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Forum Name: Valvular Heart Diseases

Question: MVP with hypertension, high aerobic exercise capacity?


 uteng2k7 - Thu Dec 17, 2009 1:22 am

I am a 24-year-old male who is thin (5'10" and about 145-150 pounds), with a strong capacity for aerobic exercise. I generally run about 4.5 miles several times a week at a fast pace. Despite this, I have had high blood pressure for several years. I originally thought it was white coat hypertension, but even blood pressure measurements at the grocery store, after sitting for a couple of minutes, usually fall into the prehypertensive range. I have tried to lower my blood pressure by running more and eating less salt, but it remains above average.

In addition to my blood pressure, I have also noticed two other circulatory-related symptoms that seem odd: one, I often become dizzy when standing up suddenly; and two, my heart beats noticeably harder and faster during sudden exertion from being sedentary, even rather moderate exertion, like going up a flight of stairs. This is true even though I can run for several miles without stopping. My body almost feels like it "shifts gears" when I start running. These symptoms seem to have appeared in recent years; I don't remember having these as a kid or adolescent.

After reading a bit about these symptoms, I noticed the first symptom is a frequent symptom of mitral valve prolapse. However, I also have heard that most people who suffer from MVP also have a reduced capacity for aerobic exercise. So, with all these facts in mind
1) Is it likely that I have MVP, despite being a runner; and
2) if so, is it likely that my persistent hypertension is causing my MVP, or vice versa?

Thank you very much for any advice.
 John Kenyon, CNA - Thu Dec 24, 2009 2:08 am

User avatar Hello -- There are a lot of questions here, but not too many facts to work with. For instance, while you state you have high blood pressure (or prehypertension) you don't tell us what numbers you're working with. That would be a big help. You also state you suffer from orthostasis (getting lightheaded upon standing after being at rest), which is a fairly common problem, especially among those who are relatively taller and thinner, but can happen in many people. You also note your heart beats "harder and faster" upon exertion after rest. This is also quite possibly normal, but again we have no numbers to look at to tell whether this is actually problematic or not.

You have looked up things on line and, in fact, suspect you might have mitral valve prolapse (MVP). Well probably 15 per cent of the healthy population has some degree of MVP, some with symptoms, most without. MVP will not, however, cause elevated BP, and is more often seen in association with lower BP or orthostasis. It's difficult to have both lightheadedness on rising and chronic hypertension.

You do sound like someone who is obsessive about his body's functioning, particularly the heart. Despite all this you are obviously aerobically very fit as you tolerate significant running exercise (which is absolutely great).

If you could provide some numbers re: resting and exercising heart rate and what you consider to be elevated BP, we might be able to sort this out for you, but the problem of overawareness of bodily functions (particularly the heart's action) belies a neurotic obsession that may not allow you to feel fully okay til you discover what's causing this somatic overawareness. It is usually some obscure emotional issue which gets played out in this fashion. Still, please give us some numbers and perhaps we can make a little sense out of your concerns.

Good luck to you. We'll be waiting to hear from you.
 uteng2k7 - Mon Jan 04, 2010 9:58 pm

Hi Mr. Kenyon,

The problem with posting exact numbers is that they seem to vary quite a bit. As far as blood pressure goes, it almost always follows the pattern of rising after mild exertion (such as walking from my car to the grocery store), and then decreasing (but still remaining higher than ideal) after a few minutes of sitting down.

For example, today my blood pressure was 157/97 when I first sat down at the machine. After a few minutes, though, it had decreased to 134/86. Two days ago, the numbers were lower--148/91 to start, and decreased to 125/79. This change in pressure worries me. My resting heart rate varies as well, but it generally seems to be about 65-70 beats per minute. I have seen readings as low as 47, but I don't know if the machine was accurate in that case.

Again, thank you for your help.
 John Kenyon, CNA - Sun Jan 31, 2010 2:54 am

User avatar While there is some pretty significant normal variation in cardiac output during the course of a day, both rate-wise and in terms of blood pressure, there are upper limits, especially regarding BP, which need to be observed. So far what you've noted is on the high side of normal. For this reason it would be worthwhile to keep watch, occasionally, but while trying to duplicate the exact conditions each time (upon rising, mid-day, evening, for instance) and noting any stressful things going on at those times also.

As for the heart rate, you're in the normal range. The 47 you noted once could have been an abberation on the part of the machine, or it could have simply been caused by a pause or premature beat having fooled the calculations of the machine, which is often seen and is usually only perplexing for those who have frequent premature beats, since this can consistently throw off the accuracy of some (but not all) machines, since they perform a 15 second calculation for rate, multiplied by 4. If there is a missed beat during that period it will be multiplied by four at least, so the reading can often be quite far from correct.

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