Problems with aortic, mitral, and tricuspid valves

[Kristy2000]

Hi, I'm 39 years old and I recently had an echocardiogram due to shortness of breath and fatigue.  The nurse practitioner left me a message that overall it was okay, with only mild sclerosis of the aortic valve (w/o flow disturbance).  I have since received a copy of the report which also lists mild mitral valve regurgitation and mild tricuspid valve regurgitation.  My questions:  is it uncommon to have issues in 3 of the valves?  Is it uncommon to have any/all of these things at my age?  Are these 3 things something the Dr. should have discussed with me, if only to say I have these things, but they aren't a problem now?  My nurse practitioner did briefly discuss the aortic valve, but only after prompting, and only to say that I should consider taking 1 low dose aspirin/day.  Should I mention the regurgitation to dentists/doctors in the future?  Is there anything I can do to prevent worsening?  I am trying to be proactive with my health, but I feel as though I am not being taken seriously because I'm still relatively young and appear to be in good health.  I'd rather not wait until the situation is dire to begin doing something.  Any advice will be greatly appreciated!!

p.s. I also have (had?) a slightly elevated d-dimer (562 ng/mL range = 0-400) that was not discussed with me.  I did however have a ct-scan of my chest (again b/c of the shortness of breath), which apparently was normal.  Thanks!

[EchoTech]

I am not a doctor.  

The short answer is that you have nothing to worry about for quite a while.  Trace to mild regurgitation (leakiness) in the mitral and tricuspid valve are to be expected and are nothing out fo the ordinary.  The mild aortic sclerosis means that there is some calcium build up on the valve.  This is a normal age related change, but usually happen in people in their fifties and up, but it is still of no immediate concern in the next decade or two.  Some people get sclerotic valves and some do not.  For the most part there is nothing that you can do or not do to help the valve, it will just have to take it's natural course.  It could stay the same for the rest of your life, or it could get worse, it's hard to predict the future.

[Kristy2000]

Thanks, I really appreciate the advice.  

[Yvette BG]

Hi--Good for you for being proactive with your health! A couple of suggestions--
I'd ask for a copy of the summary of the CT scan of your chest, too. It's a good idea to be sure to tell any doctors that your see about the sclerosis of the valve and also the mild regurgitations, so they are aware.

A lot of times, the doctor will say they want to recheck your heart at a certain interval (like maybe 2-5 years from now) when you have mild regurgitation; sometimes, it's sooner if you also have sclerosis of a valve or you're around menopause age (because of heart risk changes with hormone changes.) So if they did not say anything about when they want to recheck you/ do another echo, I would ask. And if you're comfortable with the doctor and the tests, it's not a bad idea to have the same lab do the echo when you have it repeated (for consistency).

Mild regurgitation can be stable for a long time, like EchoTech said. If you notice your symptoms are getting worse and you don't feel well, though, it's important to see your doctor and not wait until your scheduled interval.

I can relate to your concerns as a younger person. On the sclerotic valve, I'm older (51) and all the heart-related technology is so much better than it was even 15-20 years ago, thankfully! I had thickened mitral valve leaflets (of unknown cause) that were evident on an echo when I was 34; scarey. At that time, they also noted mild pulmonic insufficiency. I felt fine until I was 47, had symptoms so they did a stress test (abnormal) and a nuclear stress test (normal)-- and then an echo at my request
(gentle insistence, really) because I just didn't feel everything was right (and there were conflicting diagnoses from when I was 15 and had had a heart catherization).
A sclerotic nodule was noted on the anterior mitral leaflet, as well as mild tricuspid insufficiency and mild mitral insuffiency. At 49, (routine) repeat echo showed mild tricuspid insufficiency, mild mitral insufficiency, and mild pulmonic insufficiency. (The nodule appeared less prominent in size, etc. 2 years later, same echo tech and same machine).

I asked and my doctor said they don't know what caused the nodule/sclerotic stuff in my case. But I made some lifestyle changes and maybe that helped shrink it a
little; I don't know....Reduced stress and started choosing healthier ways to deal with it, started regular physical activity which I was supposed to be doing all along, changed my eating habits, started on some nutritional supplements with my cardiologist's OK, etc.

I also personally wonder if a dental infection I had been dealing with for a while
may have caused some inflammation around the time they first identified "the nodule."  I monkeyed around for a while (like maybe 4-6 months) with a root canal (which failed), then had a crown, then eventually an extraction of that tooth and a bridge. The bottom line---It's really important to make sure you take care of your teeth because it can impact your heart health, which more and more research is now showing.

I would also ask them to check your homocysteine, lipoprotein level, and C-reactive protein level (plus your all your lipids) if they haven't already.

I've rambled a bit, but I hope it gives you some food for thought. The best advice I can give you is don't worry too much, get informed and make some lifestyle changes, and listen to your body. That, and make sure you're comfortable with your cardiologist...

Best of luck!

[Kristy2000]

Hi, thanks for the posts - that's some good info.  I'm sorry to hear about all the stuff you've gone through.  Isn't that frustrating when they can't tell you why something is the way it is??  (my nurse prac did ask me if I'd ever had rheumatic fever, but I don't know if I have).  Good for you for making changes in your lifestyle!  That isn't easy, but everyone needs to be as proactive as possible.  There are many health related things we can have a affect on.  The hard part is fully accepting that and doing something about it!  I inherited a tendency toward high cholesterol from my Dad and have been mindful of that for several years, and am trying to exercise more, eat less sat fat, and take niacin daily.  Right now my LDL = 117 (which isn't terrible), and my total  = 193.  I am a vegetarian, though, and eat better and exercise more than most of my family and many of the people I know, and sometimes it just doesn't seem fair that I do all these things and my levels are STILL in the high range (esp. compared to folks who do nothing and eat atrociously).  Of course, my close friend brings me back to reality by saying "yes, but imagine what your cholesterol would be if you weren't doing these things."  Probably true.  The more I do now, hopefully the less I'll have to deal with later, and maybe the fewer drugs I'll have to be on.

I will make sure and follow-up on when I need a repeat of the echo.  BTW, this was all done at my reg Dr (internal med), not a cardio.  Should I inquire into seeing a cardio?  Thanks again, I hope all you're doing makes a difference for you!

[Yvette BG]

When it's time to have your next echo or if you need follow up sooner because your symptoms get worse, I would ask to see a cardiologist. Maybe I'm being overcautious, but hey, they're the heart experts, right? Good luck.