valves and peripheral edema

[Meghann]

Hi and thank you for your time.  I have had pretty noticeable ankle edema for several months now (pitting).  None of my medicines are known to cause fluid retention.  I am not overweight.  Liver function tests are normal.  Kidney function shows slightly elevated creatine levels which have increased since a recent appendectomy.  I am a 38 year old female with a myxomatous mitral valve (no regurg) and mild aortic insufficicency.  I had a follow-up echo showing the regurg has not worsened in 8 months.  my ejection fraction was 71% and the lv size is within normal range.  My questions are:  can I be retaining fluid because of the valve issues even thoug the lv is not dilated and my ef is above 50%, for example if it's beginning to worsen?  Are myxomatous valves a condition that will probably worsen and need to be followed?  Does a myxomatous valve without regurg need antibiotic prophyactic (I know the AI does).  The fluid retention question is the one that is really frustrating.  I am on 1 mg bumex per day and have lost 8 pounds of fluid that I had put on fairly rapidly and still have pitting edema.  Thank you.

[CCF-M.D.-MJM]

Hi emka,

Let me take your questions one at a time.

1. can I be retaining fluid because of the valve issues even thoug the lv is not dilated and my ef is above 50%, for example if it's beginning to worsen?

Usually not.  If you have new and significant edema associated with weight gain, you need an answer why.

The typical offenders of liver disease, kidney disease and heart disease, although sometimes hypothyroidism can do this as well.  If it isolated to one leg (?), the idea of a blood clot needs ruled out.  With your creatinine increasing, it is worth having your doctor check your urine for protein, red blood cells, white blood cells, or sedimate.  If your valve isn't leeking badly and your EF is normal, I don't think this is from your heart.

2. Are myxomatous valves a condition that will probably worsen and need to be followed?
It is worth following myxomatous valves with serial physical exams.  IF the murmur changes or worsens, then echocardiography is indicated to evaluate for changes.

3. Does a myxomatous valve without regurg need antibiotic prophyactic (I know the AI does).

Not without significant regurgitation.

I hope this helps and good luck investigating the cause of your edema.

[hbp702]

You need to see a nephrologist (kidney doctor) as soon as possible.

Not only are you retaining fluid, you are also retaining metabolic waste (creatinine). Your kidneys are doing a less than sufficiently effective job in removing water and poisonous waste from your body. This can result in systemic poisoning (uremia).

Get checked throuroughly for high BP and diabetes, these both damage kidneys.

[DottyCece]

I am not sure how the MD will answer your questions but from my own personal experience...I had a myxomatous valve (mitral) that wasn't followed as it should have been so ended up with severe regur and rapid uncontrolled atrial fir.  I had heart surgery...replacement of valve and didn't do well so had to have it re-done 11 months later.  I continued to have arrhythmias, PPM, frequent cardioversions, ablation attempts etc etc.  My ankles were swollen and I hated that and still do.  It hurts and is uncomforable all the time and it is a matter of always chasing that with the electrolytes.  Now I have been diagnosed with dilated nonischemic cardiomyopathy (cause unknown) EF 30%.  I just had a Bi-V pacer implanted and that has helped the edema.  I also had very easilty induced VT and VF so have an ICD as well.  I take Torsamide for the edema and have been able to decrease the dosage significantly.  My weight is down 9 pounds in one week so I have been pleased.  Now, I am dizzy and lightheaded probably too dry.  When one diureses a lot, creatinine does go up...that is pretty normal along with the BUN.  I know that when I have decreased the diuretic, the Cr and BUN returns to normal.  Bumex is an unusual drug to take as a outpatient.

[jan]

I was told by a dr. on this forum that you should have antibiotic prophylaxis with a myxo. valve.  I believe I was told that is should be followed by echos, also.

[cathy929]

A related discussion, Pulmonary Hypertension was started.