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    What causes intermittent pain in chest and heart palpitations?

Posted on Fri, 3 Jun 2016 in Hypertension and Heart Disease
Question: Hi sir, I have been suffering from intermittent pain in and around my chest area (around left side and in rib cage area and sometimes in left hand also) as well palpitations . This has been their since 1 year now. I had consulted a cardio here and he told that I am suffering from a condition called as Mitral valve prolapse. He told that the pain might be due to MV Prolapse only and he has given me a tablet called Inderal 10 to be taken when I am having pain. Now days I have pain almost all days w. I get anxious thinking that it is a heart attack due to which I am always nervous.Initially last year I had high cholesterol levels which now are in control after taking statin tablets.Please let me know if I should worried about this condition.
Answered by Dr. Priyank Mody 10 hours later
Brief Answer:
Tab metoprolol extended release 12.5 mg a day and 24 hour holter after 3 mo

Detailed Answer:
Hello ,
I am Dr. Mody and I would be addressing your concern.
As I start I would reassure you that your heart is strong and has no problem whatsoever.
All the symptoms you describe are attributable to mild mitral valve prolapse you have . It's just the extra movement or exertion of valve leaflet which gives rise to pain and intermittent palpitation.
This would exactly mimic a heart attack like problem and trigger a panic attack like situation .
As someone had pointed out mitral valve prolapse is very common and 1 in every 4 of your friend may have it and many throughout their life are totally unaware of it , however as you now know that it leads to unnecessary anxiety.

So how are we treating the same .
I would prefer you take tab metoprolol 12.5 mg sustained release everyday. ( in XXXXXXX the tradename is prolomet xl 12.5 anind many other)
This is similar to inderal but works only on th heart and hence don't have the side effects like inderal which may include feeling low and depression like feeling .
After 3 months get a 24 hour holter done and see if any extra beats are there or now .If not can slowing withdraw the medication .
The above medication doesn't have any significant side effects if had already taken inderal .
The only problem with inderal on sos basis is by 2 hours when the effect of the medication start your panic like attack would have resolved naturally.
Hoping I could help you .
Let me know if any clarification needed and I would be happy to help .
Do rate for others reference.
Regards Dr Priyank Mody, Cardiologist XXXXXXX
Above answer was peer-reviewed by : Dr. Raju A.T
Follow up: Dr. Priyank Mody 2 days later
Hi sir, thank you so much for your advice .
I would like to know what are the things or situations which I should avoid so that I do not aggravate the situation. Can gym work out be done with this condition?
Also please let me know if the intake of food needs to be taken into consideration.
And is their any remedy thru which I can reduce the occasional pain.
Answered by Dr. Priyank Mody 17 hours later
Brief Answer:
No limitation in food , exercise and yes to gym . metoprolol would be best

Detailed Answer:
Hello , welcome back to HCM,

There has been a lot of research on mitral valve propose considering the common nature of the condition ,

No limitation of disease activity is needed
Ya you can go to gym and perform all the activities.

How to monitor? Watch out for any extra beats or arrythmia, so activity rhythm in EKG during the symptoms or Holter monitoring if the symptoms occur everyday or loop recorder is the symptoms are rare is an objective way to record such electrical disturbance.

A 2d Echocardiography every 3 years to note the any change in severity of prolapse and to quantify any mitral regurgitation ( backleak ) is justified.

Medication :

If no symptoms I would recommend no treatment for grade 1 prolapse.
For symptoms any to prevent any progression of leak .

A beta blocker group is the most safest one .

Inderal, metoprolol belong to the same group .
In moderate to severe case a blood thinner like aspirin is recommended by some individual.

Many a times ignorance is bliss , too much information would lead to unnecessary anxiety, do take things as they come in life .

Wishing you good health.
Regards Dr Priyank Mody

Above answer was peer-reviewed by : Dr. Arnab Banerjee
Answered by
Dr. Priyank Mody


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