. This could be a completely separate neurological problem and should be looked into, since she clearely could injure herself seriously if this continues. If this is the case it's totally unrelated to the heart issues. Still it needs to be looked at. However, there is also a possibility this is being caused by hyperventilation (faulty breathing or overbreathing) which is due to anxiety which may be related to the MVP, but needs to be treated separately as an anxiety disorder. Hyperventilation may often cause coldness, numness and tingling in the hands and around the mouth, as well as profound sense of faintness (and occasionally actual fainting). It can become a chronic problem, and again, it's not dangerous, but needs to be managed. These various possibilities need to be sorted out by a cardiologist and, possibly, with the consultation of a pychologist.

I hope this is helpful. The problems are very likely all benign and much of this may be rooted in anxiety. Even though this may be associated with MVP, it needs to be treated independently. Also, neurocardiac syncope should be ruled out, as this also requires medical management, mainly to avoid injury due to falling because of fainting. If she hasn't fainted yet she probably won't, but whatever combination of non-life-threatening problems may be present, they need to be managed in order to restore calm and eliminate disruption. Please follow up with us here as needed. Good luck to you.

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