Autonomic neuropathy and cardiac problems

[Barb64]

I have progressed in a little over a year's time from no aortic stenosis to mild aortic insufficiency, from no mitral regurgitation to mild mitral regurgitation along with diastolic dysfunction, coronary artery disease, carotid artery disease, peripheral artery disease, changing of diameters and thicknesses on the echo in a year and a half:
                                7/30/08            1/30/07
      Left atrial diameter  3.9 cm           3.6 cm
      Aortic diameter      2.5 cm            3.0 cm
      LV Systolic Dim     3.3 cm           2.2  cm
      LV diastolic Dim     5.1 cm           3.7  cm
      Posterior Wall
                  Thickness  0.8 cm           1.1 cm
     Septal Thickness     0.8 cm           0.8 cm
     Ejection fraction      63                   65

I had a holter monitor after my last episode which showed average rate of 60 beats, range 50 - 91 beats, six PVCs - unifocal, 375 APC's - one run of four beats, rest isolated. I'm on toprol xl.

I have had near syncope and bradycardia episodes, about one per month, with my blood pressure going all over the place.  I tire easily.  I have small fiber neuropathy, polyneuropathy, autonomic neuropathy and a family history of females with heart attacks and strokes.  How much is known about autonomic neuropathy and cardiac problems?  Is there a way to tell the difference? What kind of specialist do you see? Is the progression on echo a normal rate? I've had problems finding a good neurologist so I've been seeing a physiatrist.
I do see a cardiologist but I'm not sure he's the best for all my problems.  He's kind and we have come to a good relationship.  He feels my SVT is under control with medication and likes my pressure and heart rate low. Does that contribute to my fatigue?

[Douglas Bogart, MD]

It does not sound like the valvular heart disease is causing the problems and it could be autonomic dysfunction that is producing your symptoms.  There is a fair amount of information regarding autonomic dysfunction.  I would suggest you go to the Mayo Clinics web site and also the AHA web site for more information.