Heart Valve Disorders

[Lauro]

Thank You for taking my question.

For the past 6 months, I have been short of breath.  I am a 58 year old female.

I had a High Density Chest CT Scan and this was ok except for finding some lil cysts on the lung. (pulmonologist ordered this)
I had Pulmonary breathing tests twice and the 1st one was just ok but the second one was much better, one month later.   I had 2 more plain chest films and they were very good with good expansion.

I had an EDG that showed some reflux. Colonoscpy was normal. I had a Broncospcopy also and this was good.  

I also had an Echocardiogram in August when the shortness of breath started and was told via the cardio's secretary on the phone, that it was Normal.  

  I did not care for this Cardiologist so will not call his office again for my question.

Question:  Will an Echocardiogram show a problem with all 4 heart valves?
My Uncle just called me and told me that he has to have an Aortic Valve replaced as he is very short of breath.  He does not remember what tests he had for this determination. He is 79 Years Old.

I am very concerend and  wondering if this could be my problem and the cause for my shortness of breath.  CBC was normal.

Thank you CC doctor for any information you can supply me.

Rosemary, in Houston, Texas

P.S.  Is Aortic Valve replacement safe for a 79 year old man?
Recuperation time?
Thanks again.

[Jeff to Rosemary]

I forgot to answer the question.
1/4 means (1 in the scale of 4 ) for mitral regurgitation is the E/A parameter of regurgitation ,here it is 1 (minimal) based on this study no problem with major leakage here 4 would be maximal.That LV shortening can be also considered normal -it might go up and down by 10% anytime.Basicly you need to get your EKG or a
better one -it costs only 30-80$ for the test .Make sure that there is a good interpreting computer hooked with it,otherways
the doctor will be using his own interpretation and it requires
almost a snipers eye and an Einsteins brain to interpret EKG correctly and not to omit something.So once again you need in your hands
1.a good EKG with interpetation(description)
2.copy of your VIDEO echo tape


PS thickening of the valves-- most people with regurgitation
have thickening of the valves -that is what mainly causes regurgitation .It doesn't look like
if you had endocarditis or have prolapsing leaflets.Check your EKG for potential P,Q,R,S,T segment changes they tell most.

[Jeff to Rosemary]

HELLO ROSEMARY,
WHAT ABOUT YOUR EKG ?IS THERE AN INTERPRETATION
OR A COMPUTER READOUT BESIDES THE GRAPH (SAYING PROBABILITY OF
ISCHEMIA OR OTHER ???????)USUALY A GOOD EKG MACHINE
WILL INTERPRET THE GRAPH OF EKG AND GIVE A "ROBOTIC READ OUT" .
VALVES CAN CAUSE PROBLEMS THAT CAN BE PICKED UP BY EKG.
I NEED TO KNOW IF YOU HAVE ST OR ST-T SEGMENT CHANGES (DEPRESSION
ISCHEMIA ,ELEVATION INFARCT-DAMAGE TO THE MUSCLE).
IT IS THE HEART MUSCLE THAT HURTS ,SHORTNESS OF BREATH CAN LEAD FURTHER TO IT .NEXT STEP FOR YOU ON YOUR OWN IS TO COLLECT ALL DATA FROM THIS EKG OR FIND A DOC -HOSPITAL WHO HAS THE "INTERPRETING EKG MACHINE" AND WILL GIVE YOU A VALUABLE READ OUT.
OTHERWAYS YOU WILL BE GUESSING -MAYBE THIS, MAYBE THAT.


THERE IS A VERY GOOD WAY OF STRENGTHTENING THE HEART MUSCLE
BEFORE/DURING SYPTOMS OCCUR(I LEARNED IT MYSELF)
YOU SHOULD TAKE A TABLET OF ASPRIRIN AND DIVIDE IT WITH A KNIFE EVENLY (YOU WILL NOT HAVE TO SWALLOW OR CHEW IT)JUST PLACE IT ON YOUR TONGUE ---THE RAW ---ASPIRIN -----CENTER OF THE TABLET FOR 3-6 SECONDS.IT WILL VERY QUICKLY ACT AND WILL DO THE JOB QUICKLY FOR REMOVING YOUR SHORTNESS OF BREATH BY INCREASING THE BLOOD SUPPLY TO YOUR HEART MUSCLE .TRY IT .
JEFF

[Lauro]

Thanks much for this information.

I just wonder when this all will end.  It seems that the docs I have met up with, expect the patient to figure out abnormalities in tests, themselves, i.e. IGM elevation and now the Echocargiogram.  

Thank God, for this site and for the caring doctors and people who respond to others.  They are truly the "angels of mercy" here.

Needing to find a good doctor here in Houston that can put things together.  My health Insurance is good anywhere.

Thank You, KD.

[kd re: longstanding MR]

Ask your docs to look further into the IGM reading.  The cardiolipins can show a possible antiphospholipid antibody syndrome that affects the clotting factors of your blood and plaque deposits in your vessels.  At least that's what I have been told.  I have also been told that a high IGM is not as important as a high IGG but should still be treated.  Antiphopholipid antibody syndrome is also commonly found with heart problems and can affect your overall vascular system.  Again, from what I was told.  It wouldn't hurt to look into it.
kd

[Lauro]

Hi Jeff..

I saw the gastro lady today and when she read where I saw another  gastro doc and was not responding to the meds he prescribed,  achifex,(sp) prilosec and prevacid, she said she could not take care of me as this other gastro doc was a friend of hers and they do rotations together.

What a blow to say the least.  She said I must have a motility disorder because I did not respond to the meds and this needs to be addressed with a motility specialist.  She could not get rid of me fast enough.

The doctors all stick together and now I know that getting a second opinion on anything is futile.

I will suffer the pains rather than go thru what I did today.

I did view the Echocardiogram that was sent to this gastro doc's office. In fact I took it with me when I left.

Bunch of numbers but most look within normal range except

LV Shortneing Fraction is 45%  Normal range is (18-42)

And:  Under Valves:

Aortic Valve        Mildly Thickened
Mirtal Valve         Midly Thickened
Tricuspid Valve      Normal

Doppler Findings:  Mild (1/4) tricuspid regurgitation. (have no idea if this means anything)

I do not see where there is any mention of a Pulmonary Valve.

Not a happy camper today.  

[Jeff TO PATRICIA]

Rosemary no need to get angry ,all you need
is the paperwork which is understandably yours
regardless of their "snail work tempo".Best thing is
always to get it personaly .You might want to double check
that the echo is fully descriptive and not a unofficial docs copy.You want to have the description of :mitral valve,tricuspid,
pulmonary ,aortic.If there is a regurgitation or stenosis
on any of them then you want that to be described either
by a: scale of E/A ratio (ranges from 0 to 4)or by terms
of :none,minimal,mild,moderate,severe(for regurgitation)
similarly for stenosis.Also you want to your heart to have
several measurments taken of~ like the size of your left vetricle measured in cm and there should be a reference range for normal dimensions in centimeters of your heart.At this point in time I believe that they can- but not necessarily will(depends if the test was at a private office or in a hospital)provide you with your own VIDEO TAPE copy of the echocardiogram.You will be able to take it to better specialists if needed also every info is usualy written at the beggining of the video tape.
regards
Jeff keep me posted

[Lauro]

Not a happy camper.  It has been 5 days now and no Echocargiogram report or EKG copy in the mail from that "wonderful" cardiologist's office.!!^%##$@!
It only takes a day in the mail as it is all local.

The Gastroenterologist's office have not sent out the EGD
and Biopsy reports of the esophagus, either.

Getting perturbed with both these doctors. I guess I will have to get tough on Monday Morning as my appointment with the new Gastro female doctor is Wednesday morning. She also wants these reports.  

I am really upset that they sure want their money right away but when one needs a report, it is very slow in coming. ~~sigh~~

[Jeff to Rosemary]

Hello,
You mentioned inflamation of the esophagus ?
Reflux may mean more space for gas/food/fluid
and less space for the heart to work .Have this evaluated
better.
Actually the "lite" brand of
Coca Cola is worse as it has less vital calories in its
scanty sugar and puts your heart at a pretty fast pace-total burn out for your heart.
Even caffeine free Coke has some ingredients that
work similarly to caffeine and should be avoided.
Please keep posted with your echo results.

Regards Jeff

[Lauro]

Thanks Jeff,  I LOVE COKE and COFFEE although I do drink the
Light Brand.  I will stay away from these.

I still do not have the ECHO report and hope it is in my mail today.

I also called for my EGD report where the Gastro Doc said I had inflammation in the espohagus and was not concerend.

I see a new GI Female Doc next week and what I hear about her, she is all business, knows her stuff and will not blow you off and will refer, (if she needs) to one she knows is the best. No politics involved.

I will keep you posted.  Hope I can read the report correctly.

Thanks again,

Rosemary

[Jeff to Rosemary]

Well I got my echocardiogram results personaly from the
doctors office-I just hate the bureacracy that is involved.All I know that coronary disease would produce symptoms
on exertion,less likely while at rest.Valve problems could cause
symptoms while at rest and at exertion(depending on the severity of their deterioration which you must know if you have any regurgitation or prolapse ).Actually my cousin has a high degree
of regurgitation of one of her valves.She feels shortness of breath even while horizontaly laying in her bed .She has to acommodate a semi-vertical position.The shortness of breath
is nothing else than lack of oxygen getting to your heart muscle
(ischemia) at some point and it could be caused by several other reasons such as infection ,but the main ones are either valve problems or coronary blockage or narrowing of an artery -if cardiac related at least.Stay away from coffee and Coca Cola
until you get better evaluation.  
Regards Jeff

[Lauro]

Thank You, Jeff.  I do notice the shortness of breath more when I am at rest, i.e. talking, than with what people normally call, everyday activities.

I am one step ahead of you.  This afternoon, I called the Cardiologist office and requested a copy of the Echocardiogram.
I also e-mailed the request, as this is a big practice and god only knows when I may receive it.

I thought about this cardiologist all day and if he had been a nice doctor, I wouldn't be having to ask a physician on the internet my concerns.

Thanks Jeff, for the information and well wishes.  

Happy New Year to you.

[Jeff to Rosemary]

It is good to request a copy of the echo that you
had done Rosemary from the doctors office.
I wouldnt rely on a teenage secretary as to the test
results-you need your own copy.
Shortness of breath -if not exercising- could be related to
Mitral,Tricuspid,Pulmonary,Aortal valve problem also.
All the best
Jeff

[Lauro]

P.S.  I failed to mention that my GP ordered a blood test called Cardiolipin and Complement Protein Quantitation.

Cardiolipin IGG Result was a 2......Normal is 0-15
Cardiolipin IGM Result was 16H......Normal is 0-12
(The IGM was the only elevation in the blood work)
No answers for this.

Is the IGM result a concern for a heart problem?

The Protein Quantitation,Complement C3 was 131.  Normal, 85-200
                         Complement C4 was 28.   Normal, 17-46

Thank You.
Rosemary

[CCF CARDIO MD - DLB]

AN echocardiogram would have evaluated all 4 valves. If it was normal, you do not have a heart valve problem. If the shortness of breath occurs with exertion, coronary artery disease is still a possibility that could be evaluated by a stress test.
Aortic valve replacement has been done safely even in people in their 80s; the recuperation time can take several weeks to a few months though.