How reliable is color doppler readings in multi-valve regurgitation

[hntrss]

I am a 33yr female, obese 204lbs, took redux 6+ months, I just had a third echo done which was read at mild to moderate aortic valve regurg, mild mitral valve regurg and trivial tricuspid valve regurg. If you quantitate the regurg using the singh method its shows 56% aortic and 29% mitral which is severe and moderate levels of regurg. Which one is correct? My cardiologist says at the levels he reads the echo at there is no reason for all the complicatons that I am getting and that I am suffering from a case of panic disorder. I have SVT, fatigue, edema (ankles), syncope and near-syncope episodes, and arrythmia's. The arrythmia's and syncope go hand in hand but have not been able to catch a syncope on the monitor. The arrythmia's that I have caught are a run of bigemini(?) PVC's for a run of about 15 sec's and lots of singles and doubles on the PVC's, also, I have caught a tachycardia of 160+ that slowed by throwing a run of 5 PAC's followed shortly by two pairs of PAC's. I have read that in multi-valve disorder especially when the two majors (aortic and mitral) are involved that the semi-quantitive measure of level of regurgitation is often misleading and appears to be less than it actually is and the only way to get a better idea is to use the jet height and volume/volicity as in the singh method. Is this correct? The other findings on my echos show that Im at the upper limits of normal except the LA which is now 4.5 cm and my ef has fallen from 70 to 55 along with my excercise limits. I really need help to understand all this which I dont believe is just a panic disorder.

[CCF-M.D.-KE]

Dear hntrss,

I am sorry to hear about the valvular and rhythm problems you have been experiencing. There are a number of methods used to quantify valvular regurgitation. These include calculating the regurgitant fraction, effective regurgitant orifice area, and interrogating the pulomonary veins to name a few. The Singh method is not something we routinely incorportate when quantifying regurgitation. Unfortunately, I am unable to answer your question without looking at the echocardiogram itself.

However, if there is  a discrepancy between  the transthoracic echocardiogram results and the clinical picture, we usually obtain a transesophageal (TEE) echocardiogram, which usually provides definitive results.

You have been experiencing a number of symptoms including palpitations and syncope and  are not satisfied with what your doctor is telling you. Though, it is possible for anxiety and panic attacks to be playing a role in your symptoms, you describe significant valve lesions which could also be playing a role.  What you really need is a second opinion. I would recommend seeing cardiologist at a large university based medical center who will be able to characterize your valve lesions and if necessary perform a TEE.  I  hope your symptoms improve.

Thanks for your question,


CCF-MD-KE

[hntrss]

I forgot to add that all the echos have been done within the last 6 months. And all the chamber sizes have gone up in these echos. the aortic root went from 2.8 to 3.8, LV EDD from 5.1 to 5.5, LV ESD 3.4 to 3.8. all just slightly larger but still within normal levels. I also forgot to add as a side effect I have shortness of breath and decreasing exersice tolerance. THANK_YOU

[itsa4847]

i agree with dr. get another opionion, these dr.s drive me nuts when they say its anxiety or panic disorder my primary told me that and i ended up in er and had a heart cath and was having cornoary artery spasms.  couldn't wait to send that result on to my x primary dr.  you will feel better with another opionion iam no dr. but i know when i have all the heart problems i know its not anxiety! good luck to you.