Valve regurgitation and long-distance running

[Guest]

I'm 28, 186 cm, 77 kg, max pulse 194, rest – 50 bpm. Got rheumatic heart disease in my childhood and now have fibrosis of the aortic valve with regurgitation (1-2), mitral valve prolapse with regurgitation (1-2) and tricuspid valve regurgitation (1).
1 year ago I gave up smoking and started endurance running. Since then I completed several 10k races and one half-marathon. My average weekly training plan includes 50k of running (5 days) with 80% done on pulse below 154-152 and only 20% done at pulse about 175-179 bpm. Also twice a week I try to do 40-minute workouts like planks, pushups and so on (with my bodyweight).
Last week I visited a doctor and here are the changes for the last year (before|after):
- Rest pulse (70 bpm|50 bpm)
- No changes in regurgitation status (aortic regurgitation LVOT 19%);
- Aorta diameter (34 mm|34 mm);
- Left ventricle (LV diastolic diameter 54mm|58mm, LV diastolic volume 142ml|167ml, LV systolic volume 39ml|57ml, Ejection fraction 72%|65%);
- Left Ventricular Mass (LV mass/BSA 93g/m2| 114 g/m2, Septal thickness 0.93 cm|1.0-1.1 cm, Posterior wall thickness 0.93 cm|1.0 cm);
- Left atrium size (35 mm| 32mm, 33/41 mm | 41/47 mm).
Since I started running, I lost about 8 kg, my blood pressure decreased from 140/90 to 130-125/70-65.
The doctor looked at the results and told me to limit physical activity (running), because it can lead to heart failure in future. Could he be over-cautious? Because it was just a cardiologist, not a sports cardiologist or physiotherapist. Could the changes in my LV be the result of the physiological, not the pathological change? Or it's the result of the cumulative effect of the aortic and mitral valve leakage? Next year I would like to finish my first marathon but now I don't know whether I should keep running. Could you express your opinion on this issue?
Thank you very much for the answer!

 

[dornole]

I have rheumatic heart disease also. I have mod-severe mitral regurgitation (3+) and some mitral stenosis, and my cardiologist says I can do anything I feel good doing. I've done a little running (about 10 miles a week) and a sprint triathlon and lift light weights and that's plenty for me. If you are attached to running, I'd press your cardiologist for more details about what "limit" means and why he's saying that. Does he think you can delay surgery that way? Avoid it entirely? Would your working with cardiac rehab make him more comfortable?

Prior to mitral valve repair (in 2002), I did develop congestive heart failure due to severe mitral stenosis. This was definitely a gradual rather than a sudden death process. I think that's important info for you to get from your doc - are you at risk for an acute, sudden, fatal problem, or for a slow degeneration? If you are going to keep running, what should you watch for? Does he maybe want to see if the changes reverse if you are less active? When are you going back for another echo? Still a year? Or sooner?

There are many very active folks on here who may have more to add, but not so many RHD or mitral folks so I thought I'd share what I could. Best of luck to you.

 

[AZ Don]

I have moderate aortic valve regurgitation and my cardiologist told me that I could exercise how I like with the understanding that I am not planning to do any competitive sports (my surgeon said the same after my valve sparing aortic aneurysm repair). I'm 54 and less competitive than I was in my 20's so not a problem for me. My Dr. specifically said not to do something like the rim to rim run (20 mile run down and back up the Grand Canyon) which I would compare to a marathon, but he did say that in general exercise was beneficial and that it would actually make it easier to identify symptoms indicating my valve is due to be replaced - something now considered inevitable.

Dr's vary widely in their views on exercise but you want to be careful when you have a condition that may be causing your heart to enlarge. I can't say what caused your heart to increase in size but I highly doubt that exercise would make your heart less efficient (lower ejection fraction), so I would suspect the other changes are due to your valves. In any case, I wouldn't recommend intense exercise without clear approval from a good cardiologist.

 

[Capizzi]

I was very clear what I was doing with my cardiologist. If your cardiologist does not understand how intense your workouts/races are, then you probably need a different cardiologist or bring him heart monitor data from your races/workouts. My primary care doctor knew her limitations, when I first raised the issue, and I was lucky enough to be referred to a cardiologist who was a cyclist. This paid off after years of monitoring, so that when I had mitral repair (at 51 yrs) they gave me a valve capable of handling a lot of stress, doing everything they could to avoid replacement and blood thinners.
I was 24 yrs old when I became very symptomatic. I could not train at the intensity required to really be competitive any more, but switched to long distance running/cycling. I had to be cautious to avoid getting over a max heart rate, stay hydrated, and reduce overall stress. Eventually there was a danger of atrial fib given how many post-ventricular events I was having, and my cardiologist knew I was going to ignore all of this during a race or mountain climbing -- surgical outcomes are much worse after your electronics go seriously wrong. I was told my heart did not exhibit any structural or electrical problem that would lead to A-fib or heart attack, so I was not particularly afraid of dropping dead. There was a point where my pathology and lack of self control (or called it active lifestyle) resulted in my cardiologist recommending immediate surgery, after 25 years of monitoring. I cannot respond to your LV changes, but I was particularly concerned about reduction in volume due to thickening of the ventricular wall and subsequent reduction in ejection fraction. I wanted to be on the front end of that problem. High intensity workouts and endurance events/training with insufficient rest will eventually make your valves worse, but living longer is going to do that too.