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ECG Results; Question about MVP, etc
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ECG Results; Question about MVP, etc

I recently had a follow-up ECG after an initial test indicated MVP (in 2007).  The results came back from the Cardiologist via my GP, who requested the original ECG to determine either progression of the MVP or otherwise.  I'm wondering what all of this data means, my GP has been less than forthcoming with information.  For a point of reference, I am a 33 y/o male with anxiety, headaches, fatigue, lightheadedness on standing (occasional), heart flutter, and depression.

From the recent ECG:
Observations

*Left Ventricle - Normal cavity. Normal wall thickness. Normal global systolic. Normal diastolic. No resting abnormalities noted.

*Left Atrium - Normal size and volume for age.

*Right Ventricle - Cavity size normal. Global systolic normal.

*Right Atrium - Cavity size normal.

*Aortic Valve - Normal structure and motion. No evidence of stenosis. No regurgitation visualized.

*Mitral Valve - Mild mitral regurgitation seen. Borderline mitral prolapse present. Myxomatous bileaflet mitral valve. Mild ruptured chordae to the anterior leaflet. Mild ruptured chordae to the posterior leaflet.

*Tricuspid Valve - Normal valve structure and opening noted. Trace Tricuspid regurgitation noted.

*Pulmonary Valve - Appears normal. No evidence of stenosis. No regurgitation visualized.

*Pericardium - Appears normal. No pericardial effusion visualized.

*Aorta - Normal aortic root size for age and BSA.

*Pulmonary Artery - Systolic pressure is normal.

*Venous - Inferior vena cava is not dilated and shows more than 50% respiratory variation.

*Other - No pleural effusion present.

Conclusions

*Above, and global ejection fraction is 50-59%
Tags: mvp, ECG, Heart
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976897_tn?1379171202
These results are not from an ECG, but from an echocardiogram.
The mitral valve has two halves (leaflets) and each leaflet is made up from three layers, atrialis, fibrosa, and spongiosa. In prolapse, you develop excess connective tissue which thickens the spongiosa layer and separates collagen bundles in the fibrosa.
This weakens the leaflets and surrounding tissue and causes the leaflets to become larger, This in turn causes the chordae to stretch. These are the tiny chords (tendons) which hold the valve leaflets in the closed position when the heart is in the systole cycle (ventricles squeezing blood out of the heart). When the tendons stretch to a certain limit, they can rupture, weakening the control over holding the valve in the closed position, allowing a leak (regurgitation). Some of your report does surprise me such as the  normal chamber sizes, mild regurgitation, and your EF is just within normal limits. I think as the report says, you are on the borderline and your GP should discuss your options. What is important at this stage is that you have your blood pressure monitored regularly and controlled. Your valve should also be monitored in my opinion because it can become serious if it becomes severe. Have the hospital given you follow up appointments for new echoscans, in say 6 month intervals?
You say your GP is not very forthcoming, but it is their duty to inform you. Demand to know if your condition has got much worse since 2007.
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1214683_tn?1266361751
Thanks so much for the reply!  That has to be the clearest explanation I've ever received.  In fact, my current doctor didn't say anything other than telling me to get my old echo to him for comparative purposes.

I do have a couple of follow-up questions, if you don't mind:

*Why the comment at the bottom of my report regarding ejection fraction?  Is that on the cusp of being a concern?  (ie: drops any lower and there's a problem)

*When you say I am on the borderline, can you elaborate?  On the borderline of having MVP (like so many others do, no biggie), or on the borderline of requiring mitigation of the problem via repair or replacement?

*I am absolutely exhausted most of the time, extremities are often VERY cold (hands/feet), have daily cold sweats, blurry vision, faint-feeling, and throbbing pains (in sync with my heartbeat) in my neck/head followed on by headache, which sometimes results in nose bleeds.  (I recently had a CT scan that apparently came back 'normal' and did have an MRI in 2007 when I collapsed in a movie theater, which is what triggered the echo and finding of MVP, although no one ever said the event was related.  CBC and Thyroid panels have come back within range as well.)  These things are bothersome to me, and I don't know whether I just have to endure this for the rest of my life or if there treatment of the MVP (etc) will alleviate most of them?
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976897_tn?1379171202
"*Why the comment at the bottom of my report regarding ejection fraction?  Is that on the cusp of being a concern?  (ie: drops any lower and there's a problem) "

the lower end of normal is around 55% but there are many people with much lower EF. This is basically a sign of how efficiently the heart is pumping blood from the chambers.
This good thing is that your chambers haven't enlarged to compensate in any way, to hold more blood so more can be pumped out each cycle. The wall thickness of your heart hasn't increased either which can happen when the heart needs to continually pump harder to compensate for low efficiency.

"*When you say I am on the borderline, can you elaborate?"

Well borderline is the word used in your report "Borderline mitral prolapse present".
This is basically saying that if the leaftets become worse, then it will be time to consider surgical intervention. The Chordae can be surgically sorted out in most cases, they are reattached to the leaflets and each one is adjusted to be the right length, causing the valve to be able to close securely. The distinguishing factor though is the actual condition of the leaflets. It is interesting that the chordae have ruptured on both leaflets now and this is probably causing the borderline comment.
When/If a decision is made that a replacement is required, I would inquire if you are eligable for the technique used via angioplasty. This is far less invasive and recovery is very speedy. It's the same technique used with stenting, only a collapsed valve is offered to the right position and then ballooned into place, basically squashing the old one into the heart wall and putting the new one in its place. I believe the usual reason for being refused this option is stenosis but you don't have any mention of this on the report.

I am surprised at the high level of symptoms you are receiving. The report shows only mild regurgitation in the valve and your EF is fine. How is your blood pressure? I would perhaps ask the cardiologist if he considers a TEE scan would be more beneficial. A normal stress echo doesn't always reveal accurate readings due to the tissue mass it has to penetrate to reach the heart. Swallowing a small scanner allows it to be guided much closer to the heart and gives much more accurate readings. With your symptoms it does make one wonder if the scan has been entirely accurate. The only way to really control those symptoms without surgery is medication. Nose bleeds can be caused by blood thinning medication or high blood pressure. Are you on meds to control your blood pressure. You say you anxious and this can also be helped with medication.
I assume they are not intending to run any perfusion scans to ensure your coronary arteries are in good shape or your carotid arteries in the neck? Have they done a stress test to see if your ecg changes on exertion?
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367994_tn?1304957193
QUOTE: "Mitral Valve - Mild mitral regurgitation seen. Borderline mitral prolapse present. Myxomatous bileaflet mitral valve. Mild ruptured chordae to the anterior leaflet. Mild ruptured chordae to the posterior leaflet"

I have mitral valve moderate to severe regurgitation for many years  Mitral valve prolapse (almost always no progression) has been properly defined on THIS thread, however, mitral regurgitation and ruptured chordae can be the issue for you.  Your valve disorders are slight but there are several etiologies that have been associated with the rupture of chordae  The leading causes are infective endocarditis, primary rupture, and the association with various connective tissue disorders.

Not applicable to you but In the acute stage, which usually occurs with a spontaneous chordae or papillary muscle (chordae attach at this site) rupture secondary to myocardial infarction (you didn't mention a prior heart attack), a sudden volume overload occurs on an unprepared left ventricle and left atrium.

For your consideration, primary tear and infective endocarditis are leading etiologies of ruptured chordae in hospitalized patients. Particularly among the patients with infective endocarditis, concomitant MVP was frequently detected. Chordal rupture should be recognized as one of the important causes of mitral regurgitation in patients with hypertrophic obstructive cardiomyopathy...ruled out as your chamber dimensions are normal!

EF is ejection fraction and normal range is 50 to 70%.  The percentage is the amount of blood pumped into circulation with each stroke. Your heart's functionality is normal.

Maxoma is benign tumor on your valve leaflets and may have a bearing on future mitral regurgation (leaflets do not proper close over the valve opening).
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1214683_tn?1266361751
Thanks again so much for the replies!  I have gained more here than in any doctor's office, thus far.

I had an office visit with my GP today to discuss the echo results from 2007 that they just received from my old Cardiologist against those of last month.  There has been progression.  I'm not a pro, so I'll just post the original 2007 results below and maybe (once again thank you) you might help me decipher.  The good news is they cleared a spot for me to see a local Cardiologist next Tuesday.

Before I post the results, to answer the questions posed:  I have had no heart attack or stroke (ruled out via CT scan recently).  A note was mentioned today from the nurse that my BP was a little high, although I left the office without getting the number (my error).  A stress test was done in 2007 and nothing was noted.  An ECG was also done at that time and while nothing was noted on the final report, there were notes on the ECG readout (which I believe are generally ignored due to being automated and not reliable.)

The 2007 echo results:

Observations
*Left Ventricle - Normal size with normal global and regional systolic function. Ejection fraction 65%. No wall motion abnormality.

*Left Atrium - Normal size.

*Right Ventricle - Normal size with normal systolic function.

*Right Atrium - Normal size.

*Aortic Valve - Normal.

*Mitral Valve - Leaflet thickening. Chordal thickening/calcification.

*Pulmonic Valve - Normal.

*Tricuspid Valve - Normal.

*Aorta - Normal root size.

*Pericardium - Normal.

*Pulmonary Artery - Normal size.

*Inferior Vena Cava - Normal size.

Doppler
*Mild mitral regurgitation, trace tricuspid regurgitation.

Conclusions
*Normal LV/RV size and function.
*Mitral valve thickening with systolic anterior motion of the chordal apparatus and mild mitral regurgitation
*Trace tricuspid regurgitation
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976897_tn?1379171202
*Mitral Valve - Leaflet thickening. Chordal thickening/calcification"

So your mitral valve wasn't as bad back then and
You EF was very good.

Ejection fraction 65%

So your condition has definitely worsened over the last two years due to scar tissue on your mitral valve leaflets.

*Trace tricuspid regurgitation - Ignore that, it's nothing.

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367994_tn?1304957193
Recent echo results show a myxomatous bileaflit and that indicates a non-cancerous growth on the two leaflet mitral valve.  The condition can't be serious as the MV regurgitation is not significant, but it may grow to be problematic.
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1214683_tn?1266361751
Thanks for all of the responses once again!

I have an appointment with a local cardiologist on Tuesday.  Depending on how that goes I may also consider a second opinion via Cleveland Clinic's MyConsult or just travel down to the location in Weston, FL.  Has anyone used them for such a condition, and if so, what were your impressions?
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1214683_tn?1266361751
Just got back from the Cardiologist visit this morning.  I was a tad nervous, mostly because I wasn't really sure I wanted to hear what I thought he might say.  Here's a synopsis (to the best of my recollection) of what was happened:

I was checked in by the nurses who did temp, weight, BP, pulse, EKG.  They noted my BP was high 142/90.

Doctor came in, seemed a little surprised to see a 33 y/o sitting in the chair.  He looked over my chart, asked 'WHO' told me I have MVP (before he'd gotten to the ECHOs).  I explained the 2007 ECHO, collapse which led to it, and then the recent ECHO result.  He shuffled the papers around and looked over the 2007 test, then the January test, then back, then back again.  He then said aloud, "Ruptured chordae on BOTH anterior and posterior leaflets, hmm...”

He took note of my symptoms, asking a few questions here and there about them.  After which, he showed me a model of my heart and explained what is wrong with it, and told me this can require repair at times.  He then told me about the TEE he was ordering.

He made a point to tell me, with the symptoms I'm having and the fact that when he had me lay on my side and pressed my stomach it caused my arteries to bulge in my neck, which he said is not a good sign.  He has put me on Lisinopril 5mg (1x/day) in the meantime due to the high BP and his concern about my heart overworking.

So that's it, I'm waiting for a scheduler to call and set up the TEE, which he said he'd like to have within the next 7-10 days.  (Outpatient procedure there, I believe.)
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976897_tn?1379171202
That's actually good because a TEE is more accurate than a standard echo scan. It;s the same technology but you swallow the scanner rather than have it passed over your skin. This was it can get closer to your heart and not have such dense tissue in the way, obscuring the image. They will get a far better idea from this. Please keep us informed :)
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