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mild mitral regurgitation

  I'm a 48 years old, female who...15 years ago was diagnosed with MVP by a cardiologist. Yet, a recent echocardiogram report states nothing about MVP but does mention that there is mild regurgitation of the mitral valve.  This did seem to puzzle my new internist.  
  A bit of history...my father had open heart surgery to replace his aorta valve with a pig's valve. and had CHF.  I've been taking Inderal for 15 years because of arrythmias, fast heart beats, and pvc(s).  The daily dosage of 80mg worked fine for 14 years. Last summer after complaining of increasing symptoms of palpitatons and fluttering sensations occurring 8 to 10 times per/hour and the fact that the results of a 24 hour holter monitor revealed regular pvc(s) and arrythmias, my physician felt that it was necessary to increase the daily dosage of Inderal to 120mg.  The increased dosage continues to reduce the symptoms I was feeling significantly.
  I feel I'm in pretty good shape since I walk two to three miles a day without feeling too tired afterwards.  However while walking, I do experience shortness of breath especially on short hills or on slightly elevated stretches.  I prefer walking alone because I often cannot keep up with the pace my friends walk...(I'm too proud to ask them to slow down).  When I'm not walking, I experience palpitations three or four times a day...especially when I'm resting and sitting in a reclining position.
  I can live with these symptoms as long as I know that it's not causing any further damage to the valve or other parts of the heart.  My questions to you Doctor are:  With or without symptoms, is mild mitral regurgitation usually a progressive condition?  Is it coreect to assume that when someone has a valve that leaks there already has been damage done to that valve? Is surgery for repair recommended only after a diagnosis of moderate to severe regurgitation has been made?  Is it unusual or common to have the symptoms I've been having...needing to take 120mg of Inderal a day even if it's only mild mitral regurgitation? Is it possible that because I've been feeling these symptoms all these years that there could something else that's not working well with the heart? How seriously should one interpret the diagnosis of mild mitral regurgitation...does it depend on how much symptoms the patient has or how much damage there is to that valve? Would it be reasonable to ask my internist to refer me to a cardiologist or is an internist trained to know when it would be the right time to refer me?
  Hope it's not too many questions.  Thanks a million for your time and the information.
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Avatar universal

Dear Helen, thank you for your question.  I can understand why you have so many
questions about MVP, MR, and palpitations/PVCs so I hope that I can help.  First,
I suggest that you read previous questions in the forum on these topics and look
at the frequetly asked questions section of the heart forum.  MVP results from
degenerative changes to the mitral valve leaflets.  Mitral regurgitation (MR)
results when the valve leaflets become incompetent and allow blood to leak back
into the left atrium when the left ventricle contracts.  Mitral regurgitation can
progress in severity so once it's detected in someone who has MVP, serial echocardiograms
should be followed (every 6-12 months).  Indications for mitral valve repair
or replacement are severe MR and enlargement of the left ventricular cavity or
deterioration in left ventricular function. Once MR develops, it usually progresses
in severity over time but each patient is different so no specific prediction
can be made about what will happen in your case.
  PVCs or palpitations commonly occur in patients with MVP and can cause symptoms
but are usually not predictive of serious heart disease or a bad prognosis.  Inderal
is a good medication to use to suppress PVCs and the increase in your dose is
appropriate to treat worsening palpitations.  The palpitations and Inderal don't
necessarily relate to the MR nor to the severity of the MR.  They are separate
issues.  I doubt you have any other significant heart disease from what you've
told me.  Your symptoms of shortness of breath with exertion may not signify
any change in your MR, but it's hard to determine for sure in this forum.  I think
it would be good for you to see a cardiologist to get regular follow-up for the
MVP/MR and palpitations.  It may be a good idea for you to have an exercise echo
stress test to evaluate the response of the MR to exercise and to see if the MR worsens
during exercise to explain your symptoms.  Your internist has done a good job
of managing your condition, but it seems reasonable to start seeing a cardiologist
now.  I hope you find this information useful.  
Information provided in the heart forum is for general purposes only.  Specific
diagnoses and therapies can only be provided by your physician.

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