Is Chronic Fatigue Syndrome related to Mitral Valve Prolapse?

General responses to selected questions from Joel Braunstein, MD, of Johns Hopkins University and Joseph Toscano, MD.

Question:

I have a friend who has mitral valve prolapse; additionally, I believe she is suffering from depression and chronic fatigue syndrome. She is tired all of the time, depressed, and achy. I have researched mitral valve prolapse and chronic fatigue syndrome and found that chronic fatigue syndrome sometimes occurs in patients with mitral valve prolapse. She is 52 years old and refuses to see a doctor for any of the symptoms she is experiencing. She believes she is not allowed to take medication because of her heart condition, so a doctor's visit and tests would just be a waste of money. I'd like to know if her possible condition (chronic fatigue syndrome) is treatable with medication and, if not, if there are effective alternative treatments.

Answer:

The diagnosis of mitral valve prolapse (MVP) (link to MVP patient guide) often can be made by a doctor while listening to the heart. It can be confirmed with an echocardiogram. The "echo" uses some gel on the chest, an ultrasound probe (similar to that used to look at pregnant women's babies), and a computer monitor to directly observe the heart's muscle and valve function. And, you're right, there does seem to be an association between MVP and chronic fatigue, though no one really knows why.

The symptom of fatigue can have many potential causes (anemia, diabetes, thyroid disease, cancer, depression, and a variety of heart and lung diseases, to name a few). The diagnosis of "chronic fatigue syndrome" (CFS) depends on evaluating for and excluding these potential causes. This is probably the most important concern in those who might have CFS. CFS itself may be a mixture of several disorders or "imbalances" in the body and the treatment is complicated. There are many approaches and sometimes a fair amount of "trial and error" (and hopefully eventually "trial and success"), but none would conflict with MVP. Usually a combination of an exercise program and medication can help most people. Cognitive behavioral therapy (a type of counseling that utilizes introspection and learning techniques) has also been shown to be helpful.

Try to emphasize the following to your friend:

  • Chronic fatigue is a maddening problem that impacts a person's life significantly.
  • A thorough evaluation (including some blood work) can exclude a variety of diseases that can cause fatigue; many of these have simple solutions to make someone feel much better. If the evaluation is negative, this is still important, because a variety of significant problems will have been excluded and the diagnosis of CFS will be confirmed.
  • If she'd like to feel better, then the expense of this would be well worth the money. She'll have more energy for the rest of her life.
  • There is no medical reason why chronic fatigue cannot be evaluated and treated in someone with MVP. Indeed, many people with chronic fatigue have MVP, and vice versa.

Unfortunately, there is no way to make her seek care. This can be frustrating for friends, family, and other loved ones. Be as compassionate as possible and try to avoid being angry or judgmental with her, because this sometimes make things worse. The only thing you can do is to try your best. The rest is up to her.