Enhanced External Counterpulsation theraphy and severe mitral regurgitation

[al1953]

I  am a 55 year old male. I have had Mitral valve prolapse since 1980. My last Echo in 04/08 shows severe regurgitation. Echo in 10/07 showed mild regurgitation. I do not know how this progressed so fast, but I am having another Echo this week to confirm. I have been asymptomatic up until about 2 months ago with some shortness of breath with exercise. My cardiologist also just diagnosed me with microvascular ischemia of the myocardium and has recommended EECP. Here is my question, can I safely undergo EECP with the severe mitral regurgitation? I think the EECP will be beneficial. Also, do you advise having minimally invasive surgery for mitral repair? Echo and CTA of my heart show normal left atrium and left ventircal size and 54% LVEF. What is your overall opinion of EECP? How could the mitral regurgitation progress to severe in 6 months? The 10/07 Echo was done at Mayo Clinic, so I know it was accurate. The 04/08 Echo was done locally here in Florida. Thank you for your time.

[al1953]

Doc, the Echo in april 2008 showed diastolic dysfunction, severe mitral regurg. and E/A reversal of mitral inflow pattern (what does that mean). None of these showed up on my 10/07 Echo at Mayo.

Thank you,
Al Fife

[al1953]

Yes, sir all of my cardiac enzymes were normal and MI was R/O at time CT was done for PE when I presented at the ER for Chest Pain. One other thing that just came to mind is I had a thallium stress test last month at the same time I did the Echo. The stress test had two findings. A fixed inferior wall defect with diaphramatic attenuation and a fixed anteroseptal defect with possible diaphramatic attenuation (I am not sure what that means). Exercise tolerence was good as were all EKG tracings during and before exercise. I got my heart rate up to 93% of max in the 8 minutes I was on the treadmill.with peak vitals of 155 heart rate and BP 150/86. Recovery was good with no significant ST-T changes. I think I have told you everything that has happened over the last 7 months. Before all this happened 7 months ago I was running 3 miles a day on the treadmill and swimming 1 mile at the YMCA. I was feeling fine. I want to be sure EECP will be OK with my Mitral regurgitation and after that , if I need Valve repair I want to get it done. I have a home in Ohio near Dayton. I am about 150 miles from Cleveland Clinic. I could probably be  able to see Dr. Hargrove for this since you think a lot of him. Mayo would be my other option at Rochester. Thank you Dr. Kirksey, for your insight. I value your advice. My cardiologist is Dr. Kenneth Kronhaus. He is good but hard to communicate with. He pioneered EECP and is supposed to be nationally known. He is also going to do a Holter monitor next week after the repeat Echo to check on the bradycardia and sick sinus syndrome. Thank you again, Al Fife

[Lee Kirksey, MD]

I would say to sit back and see what the repeat echo shows. By your cholesterol profile, it's eviddent that you are doing the things that you need to in terms of risk factor modification. I doubt that your CT scan studies and the associated dye load had anything to do with progression (that is if there actually is progression by the repeat echo). Was MI ruled out at the same time as PE evaluation with the chest pain

[al1953]

DR. Kirksey,
Thank you for your response. To follow- up, my cholesterol is 134, trigylcerides 103, HDL 34, LDL 79. I take lipitor 10 mg and diovan 160 mg. No smoke or drink. Father hxt of CAD and MI x2. Doc, I hesitate to tell you what happen between 10/07 when I had a normal echo and 4/08 when I had a bad echo. The only things I had done were two CT scans. One of my Kidneys because hematuria was found. It was normal and another CT 5 months later to R/O PE of the lung when I had some chest pain. My question is could the cardiac overload of the contrast dye used for these scans have caused a ruptured or torn chordae tendon resulting in worse mitral regurgitation?
Also, during this time my BP has dropped to 107/70 and sometimes after exercise as low as 92/61. My doc is reducing my diovan back to 80 mg. I really do not understand what is going on? My BP is consitently on the low side now rarely geting over 114/70. I do have some fatigue with this. Too many things going on too fast and I have become worried over this.
Thank you, Doc for your reply. and God Bless you ,too. I am a christian too.
Alfred Fife

[al1953]

I forgot to mention. Recently heart monitoring showed my heart had a 2.5 sec pause and dropped to 30 bpm while I was sleeping. What does this indicate? Thank you.

[Lee Kirksey, MD]

Hello
How are you? You are obviously very knowledgeable about your disorder. My first comment is that good clinical decisions are contingent upon accurate diagnostic studies. Although your clinical symptoms changed with more exercise intolerance, the question is what happened between Oct and April. Any viral symptoms, ischemic heart symptoms which might explain valve progression?. I suspect that you mean Mayo-Florida not Minnesota? That being said, your need for mitral valve replacement is dependent upon the definitive severity of the valve disease. Minimally invasive valve repair is very effective in selected patients in the hands of experienced high volume surgeons. I work with a very good surgeon, Clark Hargrove who is fantastic with valvular surgery.

I think the role of EECP will be dictated by the nature and severity of your valvular disease. In selected patients with chronic stable angina, angina refractory to nitrates and patients not candidates for bypass, angioplasty or stenting. It sounds like with your small vessel disease, you fall under the later.

I suspect that youre also going to require an conduction workup and possible pacemaker for your rhythm disturbance.

On the preventative side what is your cholesterol panel, any hypertension, smoker or family history of CAD?

Congratulations for working to stay healthy. good luck and God Bless