Valve regurgitaiton

I am a 37-year-old who was on Redux for a three month period.  I had a normal echocardiogram prior to taking Redux.  Since taking Redux I have developed asthma and was recently hospitalized.  During the hospitalization, another echo was performed and showed mitral valve thickening, mild aortic regurgitation (grad 1+)with jet/lvot diameter ratio .21 and mild to moderate tricuspid regurgitation.  I have experienced several episodes of chest pain, feeling that my heart is beating in my throat.  A 24 hour holter monitor test was done and showed frequent episodes of sinus tachycardia with rates of 100 - 155.  There were also infrequent PVCs and PACs.  I have been taking Lasix 20 mg b.i.d. for edema and Atenlol for neral mediated synopal episodes.  The Dr's don't seem to be concerned, but I seem to be getting worse.  Any amount of walking is very difficult.  I don't get much sleep at night, when I lay down my heart is racing and I have a difficult time breathing.  Sleep apnea test have been ordered, but will not be done until sometime in May.  Will this go away, or will I continue to get worse?  Is tachycardia something you just have to learn to live with?

[CCF CARDIO MD JMF]

Dear Marilyn,

I would recommend the following with regard to your sinus tachycardia.  Limit caffeine and stress if possible.  you may wish to increase your atenolol AFTER discussing this with your physician to help decrease some of the symptoms associated with your tachycardia.

You should also have your thyroid evaluated to make sure that an elevation in thyroid hormone is not causing these increased heart beats.  

As far as the history of redux and your valves, i would recommend that you continue to have this followed on a yearly basis.  

[marilyn]

I do not consume any caffeine and have had a thyroid study done that was normal. Also my cholesterol was normal.  The Drs would like me to stop the Atenlol due to increased problems with the asthma.  I have been on prednisone 60mg for seven weeks and every time they try to taper, I have problems withe increased asthma attacks and my peek flows drop.

[samantha]

I am an athletic 50 yr old woman who had a Cosgrave ring put on my Mitral Valve this past August with minimum invasive surgery. I had had rheumatic fever as a child and had stenosis and regurgitation and had become symptomatic which limited my activities. While I am doing really well, I do not have the same stamina as I had before I became symptomatic. Does the ring restore you to normal or is it slightly restrictive. I would like to know more about this ring.

[concerned]

To Marilyn, with the probs you are having w/ shortness of breath and breathing probs while lying down on top of the fluid retension, you must question your dr's about the possiblity of CHF (congestive Heart Failuar). Also, find out the size of your left ven chamber and your EF (ejection fraction). Question your dr's and ask if your #'s are in normal limits, low normal or high normal. Get copies of all test and research everything. Good luck and God bless

[Milo Vande Krol]

I am 71 years old, partially retired pastor. In 1992, I had a severe case of Endocarditis,  which resulted in the necessity of having my Aorta valve changed in Jan. 1993.  The doctor put in a St. Jude valve.  I got along very good, but 2 years ago, I began to feel very weak after any amount of physical exercise.  I had heart tests taken then, resulting in My Cardiologist advising me to change my life style and reduce the stress in my life.   Since retiring (partcially) it seems the Mitral valve has grown worse, and my srugeon advises surgery. It is a regurgitation problem.  Since he said it was not an emergency, I have made an appointment to get a second opinion at Mayo clinic in Rochester.
I have also been gathering information on the internet about the heart valve and replacement/repair.  It was here that I discovered the very modern moderately invasive proceedures that are being experimented with.

[Sharon]

I am 39yrs old and been followed by a cardiologist for 20 yrs.  I have been diagnoised with moderately severe mitral insufficiency.  I am very active and not on any medications.  My last stree echo showed left atrium 3.9 and lv Diastole 5.6.  The rest of the readings were within the normal range.  My question is when is it time for repair?  Do I wait until my reading are above normal and if I wait will there be permanent damage to my heart?

[cardiac sonographer]

Normaly with moderate to severe MR there would be significant left atrial enlarement as well as left ventricular enlargement due the extra amount of blood going into the left ventricle and the extra work the left atrium has to do.  Both your measurements are within normal limits.  for the LA 4.0 is the upper limit of normal and for the LV 5.7 is.  I would recommend standard echo be done because the could be over estimating the severity of the regurgitation or they could not be measuring the chambers correctly.  In any case you should talk to your cardiologist about this.

[Sharon]

To Cardiac Sonographer:
  Thank you for your reply.  I have a couple of questions if you could give me your opinion.  I have an echo done every 6 months and the next one scheduled is in June. How do they tell if you have an moderate to severe MR,Do they go by the measurements or what they see from the echo?  I have had the same person doing my echo for the past 12 yrs, do you think she's measuring my chambers wrong?  Do you know when they would have to do the surgery?  Is it as soon as the measurements go out of the normal limits?  It seems like I go in cycles. There's no change in a 1 or 2 and there's a change.  If you have any input I would appreciate it.

[Sharon]

To Cardiac Sonographer:
  Thank you for your reply.  I have a couple of questions if you could give me your opinion.  I have an echo done every 6 months and the next one scheduled is in June. How do they tell if you have an moderate to severe MR,Do they go by the measurements or what they see from the echo?  I have had the same person doing my echo for the past 12 yrs, do you think she's measuring my chambers wrong?  Do you know when they would have to do the surgery?  Is it as soon as the measurements go out of the normal limits?  It seems like I go in cycles. There's no change in a 1 or 2 and there's a change.  If you have any input I would appreciate it.

[Sharon]

To Cardiac Sonographer:
  Thank you for your reply.  I have a couple of questions if you could give me your opinion.  I have an echo done every 6 months and the next one scheduled is in June. How do they tell if you have an moderate to severe MR,Do they go by the measurements or what they see from the echo?  I have had the same person doing my echo for the past 12 yrs, do you think she's measuring my chambers wrong?  Do you know when they would have to do the surgery?  Is it as soon as the measurements go out of the normal limits?  It seems like I go in cycles. There's no change in a 1 or 2 and there's a change.  If you have any input I would appreciate it.

[cardiac sonographer]

To quantitate MR we use color flow.  We see how far back the regurgitation goes in to the previous chamber.  If you have has long standing MR for several years and it was even mild to moderate you should see a difference in the left atrial measurement.  I can't really say if she is doing anthing wrong without seeing your echos but severe MR without any left atrial enlargement dosen't happen unless it acute MR, but yours is long standing so it should be there.  Maybe you could tell your doctor you've done some research and you had some questions.  Good luck

[kd re: longstanding MR]

Hi
I've had a MR for about 4 years now.  In that time it moved from nothing to 3+/4+.  I've been told by 2 cardiologists that I will have to have surgery "sometime."  (They keep changing the date, saying in the next 2-3 years.)  The last time I saw the cardiologist in a teaching hospital, he said it should have been done a couple of years ago but I have other medical problems that stood in the way.  The last time I saw the local cariologist said that it could be 10 years.  There has been some mild changes in the size of the left atrium but none in the left ventricle.  I don't have any arrhythmias on a regular basis. (Probably because of all the BP meds I'm on.)
So - I don't know what this adds to the conversation but I hope it helps in some way.
To Sonographer - I'm glad you're in here.  What you had to say was interesting.

[Jamie]

To Sharon:
I was diagnosed with moderately severe reguritation of the mitral value 3mos ago.I am non-symptomatic (for now)and all my testing showed that my heart was functioning properly with no enlargement and a 62% ejection fraction. I too was confused by the cardio docs reference to the "lack" of vascular damage due to such a "significant" leak. Also, no one ever heard anything suspicious during routine exams before, causing a great amount of confusion among my doctors. I too am curious regarding ECHO & their accuracy. I have seen 3 different cardio specialists and 2 out of the three believe I just have severe MR and no prolapse and 1 doc states I have severe MR without prolapse.  Again, a different opinion based on the same ECHO. I am also wondering how to approach my current cardio doc with these questions.  I would appreciate any suggestions you may have regarding your experiences with your doctors and how you went about handling the information.  I also correspond with other forum participants, which I find to be very helpful and supportive and extremely educational.  Please feel free to e-mail me at Dollylo55@aol.
The best of luck to you.

[Sharon]

I AM 39 YEARS OLD AND 7 MONTHS AGO I FOUND OUT I HAD MITRAL STENOSIS WITH A VALVE AREA OF 2.5 CM AND 1 MONTH AGO FOR MY FOLLOWUP VISIT MY VALVE AREA WAS 1.4. I WENT TO ANOTHER CARDIOLOGIST FOR A SECOND OPINION AND GOT THE SAME RESLTS OF 1.4 CM.THE NEW DOCTOR HAS NO WAY OF KNOWING FOR SURE BUT HE   DOESN'T BELIEVE IT PROGRESSED THAT MUCH IN 6 MONTHS. PLEASE CAN AN ECHO TECH OR CARDIOLOGIST WRITE BACK AND TELL ME WHAT YOU THINK. I AM SUPPOSED TO GO BACK TO THE 1ST CARDIOLOGIST IN 4 MONTHS BUT I'M SCARED IF IT DID PROGRESS THAT MUCH IN 6 MONTHS WHAT WILL HAPPEN IN FOUR MORE MONTHS.MY LEFT ATRIUM IS STARTING TO ENLARGE BUT MY SYMPTOMS ARE'T NO WORSE THAN THEY WERE 6 MONTHS AGO, IN FACT I THOUGHT I WAS DOING BETTER SINCE I WAS PUT ON TOPROL 7 MONTHS AGO.