treatment for symptomatic moderate MR

I was recently diagnosed with moderate (2+) MR.  My doc put me on 50mg Atenolol (B-blocker) to help with the discomfort.  However, the level of discomfort I am feeling seems out of proportion with the level of MR?  Is it normal for moderate levels of MR to cause a lot of chest pain and shortness of breath?  And, what is that weird "elevator ride" feeling I get in my chest all the time?  He increased my dosage to 50 (was 25) after I had two days of it continuously.  I am seeing a cardiologist Monday but was just curious what that was.  How do I know when to ignore the chest pain and when to seek care immediately?  What is the benefit of b-blockers over ACE inhibitors?  Thanks.

[CCF-M.D.-RCJ]

phoenixdoc,

Thanks for the post.

Q1:"Is it normal for moderate levels of MR to cause a lot of chest pain and shortness of breath?"

Chest pain is unusual with MR -- but it does depend somewhat on what the pain feels like.  If it is a tightness, like that sometimes experienced when a person is short of breath, then it is not totally unusual.  Other types of pain should prompt an evaluation for an alternative source of the pain.

Shortness of breath is the chief manifestation of MR in most people.  2+ MR is not often thought of as causing much in the way of symptoms in most people, for that reason 2+ MR is most often referred to as "non-surgical".  If you are having a lot of symptoms with 2+ MR then either (1) you are one of the unlucky ones who's symptoms are out-of-proportion to the MR, (2) the MR has been underdiagnosed, or (3) something else explains your symptoms (like coronary artery disease).

Q2:"what is that weird "elevator ride" feeling I get in my chest all the time?"

No idea.  I've never heard someone describe this sensation in relation to MR.  I'll file it away for the next time someone says this.

Q3:"How do I know when to ignore the chest pain and when to seek care immediately?"

This is the million dollar question.  For first-time chest pain sufferers who have not sought attention form a health care provider, I generally tell then to seek attention promptly.  The specifics of your chest pain, as well as your previous evaluation will have to dictate when you should seek attention.  Certainly any worsening of the pain should prompt evaluation regardless of previous evaluation.

Q4:"What is the benefit of b-blockers over ACE inhibitors?"

In patients with MR, beta-blockers can actually worsen the MR and would not be considered first-line therapy by most cardiologists.  ACE-I are considered a temporizing measure to minimize symptoms in patients with symptomatic MR while they await surgery.

Hope that helps.

[Mickie]

The "elevator ride" type feeling you are getting could possibly be PVC's. People sometimes describe these as feeling like their heart goes up into thier neck, or a flip flop feeling in the chest. I often think they feel similar to "loosing my stomach" on a roller-coaster ride, but instead of down low in my abdomen the feeling is up higher in my chest and not as strong...just a thought you could ask your doctor about or research more, good luck.
Mickie

[CareBear59]

Hi Mickie,
I get the same exact feeling with my PVC's.  Not all the time, but sometimes that's the sensation I get with them. That's such a good way of describing it too. When I get that feeling with them, those are the ones that tend to send me into that feeling of doom afterward, you too?

Carrie

[phoenixdoc]

Wow, thanks to all for info on that weird feeling.  Are yours there all day long too?  Very unpleasant.  I also found it interesting that my family doc put me on a medication that makes MR worse - could explain the recent escalation of symptoms, too.  Anyway, thanks everyone for your input - much appreciated!

[Carolina03]

Phoenixdoc,

I have moderate AI/TI and asthma. I often get a feeling of tightening in my chest and throat which my doc relates to the "reactive airway" disease.

Just a thought.

K