Don't feel fully confident with the answers I received

I am a 49 year old female. I have SLE and have had a stroke and a few TIA's due to Antiphospholipid antibodies (lupus anticoagulant). I am on coumadin for that. I also have GERD and was just found to have a 1cm duodenal ulcer. I also have lupus arthritis, myopathy, high cholesterol and high blood pressure.

My  heart problems include what my doctor calls a moderate plus regurgitation in my mitral valve and supra ventricular tachycardia (which is stable with lopressor). For the past month or more I have been having increased SOB and chest discomfort with exertion. I recently had my yearly echo which is what showed (my doctors words) my mitral valve regurgitation went from mild moderate to moderate plus.  The report also says that my leaflets appear slightly myxomatous although they are not well visualized. There is also mild tricuspid regurgitation and trace pulmonary insufficiency. Everything else was fine. When the pain continued she ordered a stress test and I was injected with adenosine for that. I had significant chest pain and SOB when they did this. My results though were normal - no ischemia. While this is great news, I still don't feel right. I know that the GERD and ulcer can be causing discomfort and I am taking meds (Nexium and Carafate) for them. But, still feel different than I used to when I exert and I still have discomfort on the left side of my chest that increases when I do anything and eases when I rest. My cardiologist says that I am too high risk for a catheterization and that since there are no signs of ischemia, I can just do a repeat echo in a year and call her if I need her before that.

What are your thoughts on this? Thank You.

[Darcy Green Conaway, MD]

From the standpoint of your symptoms, I might consider a transesophageal echocardiogram to ensure the mitral regurgitation is not severe (usually moderate plus means moderate/nearly severe in its severity of regurgitation). Certainly your physician knows you better than I, but that is often what I do clinically- unless there is some obvious reason not to do that, such as you are not eligible for a valve replacement, in which case it wouldn't make much common sense to proceed. I see no reason to proceed to catheterization since you had a normal stress test so to me that is somewhat of a separate issue.