Aortic/Mitral/Pulmonary/Tricuspid regurgitation with increased PAP

[Mary__0__0]

Posted by Mary on June 10, 1999 at 13:22:08
I am a 54 year old female with a history of recurrent Rheumatic Fever.  The last bout was approximately 30 years ago. I was monitored by a coadiologist who told me my heart was enlarged to about twice its normal size. This is what showed up on the x-ray. He was concerned with both mitral and tricuspid regurgitation at the time.  I stopped seeing him because I did not take this seriously.
I had what appeared to be a heart attack approximately 10 years ago and they suspected at the time that I suffer from coronary artery spasum.  I have a history of Raynods, and Fibromyalgia.
Just over a year ago I had what my nurologist felt was a TIA.  He sent me for an echo that showed moderate to severe aortic regurgitation and moderate mitral regurgitation.
A TEE 1 year ago showed I had mild aortic and Mitral regurgitation along with some growths (Lambl's) from the aortic valve.  A recent echo shows 2+ mitral and aortic regurgitation + 1+ tricuspid and pulmonary valve regurgitation. To add to this it showed a PAP of 40 mm hg, however there is no increase in size of the ventricals or decrease in compliancy.  ( the TEE showed a slight increase in the left ventrical).
Recent holter monitoring showed I had 576 PVC's in approximately 22 hours.
I am short of breath when I try to climb hills and I fatigue fairly easily. If the PVC's are close together I feel exhausted.  My diastolic BP often drops into the low 50's, my pulse pressure is often above 70 and my pulse drops into the low 50's quite often and is seldom above 65.  Is this normal?  
I am confused as to what has shown up.  Can an enlarged ventrical decrease in size? Is the increase in PAP due to the backward flow of blood through the heart? Am I at greater risk for a major problem because of the leakage in all the valves?  What effect can the growths on the aortic valve have?  I have seen a internist who appears less than concerned.  Should I be under the care of a cardiologist?

Posted by CCF CARDIO MD - DLB on June 10, 1999 at 16:26:54
Dear Mary
The TEE did not show any severe valve problems. Other than antibiotics before invasive procedures, the findings on the TEE would not prompt any specific action. The Lambl's are unlikely to cause stroke; probably just a coincidence that they were there. I would not be overly concerned by differences between the different echocardiograms. There is always some variation depending on who is performing and interpreting these tests. Unless you develop new symptoms, there is not much that a cardiologist would do. You should have regular checkups with your internist.
I hope this has been useful. I wish you the best of luck. Feel free to write back.
Information provided here is for general purposes only. Specific questions should be addressed to your own doctor. If you would like to make an appointment at the Cleveland Clinic Heart Center, please call 1-800-CCF-CARE or inquire online by using the Heart Center website at www.ccf.org/heartcenter. The Heart Center website contains a directory of the cardiology staff that can be used to select the physician best suited to address your cardiac problem.