Amiodarone and Echos

[Kristin391]

I have just recently had a TEE.  I had four last year where they have consistently shown moderate enlargement of both atria, severe regurgitation in the tricuspid valve and mild pulmonary hytertension.  My mitral valve is prostetic with mild regurgitation and functioning well. This last one now shows mild enlargement of atria and moderate regurgitation in the tricuspid valve. There was some septal problems and EF was 50% which is the same. My question is if the problem was due to disease of the valve, then why has there been this change at this time?  My symptoms have not changed and my drugs have not changed but my BP has been significantly up.  This is the only new symptom.  I do exercise about four times per week, aerobic and weights.  Could that make a difference?
I have one other question, is it true that any amount of amiodarone can result in severe side effects?  My physician is now allowing me to try 100 mg per day down from 200 mg.   I guess I just want to know if there is a safe level or if I should pursue other things.

[CCF-M.D.-RCJ]

Kristin391,

Thanks for the post.

Q1:"My question is if the problem was due to disease of the valve, then why has there been this change at this time?"

I'm not sure what problem you mean.  Do you mean the septal problems?  BP can certainly affect valvular regurgitation, and even EF, but would be likely to affect the septum.  Pulmonary hypertension can change the septal motion, and can cause progressive disturbances in septal motion.

Q2:"is it true that any amount of amiodarone can result in severe side effects?"

Yes, but 100 mg of amiodarone is associated with a low incidence of side effects.

If you would like to clarify your first question, I'll try to answer it more thoroughly.

[Kristin391]

Sorry for the lack of clarity.  What I was asking was why were the first four ECHOs(one TEE and 3 transthoracic this past year) fairly consistent in their findings and this one (TEE yesterday) so different?  What would cause the atria to decrease in size and the TV regurgitation to decrease?  There have been no changes in drugs just an increase in BP.  Actually the symptoms of edema etc have become progressively worse. The cardiologist told me yesterday that he couldn't explain it. I am not no concerned about the septal wall motion. That was a consistent with the other ECHOs.  I was hoping that the TEE would give a clear cause for the worsening of symptoms.

[CCF-M.D.-RCJ]

I'm just not sure.

The best explanation is that the pulmonary hypertension has lessened, perhaps because the mitral valve is now performing better.

Another possibility is that this TEE missed the findings, which sometimes happens.

Best of luck.

[Rick9897]

Thanks Doc for answering my questions.  Is it possible for atrial enlargement to remold and decrease in size? I always thought it was more permanent.