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Have mild mitral valve prolapse and tmj. Having chest and back pain. Risk of heart attack?

Answered by
Dr. Anil Grover


Practicing since :1981

Answered : 922 Questions

Posted on Fri, 21 Dec 2012 in Hypertension and Heart Disease
Question: Hi,
I am a 29 year old female with mild mitral valve prolapse. On the 19th of November I started having a flare up of "MVP symptoms". I had chest pain. Then as the week progressed I had back pain. I am assuming it is muscular because when I would bend over or stretch it would hurt. This past weekend Friday and Saturday I had (what i think is given myself, but could be wrong. You tel me) an extremely sore neck and shoulders along with "pain" more like pressure in both my forearms. Now today the pressure is in left mostly and radiates down to my fingers. I went to the ER last night afraid I was definitly having or about to have a heart attack. They did a chest xray that came back clear and also a heart monitor and EKG. It showed that my heart doesnt beat at the same speed all the time. An arriythmia. Last year in August of 2011 I had a stress test and an Echo done. All saying that my heart was fine and looked great except or the very mild mitral valve prolapse with a minor amount of regurgitation. My question is that I am still so worried about having a heart attack. Everyday I am a basket case of nerves. I also have TMJ. So all these symptoms together make me nervous that i am missing the clues of a heart attack. Today I have the arm pressure and some jaw pain, but I can't decide if that is because I am clenching my teeth. Also, I went to the chiropractor and he said I had a rib out of alignment amongst other things. My heart rate is about 60 and my blood pressure today was 108/70. Do you think I am having a heart attack or are about to have one? Would the tests I had done last year still be reliable? What else could be causing my arm sensations. Also, when I press down on my arm above the elbow I can make the pressure or sensation worse. So would that be heart related or somethuing else? Thank you!
Answered by Dr. Anil Grover 1 hour later
Thanks for writing.
I am a qualified and certified cardiologist and believe me in my cardiology practice of 27 years, I might have managed hundreds of cases of heart attack in cardiology emergency, coronary care unit and XXXXXXX lab, hundreds of patients with echocardiography & Doppler examination. I do not recall even half a dozen cases of mitral valve prolapse who had myocardial infarction.
National Institute of Health, the United States states prognosis in brief as under:
Expectations (prognosis)
1.Most of the time, mitral valve prolapse is harmless and does not cause symptoms. 2.Symptoms that do occur can be treated and controlled with medicine or surgery.
3. Some abnormal heartbeats (arrhythmias) in people with mitral valve prolapse can be life-threatening. If the valve leakage becomes severe, your outlook may be similar to that of people who have mitral regurgitation from any other cause. You come in this category first part that is arrhythmia as your description does not go with severe regurgitation. I believe your doctor is competently managing the problem. If you have a question to ask on that issue please do write I will be only too glad to answer.
Now the BIG question, plan ahead when you want to dial 911 and request to be taken to hospital. That situation may never arise. For going back to National Institute of Health, the United States has following recommendation to consult a doctor for a patient of mitral valve prolapse:
Call your doctor if you have:
1.Chest discomfort, palpitations, or fainting spells that get worse
2. Long-term illnesses with fevers. You have mitral regurgitation if you go for routine procedure please tell the dentist to give you antibiotics so as to prevent infective endocarditis if the procedure involves blood coming in contact with oral cavity like in root canal treatment. Same applies to other procedures.
Now you get rid of stress you have, at 29 this will make you a real heart attack patient (which MVP alone can not) in years to come. For a change try this ancient yogic technique to get rid of stress.
Start doing yogic exercises which act as stress buster. You must remember stress is universal it is reaction to stress which matters and wrong reaction or aggressive reaction is the one which causes harm. I have taken this translation of original Sanskrit description of one of the yogic asana. It can be done without much effort ten minutes in the morning and ten minutes in the evening.
I quote:
How do you do Savasana?
1. Lie with your back, legs straight, and arms at your sides. Rest on your hands five
inches apart from your body with palms facing upward.
2. Rest on your feet drops open and closes your eyes.
3. Let your breath occur naturally, when breath is free mind also free. When the
breath is, allows moving naturally, the mind settles into itself.
4. Allow your body and mind to feel heavy on the ground.
5. From your feet soles to head-crown, consciously set free every body part, organ,
and cell.
5. Relax your face; make your eyes drop XXXXXXX into their sockets.
6. Welcome peace and silence into your mind, body, and soul.
To exit savasana:
1. First take a XXXXXXX breath followed by gentle movement from toes to head (head
be the last part) and awareness back to your body.
2. Then, slowly roll to your right side and rested there for few seconds, inhale and
comfortably move to seated position.
Hindrance or obstacles to the savasana
The most common obstacles to a Savasana practice are:

Nap (a brief sleep),
Mental agitation,

Although Savasana is the most difficult asana to perform, the focus is simple - relax everything (every body part and mind). If you get distracted or agitated, you can always undo, unwind, let go from the start
End of quote

If there is further query which you might have I will be most happy to answer. Good Luck.


With Best Wishes:
Dr Anil Grover
MBBS, MD (Medicine) DM(Cardiology)
Cardiologist and Internist
http:/ WWW.WWWW.WW
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Follow up: Dr. Anil Grover 38 minutes later
Thank you very much for your response. I will practice more yoga again. For some reason I stopped. So do you think all the tension in my shoulders and neck and back and the pressure feeling in my arms is from my stress related muscle tension or a real heart issue? I did go and get a massage and they told me I had severe tension knots. Thank you.
Answered by Dr. Anil Grover 2 hours later
Thanks for a very pertinent question.
Let us what can cause these symptoms first and foremost is
a): Heart: as result of mismatch of demand and supply of blood as it occurs in coronary artery disease due to less supply or very rapid heart rate and pressure in arrhythmia. However, these diagnoses had been considered and excluded. For example during stress test your heart rate and blood pressure rise to achieve what we call as optimal rate pressure product: no such symptoms then. Echocardiography showed normal heart structure with MVP, and this is not the pain of MVP.
b): Pressure or disease of sensation carrying nerves from these regions off body: in absence of other associated features your doctor has not felt necessary. However, I feel that just to give us satisfaction: cervical spine x-ray or scan can be suggested to your doctor, your doctor will certainly oblige you. Same is true for getting your complete blood count and fasting blood sugar done to reveal any deficiency of vitamins or presence of diabetes, which can cause neuropathy will not be out of order.

Coming back to your question, yes, it is my considered opinion that heart is not involved as a causative organ producing the symptoms you are referring to.

If you have any more question, I will be happy to answer.
It is a pleasure interacting with you.

Dr Anil Grover
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Follow up: Dr. Anil Grover 17 hours later
Thank you. I did mention my blood work being done and he said we just did a complete physical with fasting blood drawn and all blood test results were normal and healthy. My total cholesterol was 200 in part because my good cholesterol is so high. He does not feel an xray is necessary. I am still having a sore neck and jaw muscles and sore shoulders with some (not as bad) left arm and leg pain. Do you believe this is from muscular tension brought on by so much stress? Or do you think I should contact another doctor to have further testing done? I would just like some reassurance that I am healthy. Thank you.
Answered by Dr. Anil Grover 1 hour later
Thanks for writing back, it is always a pleasure reading your incisive XXXXXXX You do all the work of analysis which I should be doing.
I do not (unable to!) dispute what you have written till the question...Do you believe.....
Well, as pain or discomfort is not debilitating in any way and we have established it is not because of heart so why not give nature a chance before allowing doctors and battery of tests thrust upon you? If possible, from your job, take a break, relax and do all the physical activity you think you can handle with ease. Perform Yoga: especially the asana I wrote about. If after two weeks you feel you do have some symptoms then allow doctors to touch you with x rays and all the gadgets. Being a doctor, I can assure you, both patient and I are comfortable when we XXXXXXX as friends, not he/she as an obedient, rules abiding patient and I as a proverbial headmaster with stick in my hand. I hope you understand what I mean. Good Luck.
With Best Wishes.

Dr Anil Grover
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

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