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just curious, how many of you POTS people have MVP as well? i think dr.low from mayo is starting to investigate some sort of corelation btwn the two.....at least in his questionarrie and in a lot of these questionairres for POTS research there seemingly is always the question "do you have MVP"...

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I have MVP and some form of dysautonomia. I don't fit the pots criteria exactly but have many of the symptoms so I consider it myself with some type of autonmic dysregulation. :)

It will be interesting to see what the good Dr. comes up with :)

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Guest sonotech

Cardiactec,

Maybe you can answer this question....Isn't it true that many cases of MVP are NOT detected even with an echo? I heard some crazy percentage (like 40% ???) of MVP is not detected by diagnostic testing.

Maybe you have more info on this cuz it makes me wonder if many of us have "MVP Syndrome" but have not actually been diagnosed with MVP.

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her sonotech, yes that is true. i am actually an echo tech myself and a lot of cardio's who know enough about MVP know that both hydration and patient position have everything to do with provoking the mitral valve to prolapse.....and it's not that it would be a false positive...what it would be would be a false negative NOT to diagnose what is present since IT TRULY IS THERE! -- whether or not it only appears prolapsed JUST when you are leaning forward or being upright instead of just when supine.

some docs however debate the finding of MVP if a patient is found to have it and they are dehydrated, because dehydration is a physiologic state that can be reversed with fluids. position obviously cannot be "reversed" because who the heck is going to stay supine the rest of their life! haha.

i have had four or five echos and three have shown it to be prolapsing and two have shown it not to be prolapsing. i think a lot of it has to do with autonoic innervation to the heart on the day of the actual echo imaging......since we all know that pots fluctuates in symptoms from day to day with a wax and wane pheonomenon, it makes sense.....

i was at mayo a couple months ago and saw a cardio there and was asking her why sometimes the MVP is there and other times it is not and she said that hydration, body position during testing, and autonomic function that day all play a role but that the primary diagnotic tool for MVP is to have a patient bear down (do a valsalva) while a cardio listens with a stethescope in different position (patient body position) and then have the patient release from the valsalva and if they can hear a true click, then MVP is present. if they can, than it's not....

what are your symptoms and how many echo have you had?

get a good doc if you dont have one. some cardios are wierd and are reluctant to even tell the patient they have MVP unless it is accompanied by regurgitation (cuz then the patient and doc must acknowledge the possibility of endocarditis and the patient must be prophylactic).......

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My echos in the beginning said mvp. After a few years as the criteria changed the echos started to read "suggestive of but does not meet strict criteria". I know they can usually see a bit of the prolapse in one view but not in the other. I have trace mr/tr and premedicate whether the current dr I see says I should or not because of the trace finding.

I also had read that trace regurgitation in almost all the valves, mr/tr/pulmonic are findings that can be seen in normals. That if you pulled X amount of people off of the streets and did an echo that a good percentage of them have a trace leakage. I understand that the equipment is so sensitive it picks up everything.

Does it not also matter if you do a regular echo vs. a stress echo where you one is done before exercising and one after? Would that not pick up much more on people rather than just a regular echo.

Anyway, I was told that many people with MVP have the imbalance in their nervous system. I was always told it is not the prolapse that cause the symptoms it is the nervous system/dysautonomia. It is almost like a marker. But plenty of people can have dysautonomia and not mvp and vice versa.

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Hi,

Yes, my MVP used to show up on an echo, and it doesn't anymore. I also have a 12 year old son with some POTS symptoms. I recently took him to a pediatric cardiologist at the medical teaching college here. He found MVP. No doctor had ever even picked up a murmur on him before, but he was able to ellicit the murmur with a couple of different positions. He then verified it with an echo. He told me that it was in the "resolution stage" and that it should be gone in 2 years. (ny son has a re-check to be certain).

I told him that I was always told I had MVP, and had to take profalactic antibiotics for dental appts. etc... but that it hadn't shown up on my most recent echos. I also told him that other cardios I'd seen had said, "So many people were misdiagnosed with MVP in the 70's and 80's....." This doc said that in fact, they were probably not misdiagnosed, but there is evidence now that MVP resolves in some people.

This guy has a tremendous reputation in the medical community and I trust his opinion, so I didn't question him any further, even though it was the first time I'd heard such a thing. I guess we'll know for sure at my son's follow up.

Carolyn

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I have severe MVP to the point that the murmur hurts the doctors ears' who listen- they always call in other nurses etc. to listen because it is so unbelievably loud. Unlike a lot of other folks here, my dysautonomia is not POTS. Essentially, my dysautonomia affects my central nervous system and peripheral nervous system to quote my doc- I have a double whammy. But, yes, I have MVP (with MR)- big time.

Carmen

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I've been told I do not have MVP but after reading this I wonder.

Katherine

Me too...especially since I havent had an echo in 3 years. I may mention it on my next visit. Does anyone know if MVPs show up during a TTT?

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Guest sonotech

Cardiactec,

I have has 3 echos (one was a stress echo). I had them done during my hospital stays when I was VERY symptomatic.

My symptoms are: dizziness, tachycardia, orthostatic intolorance, hypotension, chest pain, SOB, extreme fatigue, near syncope, syncope (actually coded during my TTT), heat intolerance, exercise intolerance...these are just my hrt related symptoms, cuz I have multiple other problems related to POTS (GI, etc).

I always felt that there must be something cardiac that they are missing (like MVP).

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HEY katherine,

it would be very interesting to see if MVP could be "brought out" during a tilt table.......somebody should combine an echo study on patients with auto dys in supine and standing positions. i bet you a million the upright position causes the mitral valve to become floppy (since it is a connective, myxomatous tissue).

so to answer the question if MVPs can show up on a TTT, the syndrome may show because the syndrome part of MVP implies of symptoms that are accompanied with a myxomatous mitral valve (or floppy valve). some people have MVP and dont have any symptoms, so they are just referred to as people with MVP. people that are symptomatic are referred to as people with MVP syndrome. in order to diagnose the prolapse part to the syndrome (or symptom part) an echo would have to be done during a tilt to look at the mitral valve....it is a strange concept to understand cuz you would think people with MVP who arent symptomatic would have the symptoms that people with pots or auto dys have.....or that all people with POTS would have MVP....and some dont......that is why some docs refute the link btwn POTS and MVP cuz some people have MVP and dont have POTS or auto dys and some people have MVP and do have pots or auto dys.........so the connection btwn the two lies on some grey line, nothing is black or white.......

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mom4cem,

MVP is usually diagnosed from a parasternal view during an echo and may or may not "show up" as much from the other views echo techs aquire. so if they saw it, even if it was slight, than it was true MVP. i'd be prophylactic just to be on the safe side. i dont have much mitral regurg (trace) but have prolapse and the cardio from mayo said i need to be prophylactic even though the regurg isnt that much...

yes, trace regurg is very normal, specifically for the pulmonic and tricuspid valve.

a stress echo looks for a correlation btwn ekg changes that are consistent with how well all the walls of the myocardium are coming in, if they all come in concentrically or if one wall or part of a wall is sluggish (due to part of that wall not getting enough oxygen due to blockage in a coronary artery). a stress echo is a diagnostic tool to help prove or disprove existing coronary artery disease and would be seen with changes on ekg as the heart is stressed by walking/running on the treadmill and also would show on the post exercise pics during echo.....a regular transthoracic sometimes can pick up pre-existing coronary disease by seeing if the walls come in altogether or not, but a stress echo is better for determining this because pics are obtained before the heart is stressed (from treadmill exercise) and after the heart is stressed and also because the ekg will usually reveal changes as well during exercise...

hey sonotec,

sorry to hear about all your symptoms.. that must be tough... did the doc say what caused you to code out on the tilt?

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I have a very mild MVP. One echo they saw it another they didn't. Sometimes they hear it sometimes they don't. The Mitral Valve loves fluid. If you have a mild MVP and are properly hydrated it could appear normal. Thats usually only in very mild cases. I researched this and my cardiologist told me that it was very possible, he didn't seem suprised at all when he couldn't find it the second time.

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