Severe Mitral Regurgitation (3-4+) Concerning?

[Jakrae]

I am an otherwise healthy and in shape 36 year old man.  Over the last few months, I have been experiencing increasing fatigue (all the time), frequent shortness of breath (going up a flight of stairs, walking to the kitchen, laying down) and frequent palpatations.  My mother had a heart attack and was diagnosed with "Hypertrophic obstructive cardiomyopathy" and heart failure.

That combination of my fatigue, breath, and my mothers heart attack led me to see my doctor about it.  I know this was dumb, but my last visit was about three years prior with no issues found.  My new GP (I moved across the country) said that I had a significant murmur and was surprised that no one had told me about it.  He immediately referred me to a cardiologist.

My cardiologist ordered a 24hr holter monitor and an Echo. The echo results were: Severe mitral regurgitation, ASD, and VSD.  I was then sent for a TEE and Right and Left Cath.  These results were a bit different:

"1. Left ventricle was hyperdynamic with an EF of 70% with 3 to 4+
   mitral regurgitation noted.  LVEDP was elevated at 20 mmHg.  There
   was no gradient across aortic valve on pullback."

I'm assuming that between the TEE and the Caths, that is more detailed than the Echo, but in the more recent tests, they said there was no sign of ASD or VSD.

The Cath procedure was done last Friday, 2/23/18, and I was instructed to call the cardiologist office on Monday to set up an appointment.  He told the person that was there with me (I was sleeping through the procedures) that it was severe and surgery would be needed to fix it.  I have called the office daily and left multiple messages, but I am not getting any callbacks. The person with my said that the cardiologist made is sound like it was very important that I meet with him again soon, but it seems that they aren't as concerned about it now.

I think the EF of 70 is good, but the regurgitation is bad.  I believe the elevated LVEDP is bad as well.  I'm quite concerned and a bit afraid of the results, and I'm trying not to worry/stress over it as best I can.  That is why I'm making this post.  Should I be more aggressive in trying to reach the cardiologist office?  Should I find another cardiologist and have records sent there?  or should I just try to be patient, relax, and wait?

[2210485]

You should be both patient and aggressive. You need to be fully informed about your care and your case. You have the right as the patient to know everything and to seek a second opinion if need be.

Unfortunately with valve disease patience is also needed at times. This is a process that takes some time. Challenges exist in creating and executing a care plan, and each plan will be highly customized to your specific health status and requirements. I'll explain.

The MR is serious in your case. As is often the case with STRUCTURAL problems however, underlying cause is initially more important than the severity or condition of the valve itsself.

Checking you over for a blockage in your arteries is a part of the routine fact finding mission. Such a blockage could cause the MR and FIXING the blockage could at least partially reverse it. Throwing a valve in someone who's true problem is a heart attack is going to subject them to unnecessary risk that doesnt actually fix their true problem.

Theres a myriad of other causes that are looked at in the same way. Once all of these 'hidden' causes are ruled out the doctors are left with no choice but to acknowledge that the problem is the valve itself.

If either of the following is true:

1. Correcting the underlying cause does not correct the secondary regurgitation sufficiently.

2. The valve is physically abnormal in some way.

Then a valve replacement may be in the future.

Valve replacements unfortunately carry alot of risk. They are not placed until they absolutely have to be placed and each patient is evaluated on a case by case basis. The cardiologist will recommend followups to keep an eye on the heart; at intervals that he feels are appropriate. If the heart is compensating for the regurg well this may be an annual followup. For others who are perhaos a bit less stable a monthly checkup may be in order.

Once a patient reaches a milestone in which the cardiologist feels they might start getting really sick or the damage to the heart would not recover; they replace the valve.

This ensures that should an accident occur in the procedure (a rare but real scenario), the patient was allowed as much time tl enjoy their life as possible.

Fortunately for you we live in a time when valve replacement technology has advanced **SIGNIFICANTLY** and the risk/ statistics in terms of complication has probably been cut in half vs what we had in the 80's or 90's. (Probably being the term chosen because I don't know the exact statistic off the top of my head.. But its significant for sure)

So yeah, I don't wanna give any illusions that these procedures are entirely safe but I wouldn't stress it either. Chances are good in that scenario. Hopefully this can explain the rationale behind delaying a bit; without freaking you out even more!