Pacemaker/Severe Mitral Regurgitation and Refractory Hypertension

[dee1015]

Dear Dr.,
My question may or may not belong here but it was my only option and perhaps you can help. I'm a 34 year old female w/ a dual chamber pacemaker due to sinus node dysfunction (implanted 11/07) and have been suffering from refractory hypertension despite seeing a Hypertension Specialist at the University of Michigan. I've had the entire work up for secondary hypertension and nothing has been found thus far. Anyway, a year ago I had an echo that indicated mild mitral, aortic and tricuspid valves. Recently, I had an echo done because my physician heard a heart murmur and it indicated severe (4+) mitral regurgitation w/ thickened anterior leaflet and restricted posterior leaflet and moderate aortic regurgitation. I've also been suffering from shortness of breath w/ exertion and lying down, chest discomfort, fatigue, significant edema in feet, ankle and legs and heart palpatations. My question is...what is my next step here? Could the hypertension be making the regurg worse since it went from mild to severe in less than a years time? My Hypertension Specialist wants me to see a Cardiac Surgan at the University of Michigan. Do they have a decent program? Would it be worth a trip to Clevland Clinic to be evaluated?
Thank you so much for your reply!

[Michael J. McWilliams, M.D.]

Hypertension does worsen mitral regurgitations.  There are some pretty potent blood pressure medications out there that should be able to control you hypertension   It is worth a shot to try and control the blood pressure before proceeding with surgery if this is possible.  Your doctors will know this best.

University of Michigan is a very good institution and they provide great medical care.  The surgeons at The Cleveland Clinic are very good as well.  If you live near Ann Arbor, I would not hesitate to have my care done there.

4+ MR with symptoms is an indication for surgery.

I hope this helps.  Good luck.

[dee1015]

Thank you so much for your response. In regards to BP medications, I've tried many w/ many combinations for over a year and nothing has worked. My Hypertension Specialist is calling me an enigma! BP ranges between 168/100 to 225/128. My next question is, will any repairs to the valve undo itself if BP remains under control.? Also, my fear is if I continue to wait w/ these pressures that it'll only get worse. Given the fact that I'm already experiencing symptoms should I proceed despite the BP. Again, many thanks!