Should I worry about mild mitral regurgitation?

After telling my new Dr. about my family history of heart disease and explaining an incident a few years ago where I had chest pains, I was instructed to have an EKG and an echocardiogram.  My EKG was normal and although my echo stated no valvular heart disease it stated I had mild mitral regurgitation and a trace of tricuspid regurgitation.  After reseaching on the internet I do better understand what this means.  But my main question is this, I am young, 25 years old,  and wanting to know if mild matral regurgitation is something that usually gets worse with time or if even in my 50's, or 60's I still have a good chance of it being mild?  My father, along with a few others in my family, had a heart arrythmia and atherosclorosis.  And my father passed away from cardiac arrest at the age of 52, so I'm sure you can see my concern. I wasn't able to find in my research how often, or what % of people who have mild mitral regurgitation end up with moderate or severe regurgitation.  Any insight you can give is greatly appreciated.  Thank you.

[Cleveland Clinic]

trish,

There isn't a clear answer to your question about progression.  I certainly understand your concern -- just to let you know, mitral regurgitation itself isn't associated with sudden death.

A single echo is a snapshot of the heart in time, revealing little temporal information with respect to changes in cardiac function.  Intuitively, people with some degree of mitral regurgitation are at a higher risk to have progression to greater degrees over time.  Things that would increase this risk would be if there was specific pathology identified as a mechanism associated with the regurgitiation such as marked prolapse, or leaflet thickening. The progression of mitral regurgitation is a slow process, generally occuring over years.  In the absence of symptoms, a repeat echo in 5 years should give you some idea if your regurgitation is progressing.

Even though some will progress, its important to remember this is a very common finding in the general population and the majority of people with this finding will have no progression.  My advice is to not worry about it, lead a normal healthy life that incorporates a healthy diet, exercise, blood pressure control and routine health care from your provider.

good luck

[CraigAAA]

Hello Doc, as always thanks for allowing me to ask a question.

As a 29 year old symptomatic (chest pain, dizziness, nausea) sufferer of frequent PVC's (10-30\min) with mild hypertension for the most part controlled by 12.5 mg Atenolol daily, but with an apprantly stucuturaly normal heart could you offer an insight into the following;

1) My understanding is in general PVC's that are supressed on exercise do not pose a problem, but PVC's NOT supressed on exercise can?

A recent stress test I had, when compared to one taken some 18 months earlier showed that whilst my BPM were taken up to about 170 the PVC's were no longer completely supressed, at one point I was getting 15\min with the only notable symptom being dizziness. Though in the computers words no complex ectopy (At rest I can enter long bouts of bigeminy)

2) A lot of respected websites state that in general 6 or more PVC's\min do require treatment, if so, what is the prognosis for one getting the rate of them that I do (as high as 30\min at worst, average 15\min) Can the irritable focus develop over time ie. like water running over stone over the years if you see what I mean. So that sooner or later, a pathway may be completed which could change the situation.

3) In my case, after recording triggers for my PVC's I have noted the following inflame them;

Eating food, any food, and taking fluids (hot, cold or normal)
Sudden bouts of activity ie. becoming mobile from being at rest.
Coughing
Sneezing
Or no reason in particular, away they go

Eating food is particularly agitating, because I eat less as a result, but, what is the significance of this? Do these types of triggers indicate a cause other than physcological? As far as I can make out by virtue of what they are they must do?

Thanks as always

Regards to all

Craig

[CraigAAA]

errr

Disregard this, I thought it allowed me to post a question :s apologies.

/runs off embarressed.

Craig

[arthur]

I am not a medical doctor, but your question about triggers prompts a response.  I have had, and continue to have, PACs which are caused by foci (at or near the atria). As I understand it, PVCs can also be caused by foci(in or near the ventricles).  Foci are small regions of electrically active cardiac tissue located in regions of the heart close enough to the normal electronics to cause premature contractions. For PAC/Afib sufferers the foci are commonly found near the pulmonary vein entrances to the rear of the atria.  One thing I believe is common to both PVC and PAC initiation, is the ease with which a focal signal can travel through cardiac tissue to initiate the undesired depolarization (premature beat).  As this process is similar to (but not the same as) a nervous system signal, it is actually modulated by the state of your nervous system, in particular, your autonomic tone.  A second factor that is common to both arrhythmias, is their response to adrenaline surges.

Adrenaline, which kicks in with sudden physical activity, or anxiety, can increase the focal signal strength.  The state of your autonomic tone will modulate how well the signal travels.  Autonomic tone can be increased by physical activity, by digestion and by anxiety, as examples.  Thus, the complexity of triggering PVCs/PACs generally leads to confusion as to what kicks them up.  The reality is that everybody has foci, that everybody has a certain rate of premature beats as a result, and that some of us get more than others (it's just the way we were constructed).  

The foci in a PVC case are likely located in the deeper tissues of the ventricle and can be more difficult to treat via ablation.  But that is not to say that you shouldn't consider this route (consult an EP), if they are really as bothersome as you describe.

Good luck,

Arthur

[samueltheyoung20]

Hello

im 20 years old, exercise reg, very healthy, no stims/drug

I had a massive anxiety attack 1 year ago induced by ephedrine, and many after that due to new anxiety, but no ephedrine anymore.

, My heart would pound in my ears after getting up calmly and still does,I saw doctor and he put me on monocor adn a loop because my bp was 145/75.

when i feel carotid pulse when right calm, i feel a accurate lub-dub in SOLID waves, but if i stress quickly like getting up from chair my carotid pulse would be distinctly gushy, no solid peak. Lying in bed calmly I hear normal sound but if I move suddenly the pounding increases and i get alot of noise.

My neck is also different color than rest more purple, and i notice small blue viens only on my neck, and i notice my whole neck pulsates upon heart beat. It seems like around my mouth, eyes, neck and nose seems purple, and skin color variations is Very distinclty visible under incadescent light.The blue area around my mouth is very cold during exercise, lack o2? and my brain gets superheadaches and fogged-out with any stress. I also have a severe circulatory anxiety disorder.

I have had a ekg(ok), and echo and doc said, left ventricle valve, upp limit of normal, mild- mitral regurgitation and another valve was regurging too (???)(something about prolapse). but doc said everybody has these regurgitations???

Is it not possible that things might not show on resting echo, and might a stress test might show how my valves/heart truly are? Im worried because even after my BP med my systol went down for 3 days and now its still up at 140errrr and I still have wide  vissible pulse pressure in my carotid. could possible aortic regurgitaion explain gushy pulse during sudden movement? or am i just to tuned in? thnx

[samueltheyoung20]

yes, If i can remain completely calm alday, i dont get screwed up in my head

but when im stressed my neck goes more purple, I notice my veins its "like my heads in a shroud,altered conciousness" i definitley notice right now my upper lip is puffy, and has a purple blue look to it, i feel it in morning, my up lip feels solid, at night im all spaced out my lip is puffy/soft.

I forgot to mention this, but after my anxiety attack, i took it again after a couple of days, and had extreme heart pains, i mean extreme, and i would have to sit down, it really feels like things are backed up in my head, seem normal? also bubbles constantly pop out of my eyes and whenever my bp is up i hear tons of what sound to be like gas movement every time i move my neck, what the hey, echo say ok?

[sapphirern]

A related discussion, mild valvular regurgutation was started.