Elngd. lft atrium & incrsd velocities

[Yvette BG]

Hi—49-yr-old wmn who needs advice. Murmur at birth; heart cath age 14. Mild pulmonic valvular stenosis. Syncope at 15.  

At 24: MVP on echo. No stenosis seen. Put on beta blocker.

At 29: Possible TIA due to BC pills. Started ASA, stay on beta blocker (10 yrs.)  

34: Echo: MVP, slightly thickened mitral leaflets, mild mitral regurg. No stenosis.

47: Echo: nodule on anterior mitral leaflet. Mild tricusp regurg, mild mitral regurg, “poss. hyperdynamic state.” No stenosis noted.  

49: 48-hr. Holter: heart rate 45-150; 5 ventric ectopics, 95 supraventric ectopics including atrial couplets.

Recent echo: mild mitral regurg, mild tricuspid regurg, mild pulmonary insuff. Mildly thickened anterior MV leaflet at coadaption point.  No RV hypertrophy; no mitral stenosis (no comment on presence of pulm. stenosis). LEF 70%. Peak estimated RV systolic pressure from tricuspid valve regurgitant velocity 25.2 mmHg. Elevated aortic velocities; aortic valve cusps normal & aortic valve structure normal. IVC was 2.1 cm, but collapsed with inspiration. Left atrium at upper limits of norm. (3.66 cm two years ago; 4.01 cm in July 07).

Grandma died SCD at 51, uncle survived MI in his 50s. Dad (81) atrial fib, mod./ severe aortic stenosis, CHF. Dad's brother has atrial fib.

Questions: 1. Though conditions are mild (mitral regurg, tricuspid regurg, pulm. insufficiency), because some (all?) have been present a long time &/or since birth, are they increasing size of lft. atrium? Could this be a mismeasurement?

2. Tried beta blockers recently for palps, but pulse went low as did BP and felt fatigued, even on half a 25 mg. pill. Are betablockers advised, to slow down velocities? Would another medication be better? (Tried 2 diff. types of BB recently; bushed with both)  

3. Are these velocities of concern?

Thanks!

  

[Yvette BG]

I'm a little confused, as my echo report reads "elevated aortic velocities." Are these parameters
considered normal:
PV V Max 1.01 m/s
PV Peak Gradient 4.1 mmHg
Doppler/Mitral Valve Velocties (E) 1.16 m/s
Velocities (A) 0.96 m/s
Pressure 1/2 Time 60 msec
Deceleration Time 206 msec
MV Area 3.68 cm2?

My thyroid tests came back normal, and the bloodwork showed no anemia. Because of my past history of MVP, I'm on a "high fluid" diet (10-12 cups of water per day, more if exercising under
hot conditions).

Thanks again for your assistance.

[Cleveland Clinic]

LVOT and AV velocities are completely normal.  The rest of the measurements are normal as well.  

[Yvette BG]

Thank you for your response. Are these measurements normal--
LVOT V Max 1.04 ms
LVOT Diameter 2.0 cm
LVOT Area 3.14 cm2
AV Area (V Max) 1.92 cm2
AV V Max 1.71 m/s
AV Peak Gradient 11.7 mmHg
AV VTI Max 0.34 m
AV Mean Gradient 5.2 mmHg?
Anything here of particular concern, given above history?
Thanks again for your help.

[Cleveland Clinic]

1.  It is most likely a mismeasurement.  We don't even report atrial diameter size anymore.  the atrial area is what is typically reported, or atrial volume.  Going for 3.66 to 4.0 is a metter of moving the mouse on the echo machine just a bit up or down.  I wouldn't worry about it.  Now, it is very important that the degree of mitral insufficiency or stenosis is not underestimated.  Most experienced cardiology center known how to go about doing that.  
2.  beta blockers are there to prevent palpitations and sudden cardiac death associated with mital valve prolapse.  Don't worry, the risk of sudden death is low.  I would advise that you take them.  sometimes, taking them at night might cause less of the side-effects you are experiencing.  there has to be one beta blocker that is going to work for you.  
3.  I am sure that the physician looked at the aortic valve and the left ventricular aortic outflow track (LVOT).  There should be no evidence of aortic stenosis or LVOT obstruction.  Other conditions which increase velocities are anemia, thyroid disease and dehydration.  Get checked for those.