Aortic / Tricuspid regurgitation only 32 years old

[brussell107]

Hi, my name is Brad I am 32 years old and have just found out I have aortic regurgitation. Is there anyone else out there close to my age with similar conditions? I am 5'10, 190lbs, very athletic and I have lost 15lbs from the time I have found out about this problem a month ago, I was weightlifting, running everyday and playing competitive hockey 3 times /wk until I found out about this problem and my cardioligst told me to stop all strenuous activity, I think this is why I have lost weight and lost my appetite. Is it true that people with this condition have to stop physical activity? I have chest pain everyday and lightheadedness occasionally. I have been to the ER 4 times and have had nothing show up on the EKG or blood work as of yet, I also had a holter monitor with no signifacant findings, My heart pounds sometimes and I get worried.
On my echo I am confused with the results, One doctor told me this should not cause my symptoms and the other told me this was very very serious, could you elaborate please? I have never had rheumatic fever.

ejection fraction  68%
shortening  39%
left ventrical mass  190 grams
with a stroke volume 98ml
lv diastolic volume 144ml
lv systolic volume 46ml
lv 5.4cm (enlarged)
lv wall thickness 1.0cm
left atrium 3.8cm
estimated pulmonary artery pressure slightly elevated
mild aortic insufficiency
mild to moderate tricuspid regurgitation
right ventrical slightly enlarged but no value given

Can you please explain these findings to me and how serious are they?
I am on altace 5mg is this sufficent for this condition?

Thanks

[CCF-M.D.-MJM]

Hi Brad,

I would be frustrated in your shoes as well.  You have to markedly different recommendations.  The point of confusion is around the size of your left ventricle.  5.4 cm is enlarged, larger than one would expect from mild aortic insufficiency.  The real player here is not the aortic insufficiency but the size of your ventricle.  The next question is why is it large -- do you have a cardiomyopathy or is this related to physical conditioning.  Athletes have larger hearts than non athletes.  One consideratin is to stop physical activity and repeat the echo several months later and see if the size changes.

Is it true that people with this condition have to stop physical activity?

If I were in your shows I would do the following.  You have to very different opinions and I cannot weigh in on which one is right without seeing you and looking at the studies.  I would consider getting a second opinion at a major center.  At the Cleveland Clinic I would think about Brian Griffin, Maran Thamalarison, Williams Stewart.  If you are closer to the Mayo Clinic, Rick Nishimura is outstanding.  This is a limited list but some very good names.  There are many other people that could help at many other centers, I just listed a few names I am familiar with.

Can you please explain these findings to me and how serious are they?

As I said above, I would need to see the study on this one.

I am on altace 5mg is this sufficent for this condition?

It depends on the cause of the condition.  If it is athletic conditioning, you don't need any medication unless your blood pressure is high.  If it is from a cardiomyopathy I would increase the altace and a beta blocker like Coreg as well.

Sorry I can't be more helpful on this is one.  You are a young person and very active. I think you need some answers so you know how to proceed and a second opinion at a major teaching center is probably the way to proceed.  Good luck and thanks for posting.

[francie12]

Hi, Brad--I'm not a doctor, and our situations are not exactly the same, but our 13 yr. old son has moderate aortic regurgitation with an LV diastolic dimension of 5.6--moderately dilated.  He has been told by all doctors, with research to back it up, that it is safe to do all exercise with the important exception of anything isometric, i.e. weight lifting, push ups, sit ups, etc.  He has a mod. dilated aorta as well and they still consider cardiovascular activity to be fine, including track, soccer and basketball.  Again our situations differ in some respects, but just wanted to say that a diagnosis of aortic regurgitation does not necessarily mean a life of inactivity.  Good luck!

[CCF-M.D.-MJM]

Brad and Francie 12,

For increased LV size caused by aortic insuff., Francie12 recommendations are correct.  Your LV systolic volume is normal for a male.  You mention LV diameter (5.4 cm enlarged), but I am not sure if this is sytolic or diastolic.  I assume it is diastolic since you have a normal end systolic volume.  what struck me about what you wrote is that you only mentioned mild aortic insuff.  The problem is that if someone recommended that you not exercise they were either misinterpretting the info or I am not seeing the information they used to make this decision.   That is why I think you should have a second (third opinion) preferably at an academic center where they can really look into the details.  There may not be a problem at all -- I just think you should hear it from someone who has seen your studies.

good luck and thank you both for posting.

[dee gee]

I think all of us want to say THANK YOU doctor for your answers and reassurance.

[Carolina03]

Brad,

I was diagnosed with aortic and tricuspid regurgitation at age 36. Our measurements are very similar but the root cause may be different.  

My first cardio almost crippled me with "doom and gloom" -- "don't exercise, see me every three months, etc." I drafted my Last Will & Testament, bought a plot and thought I was going to keel over and die! WRONG!

My second doctor, on the other hand, shrugged-off my diagnosis and symptoms. I think he was overcompensating for the first doc.

My third cardio didn't treat me like a child or cripple. With his encouragement, I started to live my life again. He said that I may have an athelete's heart, so I modified my workout routine and my symptoms abated.

I don't know if this helps, but I was also diagnosed with Crohn's, an autoimmune disease. My physician thinks the disorder may be systemic, causing periodic inflammation of the blood vessels, so I'm being treated with special meds for that.

Bottom line, it took me about two years to work everything out, and get on with my life, so be persistent. My latest echo has shown some improvement. Find the best cardiologist you can afford, and keep your priorities straight. I learned a lot about myself during the health "crisis."

Blessings,

C

[jeff 67]

Gee ... my LVd is 5.7 and my LVs is 4.2 and no one has ever said I have any enlargement or placed any restrictions on what I can do and I have seen a number of cardiologists and had a number of echos.  I thought the upper limit for LVd for a male was 5.6, so I am not sure why you were told 5.4 is enlarged???

[tickertock]

MY LVd is 44.1mm , i think thats 4.41cm and my LVs is 32.3mm,,i think thats 32.3cm. I have been told my heart is on the smaller side with normal internal dimensions despite mild hypertrophy of the interventricular septum. I wonder what the normal dimensions are? EF 53%, IVSd 14 mm PVPWD 10.4 mm ??? Sometimes I worry about HCM. No family history whatsoever of it.

[tickertock]

correction  LVPWD 10.4mm

[Momto3]

Hi Tickertock,

Not sure if this is what you are looking for, but maybe this link for help to identify "normal" vales.

http://www.echobyweb.com/htm_level1_eng/echo_examination.htm

[tickertock]

Thanks for the link, I still don't like the 2-3mm off on the IVSD. The EF of 53% The cardio told me was ok even on the printout frame visual 55-60%(the whole picture I guess), all the rest same to be actually quite well within the normal, even the cardio remarked nice small heart whatever that means.

[francie12]

These values are relevant to your body surface area (BSA).  If you have a larger body size, you can have larger dimensions and still be normal..from what I understand.

[tickertock]

funny thing , I'm 41 year old male 5'9" 205 lbs, though my weight is carried quite well probably just about 20-25 lbs overweight rather than 40lbs that would show on the BMI scale even my cardio told me this.Even when I weighed just 140 lbs my heart was basically the same dimenions probably if I lose the weight the mild hypertrophy would regress, even though I had mild HTN in the past, now controlled with medication. Who knows?? more ??? than answers that's for sure.

[Gryphon]

Here's the thing about Echo's.  THE ARE RELATIVE!!  If you do enough research, you'll find that the normal reference range for Left ventricles (d)is 53mm to 58mm (or 5.3cm to 5.8cm)and 30mm to 40mm (3.0cm and 4.0cm) for (s).  SO your heart is not enlarged by these standards but, instead, well within normal ranges.  I've read research studies that have pointed out the biggest flaw of Echo "reference ranges" is that they DO NOT take into account a few factors such as:

AGE
GENDER
Body size

When a study was done by coroners doing autopsy's on men and women, they found that the hearts of men are BIGGER than the hearts of woman (DUH!) Also, a 6'4" man will have a larger Body size and, according to this study, a larger heart when compared against the reference range. AT the moment, they assume the range for a 5'3", 100 pound woman to be the same as one for a 6'4", 200 pound man.  Which is simply not true.  There is tons of debate as to how to establish new boundaries for different sub groups (such as athletes whose heart are enlarged naturally).  BUt for now, we're all lumped together.  By the way, my LV (d) was 5.7 and the echo test stated "normal"  My Cardio didn't even blink since he knows I am very active and athletic.  CHeck it out...

http://www.chfpatients.com/tests/echo.htm

Good info...

[Gryphon]

By the way...Lance armstrong's LV(d) was reported in the 6.9cm to 7.2cm range...if you're very active your heart WILL grow...

[Carolina03]

I'm heading to the gym!

[jeff 67]

Interesting data ... so I wonder why the cardio called Brussell107's 5.4cm enlarged?

[Gryphon]

I think every doctor that evaluates a Echo has a different standard to which they adhere.  That's why I fully support what they said in the article with regards to STANDARDIZING the reference fields for different subgroups.  The whole process just makes no sense but...hey...who am I to say what's right!

[7deuceman]

Hi Brad:

I had aortic regurg that deteriorated over time and almost waited too long to get the valve done. I went into heart failure
and finally VF one day (@ age 41) the ER staff saved me big-time.

Being one of the 'lucky ones',I have a significant cardio history and have gladly lived with a St Jude plastic valve and Medtronics ICD, since 1997. The valve saved my life and my EF is now 100 from a low point of 31%. (The ICD has saved my life as well, it has paced me on several occasions at night when my heart stopped...)

Please consider having your valve done as soon as it is convienient. This is a life-saving necessity you need to know.
Damage to the heart can be reversed if you give it a chance to heal and a valve will give you the best shot.  We take a blood thinner called Coumadin and it's really not too bad to live with, it will take you a few months to get it regulated and you should be fine.

Doctors always warn about not participating in contact sports because of the bleeding implications in the event of an injury.
FYI- Im an ex-pro skier and didnt want to give up the sport, but wear serious protective gear and watch out for the 'kamikazi' dudes- I participate carefully and ski way, way
slower.  You can enjoy many sports, just be aware of your new limitation.. Your doctor will help you understand these points.

Hope this helps...
Tom (7Deuceman)

[brussell107]

Thanks form all the feedback, it has helped out. Those of you with symptoms of aortic/ tricuspid regurgitation what are they and how do they effect daily life? Also I read that some people have changed their excersise program, from my interpitation symptoms have improved? Is this correct?
Thanks
Brad

[7deuceman]

Hi Brad:

My regurg symptoms were limited exertion, I couldnt sustain intense cardio workout over ten minutes, pvc's, high BP, dizziness, sometimes fullness in chest on exertion as well as arrhythmia, (PSVT.)

More FYI-

At my diagnosis by a Mayo doctor (age 23) an enlarged left ventricle at high side of normal was noted. (As you recall from my previous post) I did not want to have surgery but doctor recommended that it be done within the year. I went untreated and deteriorated to severe dilated cardiomyopathy (31% EF)before my VF event.  

Please understand I am not a doctor but I will caution you from a survivor/heart patient and as a trained outdoor emergency care/first responder (EMTb) perspective.  If you have symptoms and your doctor has diagnosed regurg, for your sake, be cautious!  Have a periodic echo and ekg, seek treatment from an established heart care center and follow your doctor's advice.
I would opt for the aortic valve replacement at some point in time especially if you are doing aggressive training/or plan to be into sports long-term.

Besides skiing, I also walk, bike, swim, yoga and (dont laugh!) 5 pound dumbells-3 sets, reps of 30 (for my upper body workout 3x week) as I train for tone not bulk. (Doctor put the weight limit on.) My point is, I have a prosthetic valve and still participate in sports and feel stronger for it! Hope this helps-

Tom/7deuceman

[HarleyM]

I also have a leaky Aorta valve and waiting replacement on 4/26/06. I am 35 years old and very active. My ef is dropping and LV is enlarged so cardio and surgeon says it's time. Here is a web site that might give you answers to many questions.
WWW.VALVEREPLACEMENT.COM

[brussell107]

I have read your post and am interested in the numbers of your EF and ventrical sizes? I was to the cardio today and they have only set me up for another echo in June. I am thinking of asking for one in the next couple of months. I have been on valvereplacement.com and have just regestered, seems to be a interesting site, Thanks.

Brad

[HarleyM]

I was born with a larger than normal heart.  My EF at 17 years old was 45%. My EF last year was 40/45%. My EF now is 35%. LV cavity size is severe. 4++++ Aortic regurg. I am still asymptomatic accept for a little fatigue at the end of long days. Today I cleaned(carpet cleaner) 10 small apartments and one office solo. This shows that I'm still in pretty good condition.  I am looking forward for all this to be behind me. I chose the ON-X valve. Hope this helps you.

[7deuceman]

Hi Harley and All:

I read your posts with interest and have a suggestion if I may- I take a small portion of CO Enzyme Q-10 to help with my cardomyopathy. (30 mg per day) It has helped my heart, however some doctors point out that COQ-10 may cause greater or less need of Coumadin for those that take it.  My 30 mg doesnt really bother my Coumadin, but every body is different as you know.
Here's a website to check out, (http://www.DrSinatra.com) the man absolutely helped me to learn about CO Q-10/words cant describe how greatful I am to Dr Sinatra...

Hope this helps!
Tom/7Deuceman