Re: Mitral Valve Regurgitation

Posted By Rich on May 04, 1999 at 16:20:34
I am 48, physically fit and thought my shortness of breath and light headedness on exertion was asthma. An x ray showed mild obstructive pulmonary disease but no edema. A pulmonary capacity test showed lung mechanics at FVC 98%; FEV1 88%; FEF 25% - 100; FEF 50% - 92%; FEF 75% - 29%; FEF 25-75% - 58%; all improved on bronchodialtion (.3cc metaprel)
I was given pulmacort and serevant, with maxair for stress situations. These were taken for two weeks...played tennis with allergist MD. Was light headed and breathless after short run. He then sent me back to Pulmonary Specialists for Stress Pulmonary/ECG. Pulmonary was apparently fine but the Bruce Protocol Treadmill was stopped at 9.59 min. due to depressed ST on ECG. Summary Stats: Max Speed 4.2; Max Grade 16; Est. Max METS 11.2; Peak Heart Rate 182; FAI % 7-0; Max ST Dep (uV) -220; Max ST Dep Time 6:24E; Leads with 100uV ST Dep, II, III, aVF; PVC's after 1min. Exer. 2;
  Summary - Good Exercise Tolerance; Somewhat flat BP response; No Ectopy; No Chest Pain; Dyspneic and Diaphoretic at end; Suspicious ECG (II,III,AVF,V5)for ischemia at peak exercise and early in recovery; quick recovery with resolution of ECG changes.
  I was sent to see a Cardiologist with this data. His office diagnosis "your probably just out of shape". Returned to PCP who did not agree and scheduled an resting echocardiogram, the office assitant phoned and faxed the results to me. They are as follows; Summary - 1. Normal right heart funtion was noted. no wall motion abnormalities were recorded. 2. Normal left ventricular systolic function was present. No wall motion abnormalities were recorded. Global left ventricular efection fraction was preserved at 59%. 3. Left ventricular diastolic dysfunction was appreciated. 4. Mild valvular hear disease was noted. Nild mitral regurgitation and mild tricuspid regurgitation were recorded. 5. No evidence of pericardial or pleural disease was apparent.
My PCP has now sent me for an Upper GI (showed uncoordinated esophogial action) did not swallow smoothly. I am concerned we are leaving the heart issues unanswered...I am pushing for a Stress Echo to clarify the Mitral Valve issue...my primary wants to move on to look in other areas...
I would love this to be something other than heart...but my symptoms are progressing...walking uphill brings on shortness of breath and lightheadedness, I have swelling in the back of my throat at night often preventing exhaling, general fatigue after relatively normal day. General ache in chest area (but no stabbing pains...yet). Should I let them dismiss the heart and mitral valve as a cause?
What specific readings are important to your evaluation of a stress echo? The Q and A info on your site indicates most tests cover size of valve, flow, backflow vol. condition of leaflets, etc. As you may note from my resting echo none of that was noted.
What information can/should be obtianed form the echo that would indicate type of damage and canidate for repair vs. replacement of mitral valve?
Is Tricuspid Regurgitation a typical by product of Mitral Regurgitation? Is it likely not to require repair/replacement?
Is balloon technique an option for mitral valve?
If cath is required is it more productive to have it done by CCF if that is where surgury (if shown necessary)would be done?
I am in a small Central Californa coast community, can you recommend any Cardiologist/Surgeons in this region?

[Cleveland Clinic, MD]

Posted By CCF CARDIO MD - CRC on May 05, 1999 at 14:22:22
Dear Rich,
Thank you for your questions.  I have tried to answer each of them one-by-one below but I think what you are really asking for is a good second (or third) opinion.  This would involve an office visit and a through review of all your records.  Of course we would be happy to see you here and can probably take care of everything (including a cath if necessary) in 2-3 days.  I would recommend Dr. Eric  Topol (Chief of cardiology - http://www.ccf.org/heartcenter/staff/topol.htm).  You can make an appointment with him by calling the number below.  If you are set on having surgery (again only if necessary) here then it would help to be evaluated here.  Alternatively, there are many good medical centers in California and I would recommend one of the university based hospitals.  Best wishes to you and if you end up coming here let Dr. Topol know it was through this site.

Q: Should I let them dismiss the heart and mitral valve as a cause?
A: Not necessarily.  The only "gold standard" test is a heart cath.  
Q: What specific readings are important to your evaluation of a stress echo?
A: What we look for is wall motion abnormalities.  This indicates an area that is not getting blood flow with stress.
Q: What information can/should be obtianed form the echo that would indicate type of damage and canidate for repair vs. replacement of mitral valve?
A: Generally mild MR needs no treatment.
Q: Is Tricuspid Regurgitation a typical by product of Mitral Regurgitation? Is it likely not to require repair/replacement?
A:  Tricuspid regurgitation may be present but is not due to the mitral regurg.  It is less likely to need repair.
Q: Is balloon technique an option for mitral valve?
A: Not for regurgitation.
Q: If cath is required is it more productive to have it done by CCF if that is where surgery (if shown necessary)would be done?
A: Yes.
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 suited to address your cardiac problem.











Follow Ups:


Mitral Valve Regurgitation Rich 5/17/1999
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Re: Mitral Valve Regurgitation CCF CARDIO MD - CRC 5/18/1999
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