How should I manage a patient with mitral valve prolapse who presents with palpitations and anxiety?

Management of a patient with mitral valve prolapse (MVP) presenting with palpitations and anxiety should begin with a thorough clinical assessment including history, physical examination, and an echocardiogram to confirm the diagnosis and assess for any mitral regurgitation or other complications NICE NG208.

Palpitations in MVP are often benign but can be distressing; reassurance is key, emphasizing the generally benign nature of MVP in the absence of significant mitral regurgitation or arrhythmias NICE NG208. If palpitations are frequent or symptomatic, ambulatory ECG monitoring (e.g., Holter) may be warranted to exclude significant arrhythmias NICE NG208. Beta-blockers can be considered to reduce palpitations and associated symptoms, as they have been shown to alleviate autonomic symptoms and reduce arrhythmia burden in MVP patients Devereux et al. 1989Bouknight & O'Rourke 2000.

Anxiety should be addressed concurrently, as it can exacerbate palpitations and overall symptom burden. Management should follow NICE guidelines for anxiety disorders, including psychoeducation, cognitive behavioural therapy (CBT), and pharmacotherapy if indicated NICE NG208,NICE CG113. Treating anxiety may reduce symptom perception and improve quality of life in MVP patients Scordo 2000.

In summary, the integrated approach involves confirming MVP diagnosis and severity, reassuring the patient, using beta-blockers for symptomatic palpitations if needed, and managing anxiety with psychological and pharmacological interventions as per standard guidelines NICE NG208,NICE CG113. Regular follow-up is important to monitor valve function and symptom progression NICE NG208.