The reason for chest pain in many MVP patients remains unknown.  Chest pain is a common symptom that brings a patient for medical attention.  

    Esophageal disorders:  A study was done in 1989 to determine the incidence of esophageal disorders and abnormal responses to edrophonium chloride and esophageal acid infusions in patients with MVP with troublesome non-ischemic chest pain.  20 patients with MVP and chest pain underwent esophageal manometry and provocative testing with edrophonium chloride and acid infusion.  7 patients with MVP but without chest pain served  as control subjects.  results: Esophageal manometry revealed esophageal disorders in 16 patients;  diffuse esophageal spasm in 14 patients, nutcracker esophagus in one, and hypotensive lower esophageal sphincter in one.  Esophageal motility was normal in four patients.  Injection of edrophonium and acid infusion tests evoked typical chest discomfort in three of 18 and five of 19 patients, respectively.  In six of seven control subjects with MVP with no chest discomfort, esophageal motility was normal and provocative testing did not produce chest discomfort.

   CONCLUSION: Esophageal disorders were common and may account for chest discomfort in certain patients with MVP and persistent chest pain syndromes.

surgical treatment:  The case of a 40 year-old woman with MVP and severe atypical chest pain is presented in 1980.  The diagnoses was confirmed by phonocardiographic, echocardiographic, and angiocardiographic studies.  The patient's long-standing, prolonged, disabling atypical chest pain could not be relieved with medical therapy, despite the administration of beta-adrenergic blocking agents, calcium antagonists, and short-acting nitrites during a 30 month period.  Valve replacement surgery was done and 12 months later the patient is totally free of symptoms, without treatment and with a normal ECG. 

  CONCLUSION: This excellent surgical result could be explained on the basis of the valvular theory of chest pain in MVP, suggesting that pain is promoted probably by a regional imbalance between oxygen availability and consumption, because of the excessive papillary muscular stretching produced by the prolapse.