PEDIATRICS Vol. 84 No. 2 August 1989, pp. 290-295
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Symptomatic Mitral Valve Prolapse in Children and Adolescents: Catecholamines, Anxiety, and Biofeedback

Mark Scott Smith MD1, Carol Doroshow MD1, William M. Womack MD1, Lore Tenckhoff MD1, Stanley Stamm MD1, and Maria Pertik RN, MN1

1 The Departments of Pediatrics and Child Psychiatry, Children's Hospital and Medical Center and University of Washington School of Medicine, Seattle, Washington

It has been proposed that symptomatic mitral valve prolapse may be associated with a hyperadrenergic state and/or increased anxiety. To test this hypothesis, Spielberger State-Trait Anxiety (STAI) scores and 24-hour urinary catecholamine collections were gathered from 11 children and adolescents without mitral valve prolapse, 6 with asymptomatic mitral valve prolapse, and 14 who had chest pain (some with additional symptoms of shortness of breath, palpitations, and fatigue). STAI scores and catecholamine excretion values were not significantly different between groups. Ten symptomatic patients were randomly assigned to either eight sessions of skin temperature biofeedback with daily home practice of relaxation-mental imagery techniques or an attention-placebo condition. Change in 24-hour urinary catecholamine excretion values and STAI scores from baseline to end of treatment did not differ significantly between treatment and placebo conditions. Although not evident at the end of treatment, a significant decrease in chest pain was found in the biofeedback group at 6-month follow-up evaluation. In summary, results of this study did not show evidence of increased sympathetic tone or levels of anxiety in symptomatic pediatric patients with mitral valve prolapse. A behavioral treatment program using biofeedback and relaxation-mental imagery techniques was associated with decreased chest pain at 6-month follow-up.

Key Words: mitral valve prolapse • catecholamine • anxiety • biofeedback • adolescent

Submitted on June 20, 1988
Accepted on August 19, 1988