Moderate to Severe MVR w/ Hypertension = SECOND OPINION?

I'm a 34 year old female with a dual-chamber pacemaker due to Sinus Node Dysfunction (implanted 11/07), Refractory Hypertension, and Valvular Disease. Less than a year ago, while being treated for SND, stage 2 hypertension was discovered (170/100 - 225/125) and a pacemaker was implanted due to severe bradycardia (20bpm-30bpm) and uncontrollable high blood pressure (couldn't take many anti-hypertensive agents because of the bradycardia). Echocardiogram at that point showed mild regurgitation in three valves - mitral, aortic and tricuspid. Since then, BP STILL remains uncontrolled despite seeing one of the best hypertension specialist in the country. BP ranges anywhere from 168/100 to 225/125 on MANY (6-8) anti-hypertensive agents. All secondary causes have been ruled out thus far as I have had the entire work up for secondary causes repeated. In addition to the high blood pressure, I've been suffering from shortness of breath w/ minimal exertion and while lying down, chest discomfort, palpatations, edema, extreme fatigue and loss of appetite. Anyway, to make a long story short, my Hypertension Specialist detected a significant murmur and ordered an echocardiogram which indicated Severe Mitral Regurgitation with thickend anterior leaflet and restricted posterior leaflet, moderate aortic regurgitation and abnormal pulmonary pressures. Hypertension Specialist referred me to a cardiologist who suggested surgery dependent upon a repeat echo. Repeat echo showed moderate to significant MR, mild AR and TR w/ improved pulmonary pressures and suggested continuing to "try" to control BP at this time as this may be the reason for the regurg and reevaluate it in 6 months. I have an appointment w/ a CC Cardiologist by the name of Dr. Shiota next week and wonder if it's worth going to? Both Dr's said it was up to me to seek a second opinion but they both concurred on the "wait & see approach"?

[Michael J. McWilliams, M.D.]

I can tell you from a personal perspective I always like working with Dr. Shiota -- he is a very nice person and good doctor.  I would probably keep the appointment and get the second opinion.  He might have some other insights into the hypertension and if you are going to need valve surgery (or may need valve surgery) at some point in  your future, it is probably a good idea to get plugged into the system.  The Cleveland Clinic has some of the best valve surgeons in the world.

Your doctors are correct that hypertension can have a significantly affect regurgitation on echocardiograms.  It is not uncommon to see signifcant changes in pulmonary hypertension and regurgitation with blood pressure control.

Good luck with your visit.

[Momto3]

Dr. Shiota is fabulous!!  He and Dr. Thalmilarisan were there for my TEE and I would go back to either one in a heartbeat!  You are in good hands!