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Heart Murmur with Atrial Fibrillation
I have had paroxysmal atrial fibrillation for about 10 years - I take flecainide 100mg twice daily and I don't have too many episodes. At a recent pre - op assessment (for shoulder surgery) I was found to have a heart murmur and the surgery has been postponed until I get an echocardiogram to see what's causing the heart murmur. Does anyone know if atrial fibrillation can cause a heart murmur to develop?
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251395 tn?1434497886
Hello...

Mitral valve problems seem to be the most common related to Atrial Fibrillation, possibly because the extra strain a defective mitral valve puts on the heart. This can cause stretching (remodeling of the atria) and put extra pressure on the pulmonary vein openings where most Atrial Fib originates.

When was your last Echo?


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Thank you so much for your reply. My last Echo was 9 years ago. That was when Atrial Fibrillation was diagnosed. Nothing was said then about a murmur. About 4 years ago a doctor mentioned hearing a heart murmur but didn't seem to be concerned about it and I'd forgotten all about it!  However the pre-assessment picked it up again. So can you tell me is it the AF that causes the Mitral Valve problem or the Mitral Valve problem that causes the AF? Thanks again for your reply.
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612551 tn?1450025775
I think I am agreeing with Brook_38 when I say the AFib is a resulting symptom, not a cause/driver of problems.  The only problem I am aware of that is caused by AFib is an increase in the probability of clot formation, which can cause a stroke.  That's why AFib treatment normally includes a blood anticoagulant.

I suffer from AFib and also suffered from a leaky (insufficiency) Mitral Valve, which was repaired with surgery just over a year ago.  My doctors said the leaky Mitral Valve caused enlargement of the left atrial chamber and likely is the root cause of the AFib.  The MV repair was not a treatment of AFib, I still have that, the repair was done to stop enlargement of the left atrial.  There is some hope the atrial will shrink back and that could stop the AFib. This was not a promise, just noted as a possibility.  I still have AFib (that's another story in itself) and don't know if the enlarged atrial has shrunk any, I may get another echocardiogram in the future to find out how it all looks.  If that isn't recommended on my second anniversary from surgery, I'll ask for it.  

Hope I didn't ramble too much.  No AFib does not cause Mitral Valve problems.
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Hi Jerry,

No you didn't ramble too much! I am very grateful for your response. I can only guess from what you've said that in all probability my echocardiogram will be fine as when I was diagnosed with AFib I had an echo and there was no mention of murmur or of Mitral Valve problems. I thought perhaps because the murmur had been diagnosed since then, that the AFib had caused the murmur which could in turn be caused by a Mitral Valve problem (if you get my drift!)

I suppose I could have developed Mitral Valve problems in the intervening years but I don't really have any symptoms - just AFib symptoms. I am thinking that the murmur will prove to be an 'innocent' one (fingers crossed!)

Hope you keep well and that your AFib doesn't cause you too many problems. Did you have to have a Mitral Valve replacement or repair? What does repair of Mitral Valve involve? I don't know much about all this as you can guess.

Thanks again for your response I am very grateful.
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612551 tn?1450025775
Mitral valve (any open heart surgery) is major.  While there are some "robotic" procedures developed in recent times I had the old fashioned through the chest sternum in November 2007.  I was fortunate (and had a good surgeon) that the valve was repaired (much better than a replacement) and while open a Mimi-Maze procedure was also done to try to stop the AFib.  It didn't.  

I had a known leaky valve condition for a number of years, discovered the same time my AFib was diagnosed.  In those years I responded reasonably well to electrocardioversions, got about 18 months of sinus rhythm out of each of two over the past 6+ years.   However, the leaky valve was causing the atrial chamber to enlarge and finally to a point my cardiologist recommended surgery to repair the valve.  I had hoped with that repair, and the subsequent reduction of back-pressure through the Mitral valve, I would be able to hold sinus for longer than the past 18 month figure.  But that was not the case, I had my last electrocardioversion last August, it lasted only two weeks.  

I'm currently trying to find the minimum Metoprolol I can take and still keep my resting HR below 90.  If I can get the Metoprolol down to a point that I don't get dizzy when making sudden physical changes, e.g., standing up abruptly, then I think I can just live with the AFib.  I've just gone down to 50 mg a day, I was as high as 200 mg at one point.  That caused very low blood pressure, as it turns out my normal BP is just fine, it doesn't need any help.  Sitting here typing my HR is in the low 80s and I expect it'll drop into the 70s when I go to sleep.  So 50 mg is working so far.
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My goodness, you've been through a lot.  Well I guess once I get my echo done I'll know what, if anything, has been happening to my heart and its valves over the intervening years since my last echo. I have to wait until January 29th to get the echo (first appointment they had!) Anyway, I'm not the worrying type - I don't worry about things until they hit me between the eyes so to speak! I'll just plod on and wait to see what happens. Only problem is my shoulder - I have been on the waiting list for 3 months to have SubAcromial decompression and something else done to the AC Joint. I was due to have that done today and now will have to wait probably until March. I don't sleep well because of the pain and was hoping to have the surgery done before Christmas! Now this murmur has caused the procedure to be postponed I will have to suffer the pain a lot longer than I'd hoped. They told me they wouldn't risk anaesthetic until they knew if the murmur was innocent or caused by leaky heart valve. Oh well, what will be will be............................  Hope you keep well and don't have too many episodes of AFib. Take care and thank you so much for your responses.
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