The recent paper of Boudoulas et al.' supports my view regarding abnormal autonomic function in mitral valve prolapse (MVP).2 Adrenergic hyperactivity may explain many of the clinical manifestations of MVP, including the associated arrhythmias and the changes in repolarization. Thirty-five patients underwent 6 blockade and 80% showed normalization or marked improvement in the ST-T changes. We were impressed by the striking similarity between the symptoms and ECG findings in MVP and cases of

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... lled neurocirculatory asthenia (NCA) and advised careful review of all cases labeled as NCA in order to exclude MVP.