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Q. I have palpitation and shortness of breath. Is the mitral valve prolapse the cause?

Answered by
Dr. Muhammad Zohaib Siddiq
and medically reviewed by Dr. Preetha J
This is a premium question & answer published on Nov 20, 2020

Hi doctor,

I have been having palpations for many years. This includes the fast, pounding heart, PVCs, PACs, bigeminy, and other weird heart movements daily. Additionally, I have body and chest tension every day, which gives me some shortness of breath, but I do not have that when I exercise. Attached is a seven day ECG I did last year. I did a stress ECG two years ago, and that was all good. I echoed two years ago, and I have a mild mitral valve prolapse with mild regurgitation. I was told nothing to worry about this. I do not know where this shortness of breath comes from, including the daily palpations. Can it be from the heart murmur? I thought my adrenals are acting up, but that test was normal, the same with the thyroid. Do you have any suggestions? I am currently taking, Propanolol 10 mg one to two a day.

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Hi,

Welcome to icliniq.com.

Thanks for the query. Your five days of Holter monitoring is normal. Your symptoms do not correlate with ectopic beats. I think there is an element of anxiety. Moreover, those with mitral valve prolapse have such weird type of symptoms. MVP (mitral valve prolapse) is usually not harmful, yet routine echocardiography should be done every two to three years to see mitral regurgitation progression. Please have echocardiography done. Take tablet Nebivolol 2.5 mg per day instead of Propranolol as Nebivolol has fewer side effects. All your previous tests are normal, so no need to worry about your heart.


Investigations to be done:

Echocardiography.

Treatment plan:

Tablet Nebivolol 2.5 mg daily once.

Preventive measures:

Avoid getting anxious; exercising will increase your heart rate, and all the ectopic activities will be suppressed.

Regarding follow up:

After three days.

Hi doctor,

Thank you for your answer.

I have been thinking about putting down Propranolol, but I read you should not just put it down. How should I do it? Can I take this down to one per day for a week and then leave it?

Secondly, if MVP's mild regurgitation is harmless and not a problem, why could that create all these shortness of breath feeling and palpations? Note that this shortness of breath is not like I cannot get air or have heavy air hunger, but it feels constant chest tension. Can I ask for an ECHO from my doctor?

#

Hello,

Welcome back to icliniq.com.

Yes, these medicines called beta-blockers should not be abruptly stopped but can gradually be tapered down. 10 mg is not a high dose. You may take it once for a week and then stop, as you said already. Propranolol, Nebivolol, and other beta-blockers are used to lower the heart rate. If your heart rate continually remains above 100 even at rest and no other cause is found such as anemia, hyperthyroidism, etc., then heart rate is controlled with these medicines. If your heart rate is normal, you do not need Nebivolol or any other such rate lowering medicine. Yes, mild MR (mitral regurgitation) is harmless. As you said, you feel shortness of breath; this occurs in severe MR, which is why I advised echocardiography. Also, have a new ECG done if not done in the last few months. Do you have asthma? Asthma also causes chest tightness. Do you have a cough?


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