Moderate AR

[SEOULSOUL]

Hello,

I (32)was diagnosed with Moderate AR, When enquired about the finding to the sonographer she said there is some problem in the heart and it is Moderate AR.

I went to the hospital with a near syncope, so there is another test scheduled a month later
And doctor wants to see me only after the scheduled test only.
So I am very worried about this as I don?t know how severe is this? Google search helped me to find some information but still not clear on many things.

My Echo result.
---------------
Chambers :Normal size cardiac chamber
Thickness :Normal thickness
LV Function Systolic: Normal
Diastolic: Normal LV filling pattern
Valve: MV, TV Native /Grossly normal
AV Native/ Slightly thickened RCC tip
Valvular resurgitation: AR GII (others are NO)
Non-RHD Moderate eccentric AR
LVEF 78%

M-Mode/2d Mesurment
--------------------
LVEDD 42 mm
LVESD 23 mm
LVEF 78%
LV Mass 137 g
LV mass index 73 g/m^2
IVSd 10mm
IVSs 15mm
PWd 10mm
PWs 16mm
LA (A-P) 33mm
(M-L) 36mm
(S-I) 53mm
LA Volume 32.mm
LA Vol Index 17.5mm^3/m^2

Doppler Mesurment
----------------
LVOT(TVI) 20cm
LVOT 1.1 m/sec
PHT of AR jet 424msec

I have taken appointment from another hospital but this is also after 8 days. My BP stays near 135/90
Some time comes down to 130/80. I feel pressure/pain in my chest some times(is it ok). Pressure at my left shoulder.
I want to know how serious is this? Is it ok to lift my one year baby? Is it ok to do walking and breathing exercise (Yoga). Do I need to take medication to control BP. As per the previous postings and other site info I understand I may need surgery now, is it possible to estimate by looking at my data how long I will be able to avoid surgery.

I checked the reference normal data for echo but many of the parameters in my echo are not there or differently name so I am not able to interpret.


Thanks
Seoulsoul

 

[SEOULSOUL]

sorry for typo

sorry for typo

As per the previous postings and other site info I understand I may not need surgery now, is it possible to estimate by looking at my data how long I will be able to avoid surgery.

 

[Ross]

Hello SeoulSoul and welcome to the forums.

Heart Echos are funny. No one can really predict when surgery will become necessary, but by the looks of things, you have a ways to go yet. The bad part about it all is that it could remain the same for a very long time or on the other hand, it could get much worse very quickly. There just isn't anyway to guess.

With chest discomfort and near Syncope, I would think they'd want to do further testing, as there may be more going on then what the echo shows. My suggestion is to see this other Doctor, get whatever tests are required and go from there.

Your blood pressure really isn't that bad. I wouldn't see any reason for medications, but that depends on your Doctor. You should be able to lift your baby just fine as long as it's not causing discomfort for you. Likewise with excercise and yoga.

Bear in mind, none of us here are professionals, so feel free to question anything you think may not be right.

Again, welcome to the forums.

 

[tobagotwo]

I'm not a medical professional, so you shouldn't plan your life (or even your weekend) by what I offer here. Some thoughts...

Moderate AR (Aortic Regurgitation) isn't usually enough to bring you to surgery, and by itself doesn't usually cause very much in the way of symptoms.

You aren't showing Left Ventricular Hypertrophy (enlargement), but your EF (ejection fraction) is really quite high, which usually comes as a matched set with LVH. EF is the percent of the blood from your left ventricle that is pushed out into the aorta each time it squeezes. About 60% or 65% would be a more expected percentage.

Are you quite a small person? Your left ventricle could be enlarged in relation to you, without being out of the bounds of "normal" for most people.

Otherwise, the suspicion would be that there's a problem with your heart's stroke (the force of your heart pumping) being too strong or prolonged, which the echo should have picked up. Or the accuracy of the echocardiogram may not be as good as we would like, or the calculation by the technician of your ejection fraction may be off.

You should find out why you have such a high ejection fraction, no matter what the final diagnosis is. If that reading is correct, it's a strong hint that something is wrong.

Healthwise, syncope also goes with being overtired, pregnant, having a reaction to medication, a sudden drop of blood pressure from getting up too fast, and a variety of other, less exotic causes.

As far as heart-related issues, some things to consider would be any blockage of the coronary arteries or the small arteries around the heart, stroke or intracranial bleeding, cardiomyopathy (degenerative heart disease), blockage (pinching) or aneurism of the aorta. These will probably be ruled out very quickly, as they're not very likely.

Offhand, I think the greatest likelihood is that you are overtired or overworked. It's good you have learned about the aortic valve regurgitation at this time, as it does need to be monitored (probably once a year at this point).

I hope it turns out to be something simple for you, and easily remedied.

Best wishes,

 

[SEOULSOUL]

Thanks Ross and tobagotwo for the reply.
I am not a small person as per the Asian standard I am 171/160.
I have consulted with few cardio (though online) they have not mentioned any thing about the high EF. I hope this is some calculation mistake my the sonographer.
The normal value in the test report is 55-76 still then I have a 2% higher than the normal maximum value.

I have an appointment with cardio for a second opinion.

I must appreciate this is forum people with positive attitude, lucky to find and being part of the forum.

Tobagotwo thanks again for your post and research.
Seoulsoul
------------------
Moderate Arotic Regurgitation

 

[tobagotwo]

The Trouble with "Normal"

The Trouble with "Normal"

One of the difficulties in determining the nature and extent of a heart condition is the concept of "normal" as it's used within this part of the medical community. It's logical to agree that a range of dimensions, pressures, and fluid volumes could be considered "normal." It's necessary to have a starting point for determining whether and where something might be going wrong.

The difficulty is that the term "normal" doesn't mean the same thing to everyone to whom it's applied. The early progression of valvular heart disease is largely based on the heart muscle becoming larger (hypertrophy), and the heart squeezing harder (hyperdynamism) to overcome either leakage (regurgitation, insufficiency) or narrowing/blockage (stenosis) of a valve, or both. Unfortunately, "normal" can work against some people, especially if their hearts start off smaller than the middle of the "normal" range. We don't believe that to be your case, but please bear with me to finish the thought.

Those whose heart sizes begin at the top size of the "normal" range will very quickly reach "larger than normal" status as their ventricle begins to become hypertrophic. They'll have an earlier option for corrective surgery, based on their "abnormal" ventricle size. Someone starting at the smallest "normal" size is going to have to develop and live with a great deal of ventricular hypertrophy before their ventricle size is considered abnormally high. This forces the smaller heart to endure much more change and damage before it's deemed to be critical, and raises the odds of permanent damage.

That long-term damage is most likely reflected in enlarged atria, which tend not to return completely to normal size after surgery, some incidental leakages of other valves caused by asymetrical heart shape from the atrial enlargement, and probably in secondary pulmonary hypertension, which may or may not dissipate over time.

The same is true of ejection fractions (EF), and their relationship to the characterization of normalcy. There can be a healthy relationship between ventricular hypertrophy (VH) and EF as well as an unhealthy one. An athlete whose heart undergoes great physical stress develops a certain amount of ventricular hypertrophy and a higher EF as a result of exercising the heart's capacity. This is sometimes called "athlete's heart." It's a benign condition, mostly because when the athelete is not competing, his heart gets to rest, which a heart with a leaking or constricted valve doesn't get to do. It's also often accompanied by a lower pulse rate, as a higher EF means that fewer heartbeats are required to push the same amount of blood. That's not the case with the valve patient's enlarged heart, which continuously struggles to push the needed amount of oxygenated blood into the aorta against obstruction, or to keep it there despite back-leakage.

Over the last few years, cardiologists have raised the bar for "normal" EF, so that everyone who races bicycles on weekends doesn't wind up being categorized as a heart patient. That's good, inthat the doctors are no longer embarrassed by classifying athletes as having abnormal heart function. That's also not good, inthat athletes do have abnormal heart function, at least insofar as it relates to the general population.

If you're a cyclist, and you have a 75% EF, you're likely in excellent shape, with enviable heart function. If you're an average person with a valve issue, and you have an EF of 75%, you usually have VH or hyperdynamic heart function, and you're on the slow, years-long path toward a heart failure cycle. For a person of average physical condition, an EF of 55-65 is a typical range.

Again, the extension of the range of "normal" may cause the doctor not to be as concerned as he probably should be. This may be why the issue of symptoms has become more important for determining when surgery is necessary over the last few years: the other determinants have been watered down to the point where they no longer serve their warning function. Unfortunately, now there are cardiologists who are insisting that surgery should not be performed unless there are symptoms, which patients sometimes deny (even to themselves), misinterpret, or genuinely don't have, despite the grave condition of their hearts.

What does this mean? It means that it's important to get a copy of your health records and test results and keep them safe. You should review them each time you get new test scores, to see the changes in your heart's dimensions and EF. Although most cardiologists don't seem to do it, I believe it's even more important to watch the trends of your heart's development than it is to compare the static results to a scale of normalcy. If your heart size starts near the smaller end of normal, and expands to the top of normal, it's more significant than if it started nearer the top size and expanded only slightly to go out of range. If you see trending, point it out to your physician.

Best wishes,

 

[Der Biermeister]

Bob

 

[SEOULSOUL]

Hi Bob,
I only understand the last para,
May be I will have to read again again
thanks for the reply,
seoulsoul

 

[francie12]

The concept of "normal" as seen on an echo report has been bugging me for a long time. Truly, you have to look at progression from echo to echo to get an accurate picture of what is happening to your individual patient. On a tip-off from one of Bob's previous posts, I'm now watching the atrial dimensions, which are progressing, and the EF, which is high. I'm glad I know to keep an eye on these things. As someone who has blindly trusted doctors in the past, and who would probably have looked at the "normal" values on the report without understanding them in context, I'm glad to know now how crucial it is to be in charge of your own (or your family member's) care.

How true that an LV that starts out small and progresses to large over a longer time is different than one that starts out large and quickly makes it to surgery dimemsions. The first has spent alot more time in a compromised state.

Also, about the atria not returning to normal size as easily after surgery...

Seriously, are most cardiologists understanding these things and watching them with their patients?

 

[Natanni]

Prior to my husbands AVR, his cardio wanted him on a blood pressure medication to keep his BP low to reduce the stress on his regurgitating bicuspid valve. He was on a mild dose of Enalapril for about 7 years. Ideally, they wanted his BP around 110/70. Without medication, his ran 130/80 and as his valve regurtiation got worse, the margins of his BP got wider to about 140/50 shortly before surgery.

 

[SEOULSOUL]

I don't find the value of the root diameter in my report.
There is parameter AOroot (22-33) but the value is left blank for my report.
All other data I have already posted.
Or the diameter is mesured by the chest MRI only not by echo.
Can someone help me to know.

SeoulSoul