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Have mitral valve prolapse and SVT. Taking Tenormin. Had moderate mitral regurgitation and mild tricuspid regurgitation. Suggestions?

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I am a 53yr old white female. I am 5ft 6 and weigh 124 lbs. I am a non smoker and I have Mitral Valve Prolapse and SVT. I take Tenormin daily and the dosage is 50mg, although I don't take that much. I only take half of half unless I have an episode of SVT. I have yearly echo's to keep a watch on the MVP. My last one was about one month ago. The Pulmonic Valve was not well visualized. I had moderate mitral regurgitation and mild tricuspid regurgitation. The conclusion stated Mitral valve prolapse, normal LV function, decreased compliance of the LV, Moderate mitral regurgitation, Mild tricuspid regurgitation. Left ventricle said the ejection fraction was 60%. I am telling you all of this because I have been trying to walk nightly for about 2 to 3 miles either outside or on the treadmill. Lately while walking my heart is skipping all while I walk. This scares me and I wonder if I should still exercise. I ask the heart dr. when I go, but he acts like it is nothing. I have also started having these shaky spells or feelings after I walk and get weak feeling and hungry. I have to get something to eat or it feels like I would pass out. My ears also start to ring. Do you have any suggestions as to why this happens? Also do you think my Mitral Valve Prolapse is bad enough to cause any of these things?
Posted Sun, 17 Nov 2013 in Hypertension and Heart Disease
 
 
Answered by Dr. Prasad 5 hours later
Brief Answer:
Drug compliance has a role...

Detailed Answer:
Hi,

Though supraventricular tachycardia is an involuntary and abnormal condition, it is a known fact that the chances of SVT is higher as heart rate increases.

I am not sure why you are not religious with your medication. Tenormin has an important role in keeping your heart rate down. Without the drug it is evident that heart rate can increase especially during exercise and strenuous activities leading to palpitation / skipping beats. I think you need to reconsider the way you take your medicine. Talk to your doctor if you find problems with Tenormin.

As far as MVP is concerned, you seem to be doing well and the heart's compensatory mechanism seems to be working sufficiently. Ejection fraction of 60% is a very good number for a 53 year old with moderate mitral regurgitation. Yes, your exercise tolerance is reduced but I suggest you to try taking your pills regularly and see if that makes any difference. If symptoms persist, you should lower the amount of exercise. You will need mitral valve replacement if the symptoms affect your normal daily activities too.

Hope this helps. Let me know if you need clarifications.

Regards
Above answer was peer-reviewed by
 
Follow-up: Have mitral valve prolapse and SVT. Taking Tenormin. Had moderate mitral regurgitation and mild tricuspid regurgitation. Suggestions? 5 hours later
I don't take the whole amount of Tenormin because my blood pressure stays about 90/57 and at times lower just on the small amount I take. It also makes my heart rate in the 50's at rest. I don't think my heart rate getting up while walking is what is making my heart skip, due to the svt. I believe it is the MVP. When you say if it affects my daily activities I would need the valve replaced, would it show it was worse than now on the echo, or should I get it replaced now because I get very short of breath a lot? You also didn't answer my other question about the shaky spells after walking and what u think about that. Could u go back and read my other questions please?
 
 
Answered by Dr. Prasad 1 hour later
Brief Answer:
MVP and exercise tolerance...

Detailed Answer:
Hi,

I apologise if I was too brief with my previous answer. I shall elaborate it now.

It's normal physiological response that heart rate should rise with exercise. The more strenuous the exercise, the more rapid your heart beats. Further in the back ground of MVP where there is a tendency to develop palpitations, I wouldn't ponder more to reason out causes of skipped beat.

Shaking, weakness and increased appetite is an indication of fatigue. The amount of exercise needed to cause muscle fatigue is individualised. Exercise tolerance is measured taking muscle fatigue and ability to breath normally into consideration. Though preserve of moderate mitral regurgitation affects your tolerance, I wouldn't consider replacing valves when you are able to tolerate normal daily activities.

In short and specific terms, all the symptoms that you notice after walking 2-3 miles are directly due to rise on heart rate, reduced exercise tolerance (development of fatigue) as well as presence of incompetent valves. Since you are perfectly well at rest and you are able to perform daily activities well, I wouldn't consider replacing valves yet. If you are vital signs are not in the accepted limits when on tenormin, I would only advice you to reduce exercise and to avoid strenuous activities.

Lastly about the echo, since the test is performed in a resting state it wouldn't relate to your 'after exercise' symptoms. That being said, the need to operate is based on resting echo findings.

I hope it's clear now. I'll be glad to assist you further if you have any doubts.

Best regards
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Follow-up: Have mitral valve prolapse and SVT. Taking Tenormin. Had moderate mitral regurgitation and mild tricuspid regurgitation. Suggestions? 19 minutes later
I still don't understand why walking just a mile or more would make me shaky and weak feeling like I am starving and have to get something to eat. It is almost like my blood sugar falls and I have to eat peanut butter or something before the shaky weak feelings are gone. I get so shaky that my hands shake really bad. I also wanted to mention another rather strange thing I have been noticing lately. I have been having the smell of ammonia after I walk and get hot. I find this weird, but when I google it, I find that many other people have the same thing. It mentions that it could be an indicator of kidney failure or liver. Have you ever heard of this strange symptom do you have any feedback on this?
 
 
Answered by Dr. Prasad 2 hours later
Brief Answer:
Get your blood sugars checked...

Detailed Answer:
Hi,

The role of hypoglycaemia is going to be significant if you have history diabetes. I say this because nature has designed human body with many compensatory mechanisms to make sure it derives energy during transient deficient state. This compensatory mechanism primarily works on the basis of insulin - a hormone that helps to burn sugar to derive energy. You would commonly develop a sugar deficient state if insulin activity is not accepted as in a diabetes patient.

Ammonia smell that you perceive occur when your muscle burns proteins instead of sugar for energy. And as I already mentioned earlier all your other symptoms of fatigue, shaking, weakness, increased appetite and the ringing ears are due to lack of energy. Energy deficient state is either due to reduced blood supply (which in turn secondary to valve incompetence) or a real reduction in blood sugar.

Since you have no history of diabetes, I would not bet on hypoglycemia as the first cause. You can off course prove me and your treating physician wrong by testing your blood sugar - fasting/post prandial blood sugar.

Hope I have this simple explanation clarifies all your doubts.

Regards
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Follow-up: Have mitral valve prolapse and SVT. Taking Tenormin. Had moderate mitral regurgitation and mild tricuspid regurgitation. Suggestions? 50 minutes later
When you say lack of energy, do you mean from my MVP? And, what do you mean when you say lack of blood supply? Like blockage? Do you think I need valve replacement?

Sorry for all the questions, but really want to understand this. My MVP is making my energy level low because of lack of blood supply to where? Is this dangerous? And if so, why hasn't my heart dr suggested surgery. He encourages me to go walking and exercise. Just confused here.
 
 
Answered by Dr. Prasad 7 hours later
Brief Answer:
Hemodynamoc changes related to MVP...

Detailed Answer:
Hi,

You don't have blocked peripheral artery blocks. Do not be worried of blocked artery.

What might be happening is explained by hemodynamic changes test related to incompetent mitral valve (developed secondary to MVP). Incompetent valve is not able to pump enough blood during high demand state (when you walk long distance or when you perform strenuous exercise).
Besides this, your theory of sugar deficiency also explains the given set of symptoms provided you have diabetes or glucose intolerant state. You can test blood sugar to exclude the possibility.

I understand your doctor ordered that you exercise, but if you are unable to tolerate it (as evident now) you need to reduce the amount of exercise. Talk to your doctor after checking your sugars.

Be rest assured, since you are completely asymptomatic at rest and as you are able to function daily normal activities without symptoms, surgical correction is not recommeded yet.

Feel free to ask doubts if you are still confused.

Best wishes
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Follow-up: Have mitral valve prolapse and SVT. Taking Tenormin. Had moderate mitral regurgitation and mild tricuspid regurgitation. Suggestions? 2 hours later
hemodynamic changes test related to incompetent mitral valve (developed secondary to MVP). Incompetent valve is not able to pump enough blood during high demand state I copied this because I don't understand what hemodynamic changes means. I also don't understand what you mean by developed secondary to MVP. Would exercise be XXXXXXX if I continue? What could happen if I do keep on doing it? I stay short of breath every day even when not exercising, but the heart dr doesn't seem to be concerned. Some days I am so tired I feel like a walking dead person. Other days I feel better.
 
 
Answered by Dr. Prasad 8 hours later
Brief Answer:
Mechanical changes of heart pump...

Detailed Answer:
Hi,

I am not sure if I am going to able to explain those medical terms in a language which you can understand. But let me try...

I hope you are aware that mitral valves plays an important function when your heart pumps. It is important because in normal circumstances this valve closes completely when the largest chamber or heart (ventricle) pumps blood to the peripheries. There are supporting structures which aid in the movements of this valve. Now, the prolapse causes the valve to become incompetent with its function. The result is your heart (the largest chamber) is unable to pump as much as blood as it can in a normal condition.

This inability to pump enough blood is what that causes symptoms of mitral valve prolapse. We are able to grade this inability in terms of mild, moderate and severe. You have been documented to have moderate degree of deficiency (moderate MR). That being said, the decision to operate your valve is only taken if you develop symptoms at rest and when you are unable to perform normal daily activities.

Now coming back to your symptoms; though you have moderate MR, Ejection fraction (pumping ability of the largest chamber) documented at rest is 60%. This is as normal as in any healthy individual with a healthy heart. We don't expect you to have serious breathing issues at rest with this much EF. But I am not sure if your heart is able to hold this EF % during high demand stage (as in strenuous exercise or prolonged walk). Therefore your doctor isn't concerned yet.

If you also notice symptoms of fatigue, breathing difficulty, palpitation even at rest, you need to talk to your treating doctor. I would order routine test to exclude other possible conditions (anemia, hyperglycemia and few other metabolic condition like a thyroid dysfunction, etc.). I would also ausculate your heart to review the capabilities of different valves and perhaps repeat echocardiogram. Treatment would be based on investigations.

I have tried my best to explain all the parameters in a simplified language. You can write back if you need clarifications.

Regards
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Follow-up: Have mitral valve prolapse and SVT. Taking Tenormin. Had moderate mitral regurgitation and mild tricuspid regurgitation. Suggestions? 9 minutes later
What does ausculate your heart mean? Would an MRI or CT of the heart better show these different valves you speak of, or would an echo show them. Just had one about a month ago and I have told the dr. many times of how I feel and had the blood work u speak of, but they said everything was ok.
 
 
Answered by Dr. Prasad 25 minutes later
Brief Answer:
Echo is better...

Detailed Answer:
Auscultation refers to hearing heart sounds using a stethescope. Your doctor would know about that.

CT and MRI scan are standard diagnostic tools to look for structural aspects. Functional abilities are better recorded on Echocardiogram. Therefore it's more useful that CT/MRI scan.

If all your test are normal (including hemogram for anemia, blood sugar and metabolic parameters), then I do not feel there are any other organic medical problem to explain your symptoms. Your doctor can decide about surgical correction, if clinical examination, ausculatory finding and echo report co relate with your symptoms.

Regards
Above answer was peer-reviewed by
 
Follow-up: Have mitral valve prolapse and SVT. Taking Tenormin. Had moderate mitral regurgitation and mild tricuspid regurgitation. Suggestions? 35 hours later
Where you said it was taking away from my muscle when I would walk and that was why I was smelling ammonia, what can I do to stop that? Also, is it XXXXXXX and what if I do the things recommended, and I still smell that ammonia smell? I ate some protein tonight before walking and still smell it a bit.
 
 
Answered by Dr. Prasad 4 hours later
Brief Answer:
Identify the problem with the help of test...

Detailed Answer:
Hi,

As I said earlier, ammonia is one of the product formed when you burn protein instead of carbohydrate. It will be formed when you exercise, starve or eat plenty of proteins. I would encourage you to talk with your doctor and perform necessary test as mentioned earlier. Seriousness of this concern would be decided based on test results.

If you wish to stop this smell, restrict protein intake, discuss with your doctor and about my opinion. If needed you will need exercise restriction.

Regards
Above answer was peer-reviewed by
 
Follow-up: Have mitral valve prolapse and SVT. Taking Tenormin. Had moderate mitral regurgitation and mild tricuspid regurgitation. Suggestions? 9 minutes later
Why would I need exercise restriction just because of that? What kind of tests do I need? I don't remember you mentioning any certain tests for the smell of ammonia. I thought one needed protein before working out or strenuous exercise. So if I ate more carbohydrates, would that help. Is this dangerous?
 
 
Answered by Dr. Prasad 1 hour later
Brief Answer:
Blood sugar check...

Detailed Answer:
Exercise restriction is based on your tolerance.

On this platform, without an opportunity to physically examination it is extremely difficult to predict at what point you will need restrictions.

Further, I have also discussed the role of high blood sugar in my previous answers. It would be better to get blood sugar checked (if that wasn't done earlier) - both fasting and postprandial sugar

Ammonia smell is due to protein break down. You may also be accumulating uric acid along with ammonia. You may also get this uric acid level checked as you check for sugars. Get the test done after you discuss with your treating doctor.

Exercise restriction and your dietary pattern will be determined by these factors and your tolerance (which seems to be slightly low now). You need to discuss these aspects specifically with the treating doctor. I am sure he will understand and order necessary investigations.

As far as protein intake, yes, protein is are important before work out; but I wouldn't recommend high proteins if you are accumulating ammonia and uric acid in your body.

Regards
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Follow-up: Have mitral valve prolapse and SVT. Taking Tenormin. Had moderate mitral regurgitation and mild tricuspid regurgitation. Suggestions? 11 hours later
I just had a fasting CBC done. Would that have shown if my sugar was high and would it show those other things u mention?
 
 
Answered by Dr. Prasad 10 hours later
Brief Answer:
No, CBC is a different test...

Detailed Answer:
Hi,

Complete blood count looks at your blood cells - total number and its proportion. This test is useful to diagnose anemia, infection and blood disorders. It doesn't help diagnose high sugar, uric acid level or vitamin level check.

Blood sugar, serum uric acid, vitamin level and thyroid function tests are completely different entities. Your treating doctor will know about these tests.

Regards
Above answer was peer-reviewed by
 
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