confused about mitral regurgitation

[cindyirene]

I am sooooo confused.

I've had a heart cath (4yrs ago) everything was normal, at least as far as artery disease. A couple of the figures on the report looked abnormal but the report said normal hemodynamics.

Last four years have had attacks, I would become extremely weak, loose my voice etc. The attacks were preceded by and followed by extremely weakness. My doctor would send me to the ER and they would eventually send me home. I got copies of my blood work and the abnormalities would always be elevated hct, elevated RDW, and elevated LDH. I would not be given an explaination for the episodes. I also got copies of the EKG that they did. Apparently I would have sinus tachy too. I noticed on the EKG that I have some changes such as negative QRS when it should have been positive, lost of R wave height , etc. etc. Anyway, these attacks were bad, even though I didn't express it well........one time advanced life support had to cardio convert me while lying on my kitchen floor....


After being with this cardiologist all my life, I decided to change. New doctor sent me to a new cardiologist who ran a echo and said that I have mild mitral regurgitation and that everyone in the world has regurgitation....end of visit. He said they were finding that it was normal to have it. I tried to ask question but this doctor did not allow questions.........I had tried to give him copies of my other reports from the same hospital but he told me he had copies..............he didn't have all of them because when I asked him why my cath said I didn't have any mitral problem, or any problems what so ever, he blew up.

I got a copy of echo report, all figures where high normal, if normal range was say .... to 3.8, my figures would be 3.8. The report said mild mitral valve regurgitation, and left concentric ventricular hypertrophy, yet this cardiologist says normal.......

Now my questions, what comes first mitral regurgitation or mitral prolapse. Does prolapse lead to regurgitation or does regurgitation lead to prolapse?

I also thought one needed antibiotics for dental surgery when yu have valve problems, my GP says they don't recommend them when it is mild regurgitation, they only recommend them for MVP.

What is regurgitation and what causes it. Why didn't it show up on the cath, why would all my figures be high norm. Will those figures go above normal when I do any exercise or any stress. Those echo figures were when I was completely still.....

 

[Mb]

Gosh, girl, I'd get a new cardiologist if I were you. The attacks are not normal. Something must be going on. Good luck!

Marybeth

 

[sylviayasgur]

hi cindyirene!
welcome to this site. it is a wonderful place to get information, support and a lot of hand- holding. the people here are just the best!
first of all, i totally agree with marybeth, get yourself another cardio!!! quick!!! something is obviously wrong and you need to check it out.
there are others here who know more about mitral valve problems, but if i'm not mistaken, mvp (which can be very trivial)
manifests itself as a murmur. i have mvp, and my cardio has to listen very closely to hear the murmur.
regurgitation, from what i understand, is the "back flow" of blood once it gets through the valve.
prolapse, in my case, means that one of the valve's leaflets flaps around a bit wildly, allowing a minimal back-flow (which shows how it is not 100% efficient).
as far as premedicating before dental work, i have strict orders to do so.
i think you should too, from what you've said about your condition.
i hope you find a new cardio before you have another attack. i hope this info helped. chances are, others aren't far behind with more info.
good luck and please come back and keep us posted.
be well, sylvia

 

[Zazzy]

Cindy,
I agree... find another cardio!

I had mild mitral regurg... went on for 10 years before I needed surgery. Now my aortic is leaking (sigh).

I also take antibiotics before any dental cleanings. You don't need them for fillings.

Take care,
Zazzy

P.S. Welcome to the group

 

[Nancy]

Hi Cindy-

For Heaven's sake get another cardiologist pronto. What you have described isn't a normal thing, passed out on the kitchen floor, needing cardioversion!!! You need to find a doctor who is intelligent enough to get to the bottom of things.

Don't hesitate, do it TODAY. And don't even clutter your mind with all your test results, you need a cardiologist who can interpret them, this isn't a "do-it-yourself" project.

You've got some friends here who really care about you, and we tell it like it is.

 

[hensylee]

If you ever find yourself near that dr's office, start running, yelling "Quack, quack, quack". He's awful and he all by himself could give one a heart attack!

There is a site on About.com that you might pose some questions. It is in the "heart disease/cardiology" section (Dr Rich). He has a forum where you can ask questions and he answers. He is an EP, retired from practice, but active in authoring books, speaking at seminars, attending same and is up on ALL the latest in heart matters. He cannot give specific dx or specific individual info but will answer any general question. He would be appalled at your treatment by this other dr. Try going there to get some further general questions and you might give him some of your numbers, as well. wish you luck in your quest for health. Sounds like you truly need some good answers, as there is definitely something wrong, sounds like to me. Cardioversion on your kitchen floor? Not a normal situation, in my humble opinion. Welcome to the site. God bless

 

[cindyirene]

Thank you Marybeth, Sylvia, Zaggy, Nancy and Hensylee.

The attacks certainly were not normal but my doctor said that it was not my heart.

I do have an appointment Wednesday with the Internist and perhaps she will explain where this MVR came from and does a person have to have MVP first in order to have MVR or does MVR lead to MVP.

Thanks again!

 

[McCln]

Cindyirene

Cindyirene

Liste to all the good advice here, gat another cardio doctor as quickly as you can. It can be trying to find one that will be a friend and informs you correctly on your real condition. You need a new doctor. Let us know how the search goes. Hang in there. You will find a good doctor soon.

Caroline
09-13-01
Aortic valve replacement
St judes valve

 

[Mara]

Cindyirene
Get another cardio! You need, at least, a second opinion. Yipes. I'd be scared if I had the "episodes" you describe.

I don't know much about mitral valve regurg. but suffered for 33 years with aortic regurg. as Sylvia said, it's the back wash of the blood that did not make it through the valve on the contraction or beat. You are best off trying to discover the cause of it and getting it fixed rather than treating symptoms. Cardioversion! Yipes that's scary! You have put up with a lot!
Good Luck
-Mara

 

[gary]

Permit me to dissent from the views above, with all due respect.

Permit me to dissent from the views above, with all due respect.

The measurements you list in the high normal range I had for years (and had annually monitored).

From the time I was 5 or 6 years old, I have had troubling measurements but a key one, Ejection Fraction, was always good, 60/65. I contracted my first Rheumatic Fever attack, damaging the Mitral valve and then, when I was 13, another Rheumatic Fever attack that put me in the hospital for a month, further slightly damaging the Mitral Valve, sending it into prolapse, but also damaging the aortic valve. Even with both valves damaged I led a fairly normal life, but the physical activity was limited thruout many decades, not permitted to do the things I can today like 'run' on a treadmill at 130-150 beats per minute for a half hour, for instance. But Surgery was avoided. And of course the advancements were well worth waiting for.

I lived with this condition, annually montiored, for 45 years, Asymptomatic as long as I did not overdue it in exercise, weight gain (I never went over 160 #, at 5'11" tall) or maximum stress (My cardiologist told me then that Extreme amounts of stress can be as damaging as exercise when overweight, perhaps more so). My blood pressure was always low normal.

Only when I experienced a bout of Congestive heart failure in 1999 reflected in the form of lethargy, dyspnea and a sense of something being really wrong, not able to catch my breath when I chose to, was the Catheter prescribed, and proved conclusively that I was just OK with mild activity, but in trouble 'at rest', did they decide to go in. The resting echo and Stress echo while demonstrating the leaks in both valves as they always did, did not reveal the extent of damage, hence the Catheter.

MVP and MVR range in severity. I still have, after the AV was replaced in April 2000, a +1-2 Mitral Valve leak and a mild Mitral Valve prolapse which the Surgeon did not believe was serious enough to tamper with when he replaced the Aortic Valve and he's one of the finest MV repair/replacment surgeons at CCF.

The two conditions, MVP and MVR are different, in that you can have the MVR without the valve being prolapsed. MVR can exist all by itself. And if the MVP and MVR together only cause a minor or trivial leak, lived with for the rest of your life without surgery.
A lot of what your cardiologist, however much of jerk he is, is true.

Hypertrophy can be a natural phenomenon with a leaky Mitral Valve and Aortic Valve. As long as the LV and LA and septum heart walls are not stretched beyond the upper limits of normal, surgery will probably be postponed till the "artist" in the Cardiologist says now is the time. Open Heart Surgery on 'simple' issues, in medium aggressive cardiologists is a last resort.

There may be other issues that the heart problems you have only make worse.

Another opinion by a top heart center like CCF is darned near mandatory.

The Dental protocol has changed a bit regarding Mitral Valve regurgitation, since the valve damage (without MVP) may be congenital, a malformation that is not particularly if at all susceptible to a Strep infection. The reason they have cut back on blanket recommendations of antibiotics for ALL dental work, is that in the aggregate, the population of patients is becoming immune to the administration of too many antibiotics, and therefore the antibiotics fail to protect, resulting in a false sense of security i.e.You may have confidence that Amoxycillin is working when it may not be.

There is a test, I understand, that will prove whether antibiotics will actually work as they promise to. I'm going to have my PCP prescribe it before my next dental appointment.

'Regurgitation' comes about when a valve, any valve, does not close tightly, and the resulting leak usually rated as: 'trivial', +1,2,3,4 (or severe, generally requirind surgery fairly soon depending on other factors such as exceeding, say, the 3.8
you mention.

A 'leak' in the valve can also occur when the valve will not open completely, Stenosis. Both Stenosis and Regurgitation can exist on the same valve. Or any variation on the theme. Stenosis is generally regarded as more alarming because the valve is 'tightening', and could close off. A floppy valve gives you and the cardiologist and surgeon more time to act or not depending on how floppy it is.

I hope this contributes to a bit of piece of mind.

Remember:

"Noah's Ark was built by an amateur
The Titanic by professionals".

 

[cindyirene]

Gary, I finally understand

Gary, I finally understand

Thank you for the very through and understandable explaination.

You mentioned several measurements that are taken into account. The IVSd for me is 1.1 (.7-1.1cm), LVd 5.2 (3.8-5.6cm), LVs is 3.1 (2.2-4.0) and LA 3.7 (1.9-4.0). These are all currently in the normal range so

If ejection fraction is important then I should be ok as my ejection fraction is nice and high, its actually 78% (50-78 norm).

I think you actually answered the reason they had to cardioconvert me. I was in excruciating pain that went from my back thru to my center chest. After they converted me, my pulse was still pretty high, I think it was 178. Perhaps that high pulse was causing the problems. They did say, at the time, I had sinus tachycardia.


You spoke of symptoms, I do have them but perhaps it is as you said..........two problems one making the other worse.

My symptoms are not the same as yours. I loose my voice, severe fatigue and have developed central sleep apneas (not many, 3 in 7 hours) I now become breathless after 4 min on a bicycle and interestingly, activity after bending over will cause me to be breathless. Our symptoms just don't match so I am doublely relieved!

Would you be able to explain two other terms that were used? What is leaflet thickening and what is a left ventricular relaxtion abnormality?

Thank you for the wonderful explaination Gary! I guess my cardiologist just lacks to ability to communicate well with some patients.

I want to thank McCln, Mara and everyone else for their kind and encourging words.

 

[gary]

Leaflet thickening on my Aortic valve was

Leaflet thickening on my Aortic valve was

the result of scar tissue formed after the Strep infections I had at 5 and 13 'ate' parts of the valve and possibly was damaging enough to fuse two of the three leaflets completely turning it into a bicuspid valve, but the jury is out in that they did not do the lab work to determine if I was born with an already bicuspid valve. The two attacks I had lead them in that direction, but I sure wish they had been more thorough in finding that out. It's gone now and they said it looked like a piece of 'white clam' with a slit in the middle, when they removed it.

The scar tissue on the leaflets, which are fairly delicate tissue, then can cause the valve to lose their flexibility at the celular level, not allowing a perfect 'seat and therefore a permanent leak. The valve is 'hinged' on the annulus, a tough ring around the interior Aorta wall from which Aortic valve's 3 (normally) leaflets sprout. Any damage by bacteria that attack the annulus, may leave the the leaflets intact but their 'hinge' is damaged causing both stenosis and regurgitation.

My cardiologists believe my MVR is the result of such an attack on the the posterior leaflet of the Mitral Valve and the resulting leak came about in this fashion.

The relaxation abnormality was noted when I came off of bypass.

The surgeon had hoped for a much stronger surge from my left ventricle when my heart was started again post-op. It did not, n providing a weak below 49 heartbeat for hours after surgery and finally resulting in the pacemaker wire (which all patients get temporarily installed for just this kind of thing among others) being hooked up and sending the heart rate to 80. Talk about a shot in the arm. I thought I finally came back from you know where and recovery from ICU and home in 3 days was right on target.

If the LV relaxes 'abnormally' (it is usually in its Diastole phase, after its Systole or squeeze to empty the chamber), it may fill with too much blood coming via the Left Atrium, thru the Mitral Valve or simply be a bit delayed (an electro-chemical or nerve problem?) in its next phase to Systole.

A Lazy Ventricle is how my surgeon put it, but did not think it was terribly important in my case to warrant more than followup in the annual exam, two of which I have had since April 2000.

In cases of LV hypertrophy over many years, such as I and many others have had, which may permanently render the left ventricle incapable of shrinking from its lifetime of enlargement, to a more natural remodeling to its original shape, earlier intervention is being looked at and performed more and more. It's simply not very good practice to avoid the risks of surgery if when they do so, the Left Ventricle is stretched beyond its ability to 'remember' what it was supposed to be and to do effectively. It may seem optimum to go in when the LV is heading for some real trouble, but the valves and EF are only moderately a problem.

The ability of the heart to compensate or decompensate by changing shape in order to survive, is one of the most interesting things about the circulatory system. I find it fascinating. It is also a primary factor in the Art the timing of Valve replacement .

 

[cindyirene]

Again..

Again..

Gary, Thank you once more!

I am now able to put things in perspective.

cindy