AORTIC SCLEROSIS AT 43 - IMPLICATIONS FOR HEART DISEASE?

[winkingwino]

Hello,

I am a 43 YO White Male who just had an Echo due to palpitations and DOE.  The Echo showed three things of concern to me, although my Cardiac Doctor tells me the Echo was unremarkable.  Findings of concern are: the aortic valve is mildly sclerotic, without stenosis; left atrial enlargement (4.5 cm), and trace mitral insufficiency.  My Cardiac Doctor wants me to repeat in 10 years or so, but after reading the recent literature on aortic sclerosis, I'm concerned now.  Complicating matters are high cholesterol (240 overall, 140 LDL, 210 Triglycerides) and borderline hypertension (I hover at 140/90 with occasional higher and lower readings).

I've asked my Primary Care Physician to start me on lipid lowering drugs and he concurred (I just started taking 20mg per day of Zocor).

My questions:  Should I be concerned about my Echo findings?  Are mild aortic sclerosis, left atrial enlargement, and trace mitral insufficiency normal findings for a 43 year old?  Should I ask my Primary Care Physician to consider hypertension medication in addition to lipid-lowering medicine?  Is there anything else I can do to lower my chance of heart disease, besides watching my diet and exercising (I run regularly four miles three times a week).  Also, you should know that I have no evidence of heart murmur or genetic or other valve problems, with the exception of aortic sclerosis.

Thanks for your time.

[winkingwino]

Thought you'd like to know, I followed up with another Cardiac Doctor today regarding my Echo results.  He told me Cardiac Surgeons use 4.5 cm as an upper range for left Atrium size and told me that if my enlarged atrium was due to hypertension, I should have shown an enlarged left ventricle first (which I have no evidence of).  He in essence told me that a 4.5 cm left Atrium is "normal" for me.  He also was not the least bit concerned about the mild aortic sclerosis.  He used a smoking analogy to explain it to me: "not everyone who smokes gets lung disease," so "not everyone with sclerosis gets heart disease."  He also saw no need to treat lipids with a 240 overall cholesterol and 140 LDL.  LDL over 160 is his threshold.  As I left I did so with the feeling that I had just wasted my Doctor's time; something his demeanor throughout my visit confirmed.  Next time I'll make sure not to go back until I've had a heart attack and am in need of open heart surgery.

Why is it so difficult to get heart specialists to take this stuff seriously?  And why such a difference between doctors on the true meaning of these abnormalities?

Frustrated, Winkingwino..

[CCF-M.D.-RCJ]

winkingwino,

Thanks for the questions.

Q1: "Should I be concerned about my Echo findings?"
The trace mitral insufficiency is totally within normal limits, and should not be of concern.  The mild aortic sclerosis and left atrial enlargement are not normal, but do not portend immediate adverse effects.  Both of these findings may be related to the hypercholesterolemia and hypertension, or something else entirely.  It should also be noted that it is premature to go into full panic mode, but it is certainly appropriate for these to be a wake-up call that some life changes may be in order.

Q2: "Should I ask my Primary Care Physician to consider hypertension medication in addition to lipid-lowering medicine?"
If you indeed have high blood pressure, then it should be treated.  The echo findings by themselves do not warrant addtional treatment.

Q3: "Is there anything else I can do to lower my chance of heart disease?"
Diet and exercise are a great start, and may be enough.  A diet similiar to the one promoted by Dean Ornish may be a good guide for you.

Hope that helps.