Help please if you can.

[Steph]

Greetings everyone. I am here to ask you all for some help. I am a 43 year old female with mod-severe MR. No other problems or symptoms other than starting to slow down a little. Some times I think it is heart related, some times just age related. It is hard to tell. My last stress test did not go very well and regurgitation has gotten worse. With your help I found out about the TEE and a logical next step and my cardio agreed. (He had planned to do the cath-I felt that it was too invasive for the stage of my condition.)

We went forward with the TEE a couple of weeks ago. The Dr. that preformed to test said that all look good. At least that is what I thought I heard.

Friday night my cardio called me and said that we need to sit down and review my results. I reminded him that I have a follow up appt. on the books for January. His response was that we could not wait that long to talk. I also mentioned that the Dr. that did the test said that all looked good. He said ?I think they had you really doped up!? His final words to me were that he wanted me to call first thing Monday and make a follow up appt and have his nurse copy the report for me so that I can review what it says. He wanted to be able to prepare for the meeting and right down any questions that I have. As you can imagine I spend the weekend a nervous wreck!!! I have not slept well since and could not wait to pick up the report.

Well first thing this morning I got my hands on the report. I was so afraid to read it but after I did I was VERY confused. I do not see anything on the report that looks alarming at all. I was hoping that someone here could help me to understand what is on the report and what it means. At this time I could not come up with any question for him other than ?WHY DO YOU WANT TO SEE ME?! Here is what it says:

Summary:
1. There was mild thickening of the mitral valve involving the anterior and posterior leaflets. No echocardiographic evidence for mirtal valve prolapse. There was moderate to severe mitral valvular regurgitation. There were TWO central mitral regurgitant jets.
2. Overall left ventricular systolic function was normal. Left ventricular ejection fraction was estimated in the range of 55% to 65%. There was no diagnostic evidence of left ventricular regional wall motion abnormalities.

Study Findings:
Mitral valve: There was mild thickening of the mitral valve involving the anterior and posterior leaflets. No echocardiographic evidence for mirtal valve prolapse. There was normal mitral valve leaflet excursion. There was no evidence for mitral valvular vegetation. There was no evidence for mitral stenosis. There was mod to severe mitral valvular regurgitation. There were two central mitral regurgitant jets.
Left Ventricle: size was normal. Systolic function normal. There was no diagnostic evidence of left ventricular regional wall notion abnormalities.

Well that is it. I hope someone can read this and make heads or tails of what the problem is (if there is a problem). I will also be looking things up on the web to see if I can find out why he sounded so alarmed. Thanks so much for your help here. You have all taught me so much and I really appreciate it.

Steph

P.S. My dog Zeus got onto my computer last night during your chat. Hope he behaved himself.

 

[Mary]

Steph,
I know zip about mitral valve reports, but I imagine it's the moderate/severe regurgitation that he is concerned about.
Other's will be along shortly, I imagine, to offer more input, but that's my two cents!

 

[Steph]

WOW !!! Sorry about all the type-o's!! I really made a mess of that post.

Thanks for your reply Mary. I am afraid that my Mod-Severe MR is no suprise though. We found that out last July. The only thing that was new here was the mild thickening of the mitral valve, and the two central mitral regurgitant jets, (however, I do not know how many you want, two could be fine.) My ejection fraction has not changed in 2 years.

Steph

 

[Phyllis]

Steph, this guidline found in the research thread may help understand when surgical intervention is necessary: http://www.emexcardio.org/artikel_apicon1.htm

Hope this helps!

 

[catwoman]

I am a 43 year old female with mod-severe MR. No other problems or symptoms other than starting to slow down a little. Some times I think it is heart related, some times just age related. It is hard to tell. My last stress test did not go very well and regurgitation has gotten worse.

Steph:

You've pretty much answered the question yourself. Age-related at 43? Shoot, no!
Been there, done that. At age 50-52, I had written off my increasing fatigue as being "age-related," too. Until I was too fatigued to get out of bed -- on a vacation day! I had MVR surgery a month before turning 53.
I can burn the candle at both ends again -- and in the middle. However, I've learned to pace myself better.

Better to get this looked into NOW rather than January.

I do know how you feel right now -- many of us have been in your shoes.

 

[Ross]

He's concerned with the thickening and regurg. Better to get you taken care of now, then to wait for the heart to enlarge and risk further damage.

 

[tobagotwo]

The report certainly didn't sound like it couldn't wait for January. You were moderate-to-severe regurgitation, which needs to be monitored, but there was no unusual ventricular wall movement, and the heart was still normal in size (although the standard for "normal size" can leave some leeway).

The "slowing down" is not age related at 43. Nor at 53, folks. That is a symptom.

However, unless he's thinking that the thickening will reduce the chance for a repair, I'm not sure what the rush is. Maybe he was standing too close when they administered your drugs for the TEE...

Best wishes,

 

[susieq14]

Hello Steph,
you poor thing! - what a weekend you must have had filled with worry! So when is your new follow-up appointment with your cardiologist? I hope that you were able to get one sooner rather than later. I read an ealrier post of yours and see where not too recently your cardiologist was too busy to explain to you about your need for a cath and now he put the fear of God in you over the weekend. Are you really satisfied with him? I hope so! Although I have the same valve problem as you I'm not that knowledgeable to offer an opinion as to what he is thinking. The only thing I would ask is if you have copies of the actual measurments from this test and past echos. When I asked my cardio which number he was watching to determine when a referral to a surgeon was needed, he said "the left ventricular systolic dimension". Has yours changed dramatically? I do hope that you get some answers from him soon and I wish you all the best.

Take Care!
Susie

 

[maka]

Hi Steph
I think you should be very happy to have a doctor that cares enough about you to call you and make a short notice appointment to discuss the result of the test with you. I believe the concern is the "severe mitral regurgitation". I had mitral valvel repair last year and did not have any sympton (sp?) but for the "severe regurgitation" The cardio wanted to make sure that it the problem was taken care early enough to avoid irreperable damage to the heart. At 40ish you are well toooooooooooooo young to be tired
You can always make an appointment with another doctor for a second opinion.

 

[Steph]

Thank you all for your replies!! I really appreciate it. I do think (hope) my condition is still at the point that we just watch and wait. Maybe the thickening does have him concerned, like you suggested Ross. My cardio has never talked to me about surgery. He has always said that I can live with this for a VERY long time without any problems. Maybe this took him by surprise.

Suzieq14, your response was very kind, thank you. I am afraid that the next appointment I could get was November 28. My cardio is very busy (not a bad thing, he is considered one of the best), but I am having a very difficult time with that. I have the name of another cardio that I am going to make an appointment with for a second opinion. Maybe he will be able to see me soon. You asked about my measurements. They are all within ?Adult normal ranges? though the LVIDs did jump up a bit to 31 with (25-35 normal).

This brings up a question that I have for all of the women heart patients on the forum.
All of the reports that I have seen have a standard range called ?Adult normal ranges?. Are there any gender specific ranges available? It has been medically proven that women and men have different size hearts, but I can not find anything that shows gender specific measurements. Shouldn?t there be some?? Just curious.

Maka, you are right I am happy that my cardio cares enough to call. Sometimes he is to quiet about what is his thinking though and doe not like to discuss anything on the phone. I can be a very impatient person. I would probably do well to have more patients and trust in his judgment.

Thanks again for all of your help.

Steph

 

[LindaVA]

Steph- Hi we are in the same boat

Steph- Hi we are in the same boat

I'm new too- see my post this morning Nov 8th... I also have thickening, etc.

Linda

 

[CathyK.]

Steph - about your gender question, my last visit with my Card - he stated normal range but then said that since I am very small that normal would be a little big for me so he takes that into consideration.

 

[Georgia]

Steph, you're definitely symptomatic. Please understand that if your cardiologist is running the flag up on this then there's reason for concern. Cardios tend to be conservative about surgery.

You should NOT be slowing down. These symptoms are the sneakiest things - just a LITTLE harder to climb stairs; need a little more sleep; can't walk quite as far; need an extra pillow at night; on and on. You're very lucky to have a card who's being aggressive. I was in the group who's doc missed my worsening condition, and was incredibly deconditioned by the time I had surgery.

You don't want damage to your heart; better to get it all taken care of as soon as the docs say you can.

Hang in there.

 

[davidfortune]

Steph,

It is best to get the valve repaired (if necessary) at the Appropriate time. Too soon and you have intervened before required and may require another intervention later in life. Too late and you have done irreversable damage to your heart.

When is the appropriate time? That's the $100,000 question. If there is significant change in left side dimensions then that is definitely an indicator for surgery. Increasing symptoms (they can be deceptively subtile as mentioned before) is another indicator for surgery.

Ask your cardio his reason for concern. If he can't explain it to you in a way you understand then I would find another cardio. Ask him what criteria he is using to judge timing on surgery.

Get a second opinion. I think this is always mandatory. Another cardio may communicate better and may have different opinions.

Meet with a surgeon. Ask him the same questions. Just talking with him doesn't obligate you to have him cutting.

Heart size does vary so the real criteria is your measurements vs. your previous measurements.

Good luck.