Calcification shown in Echo?

Hi, I recently went to the doctors because of a pounding in my chest when I lay down at night.. and a ticking sound to a fast heart beat when I inhale. I was sent for a few tests and in the Echo the radiologist said there was calcification on the valve. I know alittle about the heart, and know it was on the mitral valve (it looked much like a hockey stick). She seemed to think it wasnt to big of a deal, the only thing I am alittle questionable about is that I am only 21 and of normal weight.. Is that normal of my a person my age?

There is also the feeling like someone is pushing in the center of my chest

[cmt51597]

Hi Kathy,

You have hit on some very interesting questions in the relm of echo-- I am an experienced echo tech and will help give you some hints on answers.  

First of all it is very unusual for someone of your age, 21yrs old to have calcification of any valves, especially the mitral.  I have noticed that calcification of the aortic and mitral valves doesn't really begin to appear significantly until people reach their late 60s and becomes basically a routine finding with people in there 80s.  There are some exceptions to these.  One is if a person has a bi-cuspid aortic valve, which is a congenital abnomality and about 0.005% (half of a percent) of the world population has this congenital condition- and it results in early calcification of the aortic valve. This can occur as early as in one's 30s.  They usually replace it before it gets severe.  

The other condition where early calcification of the valves can occur is if one get rheumatic fever when they are young.  Given that this has pretty much been irradicated in this country, it is very unlikely the you've had this.  

I would say it's very unlikely that you have calcified valves at your age.  The technician probably had the harmonics on which is a tool in echo which gives tech more penetration and better visualization of the anatomy-- but it can also make the valves look thickened/calcified when in actuality they are not.  Additionally, the mitral valve can be tricky and if you look at it from some angles, you can make any mitral valve look thickened.  You should ask them if they got normal velocities through the mitral valve (less than 1.2 meters per second is normal) and that will tell you if you have a normal valve area.  

There is something called "hockey stick mitral valve" and it is exactly what it sounds like-- the mitral valve appears like a hockey stick on the echo.  If you do have this, it needs to be monitored and the technician should routinely measure the mitral valve area using Pressure 1/2 time or the continuity equation or best planimeter the MV from the short axis/MV level.  You will see them trace the opening of mitral valve from the "fishmouth view."  They will have to freeze the image and then scroll until they see the MV at its maximum opening.  This will take extra time for the echo but it is important.  They should also perform a careful measurement/assess of any mitral regurgitation with colorflow doppler.  If you have a real good technician they can also do a PISA measurement of the MV which stands for proximal isovolumic surface area.  

The key thing is, did they (the tech) calculate a MV area? (using either planimetry, Pressure 1/2T, PISA, or continuity equation?)- or at least get a mean gradient across the MV.  A normal MV area should measure between 3.5 and 6.6 cm^2.  Anything below 1.5 cm^2 for the mitral valve area is considered mitral valve stenosis (meaning the MV opening is too small) and at this point a valve repair or replacement should be considered.  

Also, ask the tech if they calculated the pressure 1/2 time.  Pressure half-times greater than 220 ms correlate well with a valve area less than 1.0 cm2. Patients with isolated mitral regurgitation have values 80 ms.

You said, "she seemed to think it wasn't too big of a deal."  How do you know this?  Did she tell you this directly?  

If you do have mitral valve stenosis (google this term), it is making it hard for the heart to fill through the smaller opening and therefore the filling of your heart is restricted.  Given this your heart and body is starved of oxygenated blood.  The description of someone pressing in the center of your chest is a typical description of someone with myocardial ischemia a.k.a agina, where the heart is not getting the oxygenated blood is needed and is often described as someone having "an elephant sitting on their chest."  Again, this is very uncommon for someone your age.  Are you overweight or have a family heart history?  

Steps you should take--first see if they got the data I talked about above.  Did they get the mitral valve area?  If they did not, or at least make some doppler measurements of the MV, get another echo or request for them to redo yours.  If the doctor you are seeing is unresponsive to your concerns or you are not getting this resolved, then get another (2nd) opinion.  Have you seen a cardiologist yet or was this echo ordered by a primary care physician or an internist.  If you haven't seen a cardiologist yet, you should probably see one.  Get a referral from your doc.  

That's the best I can explain it.  You can google all the terms I've mentioned. Echo is tricky--that's why a good echo tech is critical.  Keep asking questions until you get to the bottom of things.  

Good luck!

Cliff