Dear Doctor Column, November 10, 2003

Mitral Valve Prolapse and Anxiety — Is there a link?

Question:

I am a 26-year-old woman who was diagnosed with mitral valve prolapse a year ago. My heart condition causes fatigue, anxiety, and severe panic attacks that prevent me from driving, working, and sometimes just venturing outside. My doctor prescribed BuSpar, Xanax, and Klonopin. These drugs have helped my anxiety. My family thinks my problem is all in my head. What could be causing all this? Do you think I need counseling?

Answer:

First, let's talk about mitral valve prolapse (MVP), which occurs when the mitral valve — the heart valve that separates the upper and lower chambers on the left side of the heart — does not close properly. Normally, the two leaflets of the valve snap neatly closed. In individuals with MVP, the two leaflets balloon out when closing, resulting in a clicking sound the doctor can hear when listening to your heart with a stethoscope. If the ballooning prevents the valve from closing completely, the doctor may hear a heart murmur caused by blood flowing over the incompletely closed valve.

MVP can be present from birth or develop at any age and occurs equally in men and women. Data from the National Heart, Lung and Blood Institute's (NHLBI) Framingham Heart Study, reported in the July 1, 1999, issue of The New England Journal of Medicine, showed that MVP is less common and less serious than previously thought. Earlier estimates put the number of people with MVP at 5% to 35% of the population; the new NHLBI study showed the number is closer to 2%.

Most people with MVP never have any symptoms related to their condition and would never have known they had it if their doctor had not heard the telling click. People with MVP do need to have regular check ups by their physician to determine if any change is occurring in their condition. Those with an associated heart murmur need to take antibiotics before having dental work or a surgical procedure, to prevent any bacteria that enter the bloodstream during these procedures from settling on the ballooning valves.

In some studies of individuals with MVP, depression, anxiety, panic attacks, sleep problems, headaches, and other symptoms are frequently reported. It is not unusual for these symptoms to occur only when people are under considerable emotional stress. Other studies show, however, that these symptoms are no more common in people with MVP than in those without the problem. Their relationship, if any, to MVP remains unclear.

Your problems, whatever their cause, are quite real and are not imaginary. They also are significantly interfering with your ability to function normally. Your doctor already has you on a number of medications for anxiety and panic attacks. An additional modality that may help you deal more effectively with your symptoms is counseling or psychotherapy. Ask your doctor if you would benefit from seeing a psychologist, psychiatrist, or other mental health professional who deals with anxiety problems.