some more mitral valve questions

I recently began having pvc's several times an hour and was started on atenolol 50 mg after being diagnosed with hypertension also.  150's/90's.  Now have very few pvc's and B/P 120's/80's. However an echo for checking cause of pvc's revealed mitral valve prolapse with redundacy of posterior leaflet and a moderate mitral regurgitation, trivial tricuspid and trivial pulmonary valve regurgitation.  Have had chest pain at times over past 2 years and episodes of shortness of breath with exertion, but not always.  Will be having a stress echo next week.  If stress echo is normal, what should I expect for follow-up of regurgitation and what is the probability that it will not get worse?  41 y.o. non-smoker,  Thank you so much for any info.

[CCF-M.D.-KE]

Mitral Valve:

Your symptoms of CP and SOB may be related to your mitral regurgitation. The trivial tricuspid and pulmonary regurgitation are quite common in the general population. The stress echo will help determine whether or not the mitral regurgitation worsens with stress and will also help determine whether or not there are blockages in the heart arteries.

Medical therapy may help slow the progression of your mitral regurgitation, but you will need follow-up with regular echocardiograms to monitor the progression. If your mitral regurgitation worsens your doctor may wish to have you evaluated for mitral valve repair or replacement.


Thanks for your question,


CCF-MD-KE

[garyr]

from Cleveland Clinic, thought it might help. I have exactly the same problem as you with leaks in the same category for mitral and tricuspid valves, minus the pulmonic valve which has no leaks.

I also have one other significant problem, with an Aortic Valve replaced at the clinic two + years ago.

The CCF cardiologist advises at this time after stress echo of 10.4 mets, max heart rate of 163:  yearly checkups, a decent C-V exercise program 3-4 days a week at target heart range, no real heavy weight lifting, and pre-medicating with amoxycillin before any dental work and keeping a sharp eye out for infections for quick treatment. My Coronary arteries are normal for my age, 59, and cholesterol at 200, LDL's and HDL's a bit off but and going down (or up) with exercise, diet and no drugs.

My Cardiologist here in Pgh wants to see me in 6 months (instead of a year), due to a bout with A-Fib in June (no recurrence, yet) a low resting heart rate in high 45-54 range and a slightly dilating Left atrium.

[debra21784]

Sure hope your doc has you on a anticougulant because of the A-Fib .Even if you have had only one run..I had one run as well and it was almost fatal,instead I suffered a major Stroke at age 46.Get informed and if your doc won't put you on coumadin take an asprin a day to reduce your risk

[karie]

Did your MVP increase with time ?
Did diet, exercise , lifestyle changes help you any ?
Did you find other medical concerns that brought this to focus ?
Were you born with heart murmurs and to what degree are your rated ?
Have you tried the cardio-beeper test or the tilt table test ?

[motley]

what is a cardio-beeper?  no have not had a tilt table test recommended.  do not have a murmur, isn't that bizarre?  did not know of MVP until now, was found due to pvc's.  I am active, not overweight and eat a reasonably healthy diet.  am  unaware of any other medical problems that could have precipitated this.  am interested in knowing if any other people have had moderate regurgitation for years with no progression as I am hoping that mine does not get worse.

[NgottMV]

Hi All, I discovered my Mitral Valve Proplapse worsened Oct of 2000.  The doctor prescibed Atenonol 50 mg and Accupril 20 mg 1 x a day along with a coated 325 aspirin.

I go every 6 months for an echo cardiogram.  I just had one in July.

There was minmial changes till this July.
Dialated left atrium-remaining chamber sizes are within normal limits.l Ejection Fraction is 69%.  fraction shortening 39
My left atrium went from 3.4 to 4.6 mm.
Thickened mitral valve with mid systolic prolapse seen-remaining valves appear normal.
Moderate to Severe reguritation of the mitral valve.
Trace aortic regurgitation.  (This is new)
an Increase in regurgitation on the tricuspid from trival to mild.
Also on this test it mentions estimatated pulmonary artery systolic pressure 28 mmHg.  This was never mentioned before. (possible pulmonary hypertension in the works? i don't know)

Mild pulmonic regurgitation .
Normal mitral and aortic flow patterns
No significant aortic or mitral gradient.  (New Term this test?)
No significant left venticicular outflow tract gradient. (New)
Anyone know what that means?

I recently switched doctors.  Due to a change in heart insurance.  My GP recommended them both.  I also had this echo done at the new doctor office.  My new doctor keeps saying when I have a problem taking a WALK with my friend then I should let him know.  I thought the change in my left atrium was a significant change and wonder if another doctor would be more alarmed.?

Oh i'm 42 years old  : )
Any input is appreciated. thanks Nancy

[garyr]

I was on coumadin for two months and did not have a recurrent episode.

He terminated my coumadin and moved my dosage of aspirin from the 81s to the full adult dose once a day.

I have read that coumadin for A-fib does work to prevent coagualation BUT that if you are going to be in hospital within several hours or usually a lot less than that, and put on a heperin drip, and coumadin, the daily usage of it is superfluous.

How long was the time between the onset of your A-fib and stroke?

I understand that unless there is already a clot in the cirulatory system, it takes a minimum of 8-48 hours for a new one to form and get loose. And by that time if you are in the hospital other far more powerful anti-stroke intervention will prevent them.

[debra21784]

Wrong info.Afib is life threatening.The issue of a clot is when the heart returns to normal sinus rhythmn.I had one run that I didn't even realize I was having ,till I fell over from the clot lodging in my mid ceberal artery.It is not worth the risk despite the statistics being low or being told you are in a low risk group.My a-fib started because of mitral valve regurgitation and did not resolve after the cardiac surgery for valve repair.If I had it to do all over again I would have demanded that coumadin be started.I'd much rather risk the side effects from coumadin than have a stroke again.Don't let people tell you stroke only happens to older adults.Wrong .Your risk of stroke with a-fib is 5 x that of a person with out this disorder.A-fib does not have to be sustained a-fib for this to happen.

[motley]

I am not a doctor, but. . . It was also my understanding from reading this forum that when the mitral regurg shows signs of progressing and reaches "severe" the time to intervene is before symptoms, such as being unable to take a stroll with a friend, set in.  I read something on the internet once that I think applies here, when it comes to doctors to remember the rule is "you hired them and you can fire them"  If I were you, would seek a second opinion!  What is with these doctors anyway, we pay them.  Not the other way around.  Good luck and keep walking : )

[bradw]

Hi-

I have a brief story ,and some questions:

I just turned 40 (in May). In APril I began feeling heart palpitations.  My PCP was unable to observe any arrythmia on an ekg- however, following a workup I ws found to be hypothyroid. I began a course of synthroid, and the palpitations diminished over the next few weks. In early July, though, the palpitations returned. Again, they were not observable on ekg- and my TSH level was again elevated, so my synthroid dosage increased (from 50 to 100 mcg, which is my current dosage). As a precaution, I got a referral to a cardiologist. I was feeling relatively symptom free by the time I finally was able to get in to see the heart doc; but on the day of my visit my symptoms returned quite forcefully. My ekg show frequent PVCs, and an echo reveald a mild MVP, with minimal leakage. My Holter that next 24hrs showed 350 per hr PVCs.  At this point, my PVCs are present every day, although the diminish over the course of the day, and get worse- really persistent- as I get tired. My sleep is regularly delayed or disrupted by PVCs.  All this is characteristic of MVP and PVC, as far as I can tell, and I have not begun any therapy. I exercise every day (walking 3-4 miles) have eliminate caffeine and meat from my diet.  I have very recently begun to take magnesium supplements (400 mg @ day) and am considering CoQ10 if the magnesium is not more effective.  

As I just began a regime of synthroid which is a life sentence, I am reluctant to begin a course of beta-blockers. Is there any other way that I can reduce- if not completely eliminate - my PVCs? I have no chest pain, or shortness of breath, but it is certainly annoying and uncomfortable.

[garyr]

Were you in the hospital when you reverted to Sinus?  Was it spontaneous or did it require Cardioversion?

In the A-fib info I have read, coumdin is prescribed for those 5% of patients who are predisposed to A-fib as a precaution.

I asked my caridologist at CCF and she concurred that coumadin for those who will be in a hospital hooked up to an IV drip within hours of A-fib onset, keeping the blood in a slow-to- coagulate state, may present more risk in the general population
than not taking it.

With even one prior stroke I can see why you might be on it, but I have to believe that two cardiologists agreeing that I need not take it IF I can be in a hospital within minutes to a few hours, with a heperin drip and other measures, after another A-fib event, coumadin is not necessary. If I had a stroke, heaven forfend, I'd likely never stop taking it either, no matter what.  

[debra21784]

You can't always be in a hospital hooked up to an IV to get heparin when you are experiencing a-fib.My a-fib did in fact convert spontanesously and I had the stroke.The cardiologist will down play afib in a young adult but if you ask a nuerologist who treats stroke you will get the response that coumadin in a-fib at any age is a must.They see the effects of the a-fib(stroke)I sure would not want to have another or spend another 3 years recoving.I have been lucky,some do not recover It certainly is up to you but it is a gamble.Depends on how much you want to risk. I have now participated in 3 stroke study research programs with a major academic medical center with stroke researchers and without hesitation they alll say had I been on coumadin because of the a-fib the stroke would not have occurred.
When ever I play black jack I always hold at 19! Why take the chance!

[gotcha]

i have a mild to moderate mitral valve leakage i am 39 years of age would like to know if i would have to go through as surgery ...symptoms -weakness 'lethargy 'palpitation 'sinking feelin of the heart ...black out...would like to know if any cure by medicine

[debra21784]

Sounds like you need to see a cardiologist and have a full work up especially for " blackout".This can be an indication of comprimised hemodynamics .The valve needs to be evaluated for the amount if any regurgitation ,(echo and stress echo,TEE maybe necessary)certainly an event or holter monitor to determine any cardiac arrythmias.Some valves never cause problems and others need repair or replacement.Only a cardiologist and then a cardiac surgeon can make that determination.Get to a doc ,my preference is always a academic medical center.Good luck

[garyr]

..still, how much time elapsed between the onset of your A-fib event and the stroke?  If you are saying you didn't go to a hospital at all until you had the stroke, and were never put on a Heperin drip or otherwise cared for, within hours of A-fib onset, then the scenaria I described and the doctor from CCF's answer to you is a valid one that everyone need not take coumadin, post A-fib.

If you did not go to a hospital at the onset of A-fib, within minutes to hours (and spontaneously 'cardioverted' on your own, which frequently occurs), it would be a gravely serious self-diagnosis error.

This would help explain why a lone A-fib event, with immediate hospital care, would not require lifetime Coumadin therapy.

[Tallulabelle]

I was diagnosed with MVP over 20 yrs ago after having a spell of
P.A.T. Tachycardia. I was told it was not life threatening. My
Mother suffered from severe P.A.T. Tachycardia all her life, she took beta-blockers and Valium most of her life. I've never had to take medication for Tachycardia spells. Also my Mother did not have MVP. To stop a spell of Tachycardia I fill a large
bowl full of cold water , take 2 deep breaths and on your third
breath blow all air out of lungs emptying the lungs and dip your face in bowl of water, hold it there as long as you can and
then come up for air, it will stop a spell on first or second try just remember very important that lungs are empty. Hope it helps someone. I also take adult aspirin once a day and sometimes more if I have pain.