Is it ok to train for marathon over summer?

I am a runner, have run a number of marathons.  I am 43 yo 5’6”; female.   In 2003 my physician suggested an echo prior to training for boston marathon, as I was having mild symptoms (pressure in chest) and had a history of MVP (from childhood).

I moved to another state and began having shortness of breath during training.  I called the facility that did the echo, and it turns out the test results were never sent to my doctor.  Oops!  Since then, the pressure in chest and breathing has been getting worse.  There are times I have stopped running all together.  My doctor has also indicated that I have some issues with asthma/copd (would love an answer about that one too) , he tells me he is unable to determine if my breathing difficulties are related to my heart.  The question(s) that I would love to have answered are: what is causing my problem with breathing/ pressure/ tingling; is it safe to train (marathon) at a higher intensity, what is causing the heart situation and will it worsen?

Here are some abbreviated test results:

In 2003 (during training for marathon):
Grade 3 (moderate / severe tricuspid insufficiency)
Left Atrium mildly enlarged
Right Atrium moderately enlarged
Trivial to mild MR
Borderline MVP

Diagnosis – valvular disease

In 2005 (not training or running)
Moderate tricuspid insufficiency
Mild mitral insufficiency

In 2009 (just prior to training)
Mild to moderate mitral regurgitation
Moderate Tricuspid Regurgitation
Borderline Pulmonary Hypertension
Right atrial enlargement
Left atrial size upper limits

In addition, spirometry test in 2010:
  Pre- 47% fvc and 59 % fev1
  Post – up 12%

My usual peak flow is around 300.  

[Lee Kirksey, MD]

Hello
Thats quite a story. You have elevated Pulmonary pressures and right heart dysfunction. Do you have a cardiologist? Where do you live? If I were you, I would immediately gather all prior tests, records and reports and go to your regional heart center of excellence. Your complaints and findings seem to have been dismissed. You must be insistent and expeditious in getting this done and I would refrain from training until you complete your evaluation. please repost after you have seen someone else.Thanks and Best of health.

[tiger317]

Hi..I was experiencing much of the same symptoms for about 5 years, with echo monitoring every 6 months.  Although doctors said I shouldn't be experiencing these symptoms with severity (or lack of) of MVR, they did an angiogram 2 years ago and said things were fine..this time they did the "rolls royce' of angiograms, (where they look at both sides of heart instead of just one side), and discovered there is quite a large bulge (aneurism (aneurysm)) (sp?) in the aorta. My surgery is tomorrow to repair/replace the aorta and aortic valve...I pressed for answers for a long time.  Originally, I think the doctor thought this just started, then I explained I had been aware of the situation for 30 years, it hadn't bothered me until the last few.  I am a 52 year old female and feel strong about the surgery.
My thoughts and prayers are with you..if you know there is a problem, push for answers.  Good luck to you.
S.

[luv2run2010]

Thank you for your reply.  I will look into your suggestion.  Of course, when I sent off my post I left out half of the issues that I assumed I didn't need to mention, such as the jumping bean my heart tends to become (tachycardia) and the pulsing/ discomfort in my neck and chest.  I was in a bit of a hurry, as my physician had just declined my request to have my echocardiogram done ( he is doing them yearly now and it has been 11 months?).  I would like to see what putting it through a marathon did to the changes I saw without training (2009).  Can't imagine why he would not allow the test, and so this forum; in addition to setting up an out of network consultation are my current options.

Thank you again for taking the time to post, I will mention it to the cardiologist once I have met him.

[luv2run2010]

Dr. Kirksey,

I appreciate your reply, as well as this forum.  What a terrific resource.  As per your questions; I live in NJ and the first echo was done at Ohio State (go Buckeye’s). I have not had a cardiologist since I was a teenager, however have gone out or network and found a facility in Hackensack, NJ.  Will be going in the next few weeks, and until then will keep the mileage down.  Just finished a marathon in May and really wanted to keep up the base so that the next one would be easier to train for.  Oh well.  I was really simply hoping that I would get some assistance with the breathing and raise my performance (LA Threshold).  Am remaining hopeful..      

[Lee Kirksey, MD]

Hello
There will be many more marathons. Good luck with your consultation. Obviously make sure that you take all of your tests and results. You have a number of fantastic tertiary care heart centers of excellence to the north and south. Im sure everything will turn out well. Good luck. keep us posted

[luv2run2010]

Dr. Kirksey,

Hello again.  You were correct in telling me to seek a second opinion. Cardiologist does not believe my SOB is caused by asthma or COPD, he believes it is cardiac.  Thus far tests have shown arrhythmias (during stress test) and abnormal ecg’s and an increase in tricuspid insufficiency.  He is looking for a congenital cause for the elevated pressures (which have increased at least 25mm hg since last echo).  I do not have all test results (ie heart size etc), but these were enough.  For now, no marathons.  That will change in future.  I am debating whether I should provide feedback to primary care physician, not for myself but because I’d hate to see it happen to someone else.  Will pray about that one,  Thank you again for your insights.

[Lee Kirksey, MD]

It is true that medicine is an art. It never hurts to have a fresh set of eyes. I wish you the best in your journey to address this issue. There probably is a diplomatic way to say and remind your pcp that he provides a very important function of referring patients for additional specialized services.

[luv2run2010]

Hello again Doctor,

I am struggling to make a decision to move forward with the angiogram.  I didn’t know that the stress echo and the resting echo were so very different in their results.  The stress echo showed estimated pulmonary pressure of 31 mm hg while the resting echo showed estimated pressure of 50 mm hg.  When I realized all the decisions he was making was based upon two such different numbers (and that 31 was much closer to what I had been seeing in past), I asked him to repeat the resting echo.  He said no.  He said that it would confuse the issue.  He is a very compassionate and thorough doctor, I felt very confident when I met him.  I just don’t want to move forward into invasive testing without being certain I need the test.  Besides, I am afraid of the catheterization.  

I understand that I am asking a number of questions here, and if needed I am happy to resubmit this as a “new thread”.