Mitral valve prolapse

[jfaction]

I haven't posted in an entire year; last year I posted asking about a tingling in the chest and about rowing with knee arthritis. An MRI showed that all of the cartilege on the outer half of the kneecap and femur were worn away. Suddenly instead of erging I was not only not erging but staving off a knee replacement. My knee has not worsened terribly, but biking and hiking are now painful, although I can erg at half slide. I admit I have felt a bit depressed about this...

Then a few months ago I learned I have mitral valve prolapse (and suddenly my knee problem didn't seem so bad!). It is extremely mild, with only a trace amount of leakage. I don't have any other symptoms besides an occasional extra heartbeat and the random chest pain. This seems to explain some of the chest pain I'd posted about before (although I'm still watchful for any other pain of significance).

I feel lucky that I have a mild case and I have decided I am going to resume erging. The pleasure of rowing, if only on the erg for now, is not insignificant and if anything, more relevant than before, and I really want to stay in good shape. It's challenging to stay fit without rowing or biking (or, obviously, running or skiing or other sports that are hard on knees). If I have to do it at half slide, so be it. I'm sure one day there will be a good way to regenerate cartilege, and keeping my heart healthy and staying in shape is more important right now.

I've searched the archives and know a few here here have MVP. Since a year or two have gone since some of the posts about MVP, I wanted to ask if your conditions have remained the same. Have you had to scale down the intensity of your rowing? Have you had any other problems related to your MVP?

Thanks
Shannon

[DavidA]

My wife also has mild MVP. She has not scaled back her exercising or busy schedule, and has not an issues at all.

David

[BobD]

I have the same Mitral Valve problem and an enlarged chamber. this caused arrhymia. It was probably caused by high BP which in spite of exercise and one med, had crept up to 160/110

After 3 weeks of normal BP the leak had decreased as he put me on 2 additional pills resulting in a BP of 126/73. He no longer regards Mitral Valve repair as urgent. He believes the chamber size will decrease now that it is not working against the high BP.

I was in the USA for a month with normal BP and since I watch my alcohol consumption I have had no arrhymia recurrences. I have a follow-up vist on the May 30th.

He has limited me to a HR max of 130 to 140.

[jfaction]

Thanks for the replies. BobD, did he mention why he wants you to keep your heartrate at that level - is it because of the enlarged chamber or does he think a high heartrate is dangerous for MVP?


Thanks
Shannon

[BobD]

Shannon he is keeping at the low pulse rate because the higher my pulse, the harder the chamber is/was having to work against the exit high blood pressure and this means the internal chamber pressure is higher during the pump output stroke when the chamber contracts is causing a high enough pressure that the mitral valve is being forced open when it should be closed, causing blood to be pumped (blow back) back into my lungs (not good) and chamber enlargment which also increases the arrhythmia incidents. He wants me to work at a low pulse rate to build endurance and as my BP is now normal the chamber should shrink (a muscle that is not being used as hard anymore), and I should be able to increase my fitness again.

Now taking an angiotensin 2x daily, a calcium channel blocker and a diuretic once daily but my BP went from 160/110 to 126/76 in two weeks.

Sometimes weight control and exercise are not enough

A stress EKG was no problem and I have no signs of coronary heart desease.

[LJWagner]

My symptom with MVP of too much exercise was that one is breathing harder than you should be for the amount of work you are doing.

If the valve is altered such that it can not heal itself, you are stuck with it. I did not have a prolapse, but regurgitation due to 1) infection, and 2) valve strain. From both, just a slow walk sent my heart rate to 120, and I was breathing moderately fast.

With those, I took time way from exercise 2-4 weeks to let it heal, then I only "exercised" without breathing hard. It was pretty tame for 8-10 weeks, but little by little I could work harder and harder, longer and longer.

In 6 months, I was doing pretty much anything I wanted. I can now erg at a heart rate of 145 for 20-30 minutes, and crank it up to 155, 165, even 175 for a minute or so and not be breathing hard during any of it. Since I am 55, my max HR is supposed to be 165, so 175 without breathing hard is excellent.

My strength kind of sucks. From year after year of backing off for heart rehabs, my strength is quite unimpressive. I did recently do a 2k piece at about 9:06 or so, staying around 2:12-2:17 the whole time. I can bring it down to 1:52 pace, but that is tough to do past about 30 seconds.

I use a three part guideline:

from whatever your workout max heart rate is, when you back off to rest, or cooldown, I hope to see:

1) 1st minute HR reduction of at least 12
2) HR reduction after 2 minutes of at least 30
3) HR reduction after 10 minutes to normal.

I make the first two nearly always. I rarely get the 3rd. I'm happy if it comes down to 85 in 10 minutes. Resting HR for me is 58-65, depending if I have had a day or two off from exercise.

[BobD]

@ LJ, yes I think this is what he is trying to do with me and the results we are hoping for. The C2 with a Polar interface is ideal for excellent monitoring and control of my HR during exercise.

My valve had recovered sufficently after 3 weeks of normal BP that he no longer regarded a repair as urgent. This Friday we will look at it again after 6 weeks more of normal BP. Fingers crossed!!

[jfaction]

I was under the impression that a prolapse can't recover on its own - or are you meaning the chamber size had gone back to normal?

LJ thanks so much for your reply and I'm glad you didn't have a prolapse.

Shannon

[BobD]

Shannon I've confused this.

LJ and I have regurgitation, and evidently a valve can recover from this, the question is how much?

Also my Doc says the chamber will shrink again as the heart is a modified muscle and muscles adapt to load or lack there of. I hope so. I will let you know what is happening next week after my Friday exam.

He has hinted that I will always have to keep my heart rate relatively low during exercise which is difficult for me as I am a pusher of my own self

[LJWagner]

I'm not sure what a valve can and cannot recover from.

My last stress test in October 2007 showed I did have a small amount of regurgitation, but I don't feel it a bit. When it did bother me, they said it was just a 1 on a scale of 5, mild.

But recover it did, from two different things. Rest and gradual exercise works for just about every part of the body, even those valves.

My stress test had me breathing hard at an HR of 150, so my cardiologist wants me limited to a max HR of 130. He does not like hearing that I go well above that rowing.

I've found a number of articles on www.pubmed.gov in which some rehab studies have documented that max heart rate is dependent on the type of exercise performed and the person's prior training. The Borg scale is important, which is measurement based on perceived exertion.

For me, bicycle is more limiting than treadmill, which is more limiting than rowing. Running/jogging my heart rate just keeps going up, so I don't do that for more than 2 minutes, since it puts my HR over 150 even at a slow jog.

In valve recovery, pay attention to your breathing. It should feel pretty easy almost always.