echo

I just had an echo done by my ep because he said he was not familiar with the person who read the first and how the interpretations ran.  This was to decide if I needed antibiotic prophy., which he does not agree with for mild regurg.  I have an appt. to find out the results Dec. 15.  To keep a short story short, because I was going to have a mole removed, another dr. in his group had an office girl call and she said I needed the antibiotics because of mild mvp.  What I want to know is how can this be when I just had an echo 6 - 7 mos. ago that specifically stated "no evidence of prolapse" ( thicken'g of anterior leaflet and mild regurg.)?!  Also, why would this dr. tell me to take antibiotics for mild, when my dr. wouldn't?  Doesn't he care how my dr. deals with this?  What's going on?

[Cleveland Clinic, MD]

In general antibiotics are not needed for MVP alone, only when it is accompanied by regurgitation.  Usually dermatologic procedures do not require antibiotics.

[jan]

I do have mild regurg.  My questions were: 1. Why this echo says mild mvp when the last, just 6 - 7 mos. ago, said no evidence of prolapse.  2. My ep doesn't think I need antibiotics for teeth cleaning or anything with just mild and I was wondering why another dr. in his group would tell me to get it knowing he feels that way. 3. And since you say I don't need it remove my mole, would it be wrong to tell my pcp that he doesn't even need to consider it?

[jan]

P.S.  Also, tr should up on this one ( and who knows what else).  Again, I have to wonder, why the difference?

[Cleveland Clinic, MD]

In medicine, as with many things in life, not everything is black and white; there are many shades of gray.  Antibiotic prophylaxsis is one of those issues.  There is a diversity of opinions about the best use of prohylaxtic antibiotics and your doctors reflect this.  I use the American Heart Association recommendations which are becoming more conservative in their recommendations.  You can get a patient card from them by sending  a SASE to The American Heart Association, 7272 Greenville Ave., Dallas, TX 75231-4596 and ask for the bacterial endocarditis prophylaxsis card.  You can also find this information in the Journal of the American Medical Association 1997;277:1794-1801.

[jan]

And what about my original question?  Why is there a difference in the echo?  Was something wrong with the first or with the person who read it?  Or could these actually be changes already?

[Cleveland Clinic, MD]

I have no way of knowing.  You would have to ask your doctor.