MVP/echo questions.

My apologies in advance, this is pretty long.

I'm a 29 YO female.  10 years ago my family doctor heard a murmur and sent me to a cardiologist, who took an EKG and an echo, and said "looks like mild mitral valve prolapse with mild regurgitation; nothing to be concerned about; have another echo done in a few years just to check up on it".

About 5 or 6 years ago, I got chest pains (felt "tight" all around my chest; the pain fluctuated for a couple hours, and gradually faded - not associated with food or eating, as far as I can tell)...I went in, and they said "it's probably related to your MVP, since we can't find anything else wrong with you." (mostly they asked questions and took an EKG).  I've gotten the same pains, lasting anywhere from 2-5 hours roughly once or twice a year since then; not often enough to get a feel for what might be triggering them.

Last December, near the end of a week when I didn't get as much sleep as I usually do, I got the pains again; they went away, and I didn't think much of it, but then two days later, I got them again, late at night, and they were bad enough to keep me awake, so I called my HMO advice nurse, and she said to go to the hospital just in case.

The doctor at the hospital said "you haven't gotten an echo in 10 years? Get another one soon!"

I had the echo done in mid-January, and it came back to my family doctor, and he told me it seemed normal, and that I should get the original echo report from my first HMO (I moved from Group Health to Kaiser 6 years ago), and hand it to the cardiologist when I went, so he could compare.

At my appointment with my cardiologist in early February, he told me lots of things:
1) My "atypical chest pain" _might_ be related to the MVP or regurgitation, but he thought it unlikely; he didn't have a better theory, though, and since it's not frequent (except last December), and hasn't gotten worse in the 5 or 6 years I've had it, he didn't seem to think it very important.
2) My prolapse and regurgitation are minimal, and don't seem to have gotten worse in 10 years, so it's not likely that it ever will (possible, but not likely).
3) atypical chest pain is not a symptom of increasing mitral regurgitation, but shortness of breath and lowered exercise tolerance are.
4) I'm to come back in 5 years for another echo, unless I have symptoms before then.

I got the feeling his main goal was to keep me from panicking about heart problems, so I'm not absolutely convinced he was levelling with me (I wasn't about to panic; I'd educated myself enough to know worst-probabilities, and how I would deal with them, and wasn't worried, I just wanted numbers and details).

At my request, he gave me a copy of the report from my echo in January, and I got to keep a copy of the report I gave him from 1990.

The numbers on the 1990 report are all within the "adult normal" ranges (though LV diast was 53, which is upper end, and I'm not a large person (5'5", 115 at the time), and there's no EF estimate), and it says the quality of the read was excellent, and the interpretation says: "there is classic MVP charactarized by redundancy and prolapse of both leaflets of the MV toward the LA during systole as seen on the parasternal long axis views.  The PSAX show redundancy of both leaflets.  There is only very mild MR seen on the color flow Doppler study with the systolic flow disturbance confined to the area directly behind both leaflets with the regurgitant jet having a somewhat posteric direction. Everything else is unremarkable except for equivocal tricuspid valve prolapse. There is trivial PI, which is commonly seen in "normal" patients on the color flow Doppler study"

The echo from January starts out saying the quality of the read is poor/borderline, with poor sound wave transmission, then goes on to give numbers, two of which concern me a bit: LVd is 62, and the estimated EF is 50-65% (which is know is "normal", but low normal). LVs is 32, and it says that "global LV function" is normal, and the dopplar analysis says mild mitral regurgitation, everthing else normal, and one of the items in the interpretation is "the LV cavity size and wall motion are totally normal"  It also gives a slightly different take on the valves themselves, saying the posterior leaflet is small, thin, and normal, and the anterior elongated with minimal thickening of the edge. It says this probably represents a variant of myxamatoid mitral valve disease with mimimal prolapse and a very mild amount of regurgitation associated.

So, my questions:
1) Do you agree with the statements my cardiologist made, or was he sugar-coating it?  Should I really wait 5 years? If the chest pain isn't related, what else might it be?
2) Is the LVd dimension in the latest echo a concern, or do you agree with the interpretation?
3) is the poor quality of the echo a concern? Should I request that another one be taken, or will it likely also be poor?  How much does the quality of the read affect the accuracy of the numbers, and what can cause poor sound wave transmission in an echo?
4) Are there any other tests I should have taken as a precaution or as a baseline?
5) Can they really tell how mild or severe the regurgitaiton is from a plain echo, or are they making an educated guess?  From the recent (last two years) journal articles I've read, it seems like it's pretty hard to actually pinpoint, but is it even remotely possible that the regurgitation is significantly worse than they think?
6) are the two physical descriptions of the valves congruent (I can't really tell just from reading them, but one seems to think both leaflets are big, and the other says only one is), or would there have to have been significant changes for them both to be right, or could the differing qualities of the echos account for any differences?

As I said, I'm really NOT freaked out about this, I'm just wanting to be absolutely as educated as possible, and want to know that everything's being done that should be.

Thanks so much!

  -Sandy

[CCF CARDIO MD - DLB]

Of course, without actually looking at your echocardiograms, I cannot really say much about whether you do or do not have MVP. Based on the data you have presented, I agree with everything your cardiologist has said. I do not think that your symptoms are related to MVP. As your cardiologist wisely implies, if there were something seriously wrong with your heart that is causing the pains, the condition should have worsened, since you have not been receiving any specific form of treatment. Furthermore, I think it was kind of your cardiologist to try to make you less anxious about your condition, as you do seem to have expended a fair amount of energy worrying about this. Even though you state that you are not worried, I think that, at least at a subconscious level, you are very worried. Therefore, following your cardiologist's advice seems safe and appropriate. As far as what is causing your symptoms, I do not know, but the fact that it has gone on for so long with no serious consequences is reassuring. It could be acid reflux, or it could be the sort of aches and pains that we all occasionally get from the muscles and joints in our chest wall. It could also be a physical manifestation of stresses in your life. You might want to discuss these possibilities with your primary care doctor.

[Sandy Candioglos]

For the record, I said that I wasn't panicked, or freaked out; I never said I wasn't worried or concerned.  The way I try to alleviate that concern is by being educated about what's going on.  Being told "there, there, don't worry" does NOTHING to help me worry less.  Maybe I'm different from most people that way, but I really DO want to be referred to studies and be given numbers and probabilities and such; quantification _helps_ me; I don't want the summary form.  

I do appreciate the quick response, though; I guess I'll go back to my doctors and ask them my specific questions _again_, and see if I can get answers this time.

  -Sandy

[Cardio MD please answer "cardiomyopathy"]

Dear CCF Cardio MD:

please answer the below question when you get a chance...it appears to have been skipped.

thanks,

Ian

[Sandy]

My guess is that your question went to a different doctor, who's taking their time answering. Maybe that means you'll actually get your questions answered.

[BE HAPPY!]

Sandy:  Please don't take this the wrong way, but I think you were kind of rude to the Doctor and they do not deserve to be spoken to that way. Clearly you weren't happy with the answer you received, but I don't think you need to be so angry with him.  Remember, this is a free service and the Doctor is answering the questions as objectively and truthfully as possible. You are fortunate to have such good health and be HAPPY that you have such a good prognosis!!  :)

Doctor:  Please don't think the rest of us feel this way!!!  Thanks for all your expert advise and time.

[Jay]

What operation is needed if your mitro valve needs to be repaired or replaced

[Patrice]

Hi Jay,

I just had surgery 6 weeks ago @U of M on my mitral valve and I was lucky enough that they could repair it(I don't have to deal with coumadin for the rest of my life. Only 6 weeks).  My situation is a little diffrent but if the doctor cannot do a minimal invasive appraoch(small incision) then they would enter in through the chest or through the side(bra line).  They entered through my side because one year ago I had surgery and they entered in my chest and there is to much scar tissue there so it was safer to enter in through the side.  My operation was not related to MVP although I wish it was this way I would have only had to go through this once.  Anyway, whatever way the doctor chooses to enter for this surgery it is a MAJOR SURGERY!!!!!!!  Don't think, that one way you, will have a smaller scar means the surgery is easier on you. it is OPEN HEART SURGERY no matter how you look at it.  If anyone is reading this and headed for surgery GOOD LUCK & BEST WISHES!!!!!!  Obviously, I am not a doctor but I hope this information helped you.

[Kathy]

I think you're providing a wonderful service, answering
peoples' questions on line and not charging anything. I'd
like to ask my cardiologist a lot of questions everytime I
see him but I know he is hard pressed for time. Now that I
about you maybe I'll be asking a question or two in the too
far off future.

[Barbara Silverstein]

I learned of my MVP a few years ago; I'm 48, female.  Nothing ever prompted me to learn more extensively about this condition
because it isn't really threatening as I was told.  Lately, however, probably for 2 weeks, I've been experiencing sharp
(shock like, gas like) pains in my heart area with more consistency, and more concern.  Some are mild and some are "stop"
in your tracks type pains.  Once I was driving, and pulled over
because it scared me.  There is no other pain in my chest, arms
etc. related to these shocks.  They last only for a few seconds.
Some days I feel them 3-4 times, some are mild, uncomfortable
but not as sharp.  Would an echo cardiogram be the answer for
diagnosis or some other test? Do you have any thoughts on possibilities of a condition or treatment?  I haven't seen a doctor yet.

[Cheryl]

I am 42 and was diagnosed with MVP 6 years ago. I have been on Inderal LA 60MG for treatment. Lately I have been experiencing pvc's along with the mvp symptoms. They tend to keep me awake at night..with a feeling of tightness in the chest, and exhaustion in the morning. My doctor just increased my Inderal to 80 MG...I just started this today. Is there anything else I can do? I know what is happening, but it still scares you when it is going on, almost like you are having a hard time breathing during the symptoms. Thank you for your time.

[[e-mail]]

Have just received notice from my insurance company that due to a heart murmur my premium will be at a higher rate.  Just how serious can a heart murmur be.  I am concerned.  Thank you.

[Suzanne]

How is MVP linked with anxiety,  panic attacks,  and other disorders such as obsessive/compulsive?  I've noticed that many women with MVP are "touchy"  (like Sandy)  and panic when symptoms arise.  Just think of all the people (women especially)  that think that they are going insane because of the panic they feel during an MVP episode.  Doctors could be making errors in diagnosis and prescribing anti-psychotic drugs for people who really don't need them!  Echos seem to be fading into the background now that everyone can be "cured"  with Prozac and friends.

[maryann]

Please tell me what syptoms (symptoms) occur during a "episode"for MVP. i was diagnosed with mvp 3 years ago and I have numbness in my arm and face. is this normal? Thanks