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225 NEUROVASCULAR CHEST WALL PAIN: MITRAL VALVE PROLAPSE SYNDROME.
  1. N. M. Mina,
  2. R. Barndt
  1. Bethel Public Service Clinic, Los Angeles, CA

Abstract

Our pilot studies (PS) show that high adrenergic neurovascular tone (ANVT) causes chest wall symptoms (CWS). The presence of recurrent palpitations and non-exertional chest pain has been called mitral valve prolapse (MVP) syndrome when a murmur is present and associated with 2D echo findings of MVP. Our PS show that neurovascular CWS are associated with significant (Sig) decreases in systolic time intervals (STI) and are not related to the shape of the mitral valve. Prospective studies (Pros) were done with a random sample of the general population, selecting patients for study with recurrent CWS and a rise in systolic pulse pressure (RPP) > 15 mm Hg during sustained isometric handgrip (5 PSI/3min). This is PS screening criteria to predict high ANVT. STI were used as a measure of ANVT (STI = PEP/LEVET × 100%). Serial measurements were made for 3 years of SBP, RPP, STI, systemic vascular resistance (SVR), and symptom levels (scale 1-100 severity by patient) at time (T) 1 baseline low stress, T2 during Sig symptoms with stress, and T3 during treatment (Rx). MVP (by 2D echo) and mitral insufficiency (by Doppler) were assessed by three independent graders. All data were placed into a blind matrix for analysis later. Rx consisted of diltiazem CD 240-360 mg/day, tenormin 12.5-100 mg/day, and amitryptiline 10-50 mg/day. Patients were 3/1 female/male, 18-65 years, all Caucasian. Exclusions: exertional angina, hypertension, smoking, diabetes, and on other drugs. Normal controls were age/sex/race matched.

Results group (G) means shown.

Where *Sig difference from C at p < .01 by t-test. % MVP = % with MVP by 2D. %MMI = % with mild mitral insufficiency by Doppler. The percentage of patients with MVP, by classical definition, was not significantly different from C in the PS and Pros groups. The shape of the mitral valve had no Sig relationship with SL. Mild mitral insufficiency was significantly greater in PS and Pros groups than C groups. Sig increases in SL occurred with Sig decreases in STI. This demonstrates that SL are related to Sig increases in ANVT. Effective Rx causes Sig increases in STI, Sig reduction in SVR, and Sig decreases in SL to C levels. Thus, high ANVT causes chest wall symptoms that can be controlled by treatment.

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