Chest pain associated with mitral valve prolapse. Evidence for esophageal origin

The cause of chest pain associated with mitral valve prolapse remains unclear. A young woman with chest pain ascribed to mitral valve prolapse is described. Response of chest discomfort to atenolol therapy had been poor. The patient's chest discomfort and concomitant esophageal spasm were provoked by intravenous infusion of edrophonium chloride during esophageal manometry. A Bernstein acid infusion test also induced her chest pain. Review of systems revealed intermittent dysphagia and postprandial heartburn. In certain patients with mitral valve prolapse, esophageal motility disorders may be the cause of chest discomfort.