Curious about an Echo I had

[miche31263]

I am a 40yr old female, history of anxiety and panic, with racing heart.  I had 2 holters done 5 and 8 years ago.  They caught 1400 pacs and pvcs with otherwise normal heart on the first one, and the second one showed 52 atrial couplets and 2 brief episodes of svt, (longest 6 beats) otherwise normal study on the second one.   My Dr. tried to refer me to a Cardio, but he told her with my results she could easily treat me with a low dose bb or anxiety med.  I am taking Propanolol and Lexapro right now, and it has helped.  I don't get many bad episodes anymore.  here is my problem-
I recently started having anxiety over my heart again because I had an echo done 8 years ago, and never had a follow up on that.  I was told I didn’t need to and my Dr. does not seem worried but at my request is doing another echo this Friday to calm my mind.
The echo from 8 years ago said - normal chamber dimensions, normal ventricular wall motion.  EF of 69%.  A trace of TR and MR identified, both were physiologic, occurring in early systole only.  The valvular parameters state that there were some myxomatous changes suggested to the mitral leaflets with bowing of both the anterior and posterior leaflet.  In the M-mode analysis, the posterior leaflet did not appear to coapt early in systole.  The anterior on 2D examination appeared to distort but actual diagnostic prolapsed could not be identified  
The end impression was
1. Probably mitral valve prolapsed, mild.
2.  No other abnormality identified.
I read that any mvp and regurgitation with or without myxomatous changes should be followed up yearly, yet my Dr. isn’t worried.  She says she can’t even hear a heart murmur on her stethoscope, and I’ve been with her since the start. Would a beta blocker help or worsen this condition?  I guess I'm just wondering if I"m overreacting and don't need this echo, or if I should have been getting it yearly.  I don't understand what the entire echo means.
Thank You.  Michelle

[Koregol Prabhakar, MD]

Dear miche31263,

Yes it is true that there can be some bowing of MV without qualifying for a MVP. In such cases nothing needs to be done unless you have new cardiac symptoms, or your doctor finds some abnormality on examination.

Your Holter looks quite normal to me. Beta blockers do help patients with MVP and definitely don’t worsen it. But for all the confusion you are going through, it would be worthwhile to get it confirmed by a cardiologist with a 2D ECHO.

Hope that this information helps and hope that you will get better soon.

Thank you for using MedHelp's "Ask an Expert" Service, where we feature some of world's renowned medical experts in their fields. Millions have benefitted from our service to get personalized advice for them and for their loved ones.

Best Regards.
Dr. Prabhakar Koregol

[miche31263]

Well, the Dr. had her nurse call me today.  She said my echo was normal with no evidence of MVP, despite that 8 yrs ago it looked there might have been.  She said no follow up echo is needed in the future unless there are major symptoms.  Not sure what that means.  I have a follow up for next Thursday regarding other health matters but I guess I wish the Dr. herself could have called.  I would have liked to have known a little bit more, as there is more to the echo than that.  (the EF, the regurgitation...) But I guess normal is good lol.  Michelle

[miche31263]

Thank you again.  I will just try to relax and await my Dr's call tommorrow.  I just didn't like seeing at 40 I already have mitral regurgitation, and am not sure how bad it is.  I did read that if it's a trace of regurge, they don't even worry about it, so I'm hoping that's my case.  I wish I had your "what will be, will be" attitude.  Makes a big difference.  Take Care, Michelle

[CrohnieToo]

Maybe it will help for you to know that my mild MVP was first detected and reported by a doctor at Mayo Clinic in Rochester, MN in early 1976. I've been back to Mayo several times thru the years for my Crohn's disease (also Dx'd at Mayo), including for a bowel resection, and while they are aware of that mild MVP Dx Mayo has never deemed it necessary to run any further tests except to listen for it. And BELIEVE me, Mayo is THOROUGH!

[CrohnieToo]

Yes, Miche, as a matter of fact a couple of years ago one of my tests did show some mild regurgiation. And, no, it hasn't concerned me. As I said MVP runs in my dad's family, they are all long-lived. My MVP was discovered back in 1976 and hasn't caused a problem, it took until sometime after 2000 for any mild regurgitation to show up on some test or image so what is to be concerned about?

I am dead set against surgery unless there is absolutely no other option and I am so miserable that surgery sounds better than what I am going thru. My doctors are all aware of that. You have to keep in mind, every surgery creates scar tissue, what they take out they can't put back in. In a matter of mild MVP, mild regurgitation, the risk of surgery is MUCH greater than the risk from the regurgitation. MVP is one of the most common "benign" cardiac abnormalities that occur in humans. No surgeon worth his salt would recommend surgery for MVP unless it was SERIOUS and worth the risk.

Hey, if something I say or have experienced can be of help to you I am only to glad to share. And - I'm one of those "what will be, will be" folks. I prefer not to look for a problem until it BECOMES a problem.

[miche31263]

Thank you so much for your reply.  I know I am going to need to get some type of therapy again for my panic and abnormal response to anxiety.  I started on Lexapro and Xanax (as needed), but as of yet, still having very abnormal panic and anxiety.  I stayed up late again last night reading about a specialist in my area who performs mvp surgeries.  This is how my mind works, I may never need to have my valves replaced, but because they saw a little regurgitation on the echo, I now am convinced it will someday get worse and I will someday have to have surgery, and that scares me to death.  So I sit and worry.  I don't like waiting and watching, but on the other hand, you couldn't get me near a cardiologist right now.  
May I ask if you had regurgitation with your mvp, and if so, why did your Dr. not ever talk to you about a heart valve surgery?  You don't seem upset at all with it...?
Thank you again for talking to me, it is so nice to have someone to talk with.  Michelle

[CrohnieToo]

Miche, MVP runs in my dad's family. He was the youngest of 8 to die (at 79, just a few days shy of 80). I was found to have MVP when I was in my 30s (I'm 69 now). We never bothered to follow up any further on the MVP. I just saw no need to and obviously neither have any of my doctors.

It is only this past year that I have had ANYTHING going "wrong" w/my heart. I developed very mild Atrial fibrillation secondary to (caused by) my COPD (caused by 50+ years of smoking). My A fib has been easily controlled w/Rythmol. I haven't had an episode since my third day on Rythmol. I'm also on coumadin, of course. And Toprol to slow my heart rate down (due to the COPD). We tried Diltiazem first in place of the Toprol but I had a problem w/edema w/the Diltiazem.

If its been 5 years since you've had an echo there's no harm in having another - except your tendency to anxiety and panic attacks. None of us are completely "normal". They can always find some minor thing or things that could even be artifact but they mention just to CTA.  

[miche31263]

I realized that I posted this under Heart Rythym instead of Heart Disorders, I apologize.  I went back in today for an 8 year follow up echo.  The tech said while she can't diagnose anything, she could tell me some things.  She said that there was slight regurgitation on the triscupid and mitral valves.  She acted like that wasn't a very big deal?  She said in regards to the mitral valve prolapse, she just wasn't seeing it, or wasn't sure, because there are new guidelines to what real MVP is, and she said I didn't seem to fit the guidelines, but that there was some slight bowing on the leaflets, but not bad.  So she said we would have to wait to see what the Dr. decides.  So can you have bowing on the leaflets, with mr, and actually not have MVP? Thank you, Michelle