Valve Calcification

[kd]

Hi, I have a few questions about calcification in the heart.  Several years ago, when I was in my early 40s, echocardiograms started showing aortic calcification and atherosclerosis in the ascending arch.  I  had a mitral valve prolapse.  By my mid-40s the mitral valve prolapse showed mild regurgitation which grew to severe within a couple of years.  Now, I am 50 and it has been severe for about 3 years.  
  I had an echocardiogram done at CCF for several years and it showed increasing calcification from the aorta spreading to the mitral valve annulus, etc.  At that time, my CCF cardiologist said to go though my local cardiologist and when he suggested surgery, to come back.  I should probably tell you that I have had a couple of strokes and have extensive, increasing atherosclerosis and that is why surgery wasn't done earlier.  I also have variably-controlled isolated systolic hypertension.  
   The heart chambers are not getting much larger.  In fact, to a minimal extent, they seem to be getting smaller and my local cardiologist mentioned he never saw anyone's heart get so small on contraction during a stress test.  My ejection fraction during the last test was 75%.

Questions:
1. For the last 3 years, my local cardiologist has done echocardiograms but none of them showed the calcification.  I am not questioning whether it is there but am asking whether there is such such a discrepancy between techniques that it would not show up?
2. Does there become a point of no return in terms of fixing the valve?
3. Can this contribute to by bouts (for weeks) of extreme fatigue?
4. Is there anything I can do about the calcification?  I am on Plavix, Cardizem CD, Lozol, Folic Acid, and Dilantin (stroke-induced seizure activity).
5. When I mentioned the calcification from earlier reports to my local cariologist, he brushed them off and said that CCF may have just gotten better pictures.  My rib cage is small so it is hard to get a good view.  Is the calcification important to anything?  Is it something to just be brushed off?
6.  How far can it spread and what can it do if left unattended?

I don't want surgery because of the risk of stroke - and right now everyone says it would be pretty risky...HOWEVER, I don't want to let something go that should have been taken care of earlier and then regret it, either.  I'm not getting any answers out of my current cardiologist.  I feel that everyone has pretty much written me off.

Thanks for your assistance,
kd

[CCF-M.D.-CRC]

Dear kd,
The calcification is not so much of an issue as the regurgitation.  Calcification by itself is a normal part of aging and may contribute eventually to stenosis of the valve.  Until that happens however there is nothing to be done.  The regurgitation however can lead to problems and must be closely watched.  The reason your heart has such a good pumping function is that it has a very low resistance to pump against with the regurgitation.  The things to watch for is any decrease in the pumping function, the onset of atrial fibrillation or an increase in symptoms.  Fatigue may be the only symptom.  It is possible to wait too long to repair a mitral valve leading to permanent damage of the heart. At this point it may be a good idea for you to have another evaluation at CCF.  I would call and make an appointment with the cardiologist you saw here within the next 6 months.

[gregd64]

Hi, what made you go to a cardiologist in the first place?

This sort of heart condition or potential runs in my family and my doctor won't even give me a stress test....  did you have specific symtoms?

Thanks

Greg

[kd re: longstanding MR]

Hi, Greg.
I had bruits in my carotids (it's kind of a turbulance sound) since I was in high school.  That led to the diagnosis of the mitral valve prolapse which I probably had since birth.  There was nothing to do about it except antibiotics before dental work and no regurgitation so I didn't think much about it.  I don't know why I started to go to Cleveland Clinic.  It seems like it started with my peripheral vascular disease and surgery and then I had eye problems so they sent me to the neuropthamologist and peripheral vascular doctor at CCF.  When they noted the bruits, they sent me to the cardiologist up there for a consult.  I stuck with him for a couple of years but when travel started getting more difficult and I also contacted someone more locally (for 'just in case'), he suggested I stick with the local doctor until he (the CCF cardio) is needed.  I  have been very fortunate in my primary physicians that they send me where I need to go.
Check your insurance and see if you can go on your own or whether you need a referral from your regular doc.
kd

[gregd64]

KD,

My Insurance is Blue Cross of Massachuesettes and its a ppo,
they say I can go to any specialist I want to thats in the
Magic list they provide and believe it or not there are several very good Cardio specialists 8 miles from my home. Anything out of the list I pay the deductable which is low and from then on they pay everything but Copay. I just don't know what to say or how to go about it... DO I just call up one of them and say "hey my doctor says I've just got it in my head I have something wrong
with my heart" but will you check me out? I feel foolish because Im only 36 but my father died at 52 and his mother had Quad bypass.. so maybe you can see my point when I would like to saty ahead of the game.

Thanks for your info.

Greg

[kd re: longstanding MR]

It seems to me that all you would have to say is that you have a family history of heart problems and would like to see a cardiologist to follow-up on it.  The receptionist might ask if you are having any symptoms and you can tell her if you are.  Eg: if you think you have high blood pressure or are having arrhythmias or whatever.  Even if you aren't, by telling her that you have a family history, you should be able to get in.  Don't talk about what your current doctor is saying, since he doesn't have to refer you, until you get into the appt.  Give it a try and let me know what happens.
kd

[gregd64]

Ok I'll try getting an appointment this week and let you know what happens.. Thanks

Greg