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IDCM, mitral and aortic valve regurgitation

  I was diagnosed with Idiopathic Dilated Cardiomyopathy a little over 6 mos. ago.  At the time I also had mild aortic valve regurgitation and severe mitral valve regurgitation.  I was having symptoms of CHF.  I was put on Demadex, Prinivil, Lanoxin and K-Dur.  My condition has gone up and down along with ventricle size and EF.  My EF right now is 38%, I also have hypertrophy.  I am not on Coreg because I have also been recently diagnosed with asthma.  The mitral regurgitation is now moderate according to Echo.  I still have symptoms, but am a little better then when I was first diagnosed and went on medications.  I have been told that valve replacement would not help in my case.
  My questions are: Does valve regurgitation effect EF and prognosis and does the asthma effect prognosis.  From what I understand this disease is progressive and there is no cure.  I also understand that most people diagnosed with this disease very rarely live past five years after diagnosis.  I greatly appreciate you reading and answering my questions and would also appreciate any advise.  Thank you.
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Dear Staci,
When severe mitral and or aortic regurgitation goes untreated for long
periods of time, the valve disease itself can cause the cardiomyopathy (CM), and this
is exactly why we follow patients with valvular regurgitation (either AR, MR, or both)
every 6months to a year, i.e. so that we can repair and or replace the valve
before the cardiomyopathy (CM) sets in.  There is not really an answer as to how much
a patient like you would benefit from repair and or replacement of the severly
leaking valve, BUT that certainly does not keep us from operating on patients like
yourself, who have already developed a CM, especially since some of the
patients do very well, if not better with their valve fixed (mind you there is
a small possibility number one that your CM developed aside from the
leaky valve, and the valve is actually leaky because of the CM.  Also there are
a small percentage of patients with CM and a severly leaky mitral valve that do
worse with repair and or replacement of the mitral valve.)
The prognosis for CHF is poor if untreated; medical treatment improve the
prognosis as does surgical intervention and transplant.  These absolutely
need to be considered in all CHF patients and if these have not been discussed
with you, then it is best you seek a second opinion at a major heart center
that is experienced in valve repair and does heart transplants.
As for the asthma, by keeping you off medications like coreg, yes it affects
your prognosis in a negative manner since coreg greatly benefits those CHF
patients who can tolerate it.
I hope this information is useful. Information provided in the heart forum is for
general purposes only. Only your physician can provided specific diagnoses and therapies.
Feel free to write back with further questions. Good luck!
If you would like to make an appointment at the Cleveland Clinic Heart Center, please
call 1-800-CCF-CARE or inquire online by using the Heart Center website at
www.ccf.org/heartcenter. The Heart Center website contains a directory of the
cardiology staff that can be used to select the physician best suited to address your
cardiac problem.

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