Heart Murmurs and Pericardial Effusion

[Gail-R]

  Hi. I am a 47 year old female diagnosed by Echocardiogram with mitral valve heart murmur - soft murmur, 2-3 on Scale of 6, trace mitral valve regurgitation, trace tricuspid valve regurgitation, and a small pericardial effusion anteriorly and apically. Normal chamber sizes, valves appear structurally normal. M-Mode Ejection Fraction 75%.
  A 24 hour Holter Monitor for chest pains, palpitations and syncopal episodes showed normal sinus rhythm for the most part with occasional PAC/VPC's with no other disrhythmia or any type of conduction delays or blocks. No ischemic changes noted. 24 hour Holter considered within normal limits.
  An EEG taken reported as follows:  Patient is 47 year old woman with seizures described as mixed seizures. She did have a head injury in an MVA and apparently had a CVA according to paperwork. 18 channel EEG w 10-20 Int'l arrangement. Heart rate 54, mostly regular, except for intermittent additional beats. There was considerable artifact throughout this tracing and it seemed to be somewhat attenuated with respect to voltage and reflected low voltage throughout the majority of the tracing aside from the pin artifact. Background rhythm was 11 in posterior regions. Aside from the artifact there was no clear evidence of epileptogenic fossi. Hyperventillation was not performed. Photic stimulation did not reveal good driving. If clinically warranted a repeat EEG may be obtained.
  A thyroid test was normal. Blood sugar test was 90. 2 chest xrays showed normal size heart. Patient taking no medications currently. Patient does not drink alcohol or take recreational drugs (ever). Family history shows 4 male members on father's side of family died of heart attacks in their late 50s
  I saw my Family Physician in April 1998 after having chest pains (pressure in center of chest) shortness of breath and weakened left arm the night before which lasted several hours. Dr diagnosed acid reflux, took an office EKG which he said was "relatively benign" and told me to stop smoking (which I did after 34 years of smoking) In August 1998, during Physical Therapy, while I was laying on hot gel packs for my back and neck preparatory to having neck traction, I had a seizure (no previous history)all 4 limbs shook, right arm was weakened (no catch reflex) and the Therapist could not arouse me so I was sent to the hospital ER. I came to, was given IV fluids and monitored then sent home that evening. I am in PT for a violent car accident I was in in July 1997. I received injuries to my sternum, right shoulder, collarbone fracture, torn rt rotator cuff, head (concussion - no fractures) rt arm and hand, and neck in areas of C-5-6-7. I have 2 pinched nerves - median and brachial plexus resulting in weakness and numbness and clumsiness in both hands and forearms and tingling in the left side of face. Also a rt shoulder area impingement. I still have a lot of fatigue and weakness. I still sometimes feel a fluttering or squeezing pressure in the center of my chest - especially when laying down. Upon exertion this doesn't worsen but I will get short of breath and lightheaded. I had just the 1 seizure. I walk 2 miles 3-4 times per week outdoors.
  How serious do you feel my heart problems are? I do not have a history of heart problems myself - could these problems be a result of the car accident? I did receive a terribly hard blow to the sternum (xrays showed no fracture) which was extremely painful for 3 months. I am concerned because of my doctor's saying way back in April that it was only indigestion (with a weakened arm??) and refusing to do further tests- then in Aug I had more trouble as described here. My Neurologist found the heart murmur and suggested the Echocardiogram which my Family DR had to agree to after the seizure in PT. I do not have much confidence in my Family Physician any longer. I would greatly appreciate reading in the Forum what your opinion is and I thank you in advance.  Gail R

[CCF Cardio MD - MTR]

Dear Gail, thank you for your detailed and thorough question.  The results of your echocardiogram are normal since trace valve regurgitation is normal and a small pericardial effusion can be frequently found in many patients.  Many patients have a benign heart murmur that poses no consequences for them - I believe you are one of those patients based on your echocardiogram results.  The chest fluttering was not determined to be an arrhythmia on your Holter Monitor so I think you may be feeling occasional premature beats (PACs or PVCs) which are also normal.  However, premature beats can be precipitated by tobacco, alcohol, and caffeine so you should avoid those precipitants (also, congrats on quitting smoking).   The chest pressure you describe is unlikely to be caused by angina and most likely is related to the chest trauma that you incurred during your accident.  However, to conclusively resolve this issue, you would need to have a stress test performed.  You can check with your physician about pursuing such a study.  Finally, I hope you are being treated for your seizure.  I'm not a neurologist so I can't interpret the results of your EEG, but it may be useful for you to see a neurologist if you haven't already.  
I hope you find this information useful.  Information provided in the heart forum is for general purposes only.  Only your physician can provide specific diagnoses and therapies. Please feel free to write back with additional questions.
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