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Forum Name: Valvular Heart Diseases

Question: Echocardiogram results: EF (m-mode) Tricuspid-Aortic regurge


 gabby - Fri Feb 07, 2003 10:48 pm

Hello Doctor,

This is my very first post. I just got the results of an echo that was performed in Dec. I am former Fen Phen user. :(

The measurements on my report are EF (m-mode) 64% Which I understand is good.

The appearance of all four valves is normal however, I have moderate aortic regurge. My measurements are AI 2+ AI 31% I have Moderate 2+ Tricuspid Valve Regurge according to the echo report.

I have moderate Pulmonary Hypertension with an estimated pap at 46 according to the report.

My question is, is the report kind of iffy, or does it indicate that I should be under doctor's care right away. This echo was done at my lawyer's office.

I don't have medical insurance or money out of pocket to pay for doctors or tests. So I wonder by the results of this echo how assertive I need to be to see a doctor.

I do understand that I would need more tests to get a definative answer, about the pulmonary hypertension matter.

Thank you so much for this forum. What a blessing!

Gabby
 Dr. Yasser Mokhtar - Sun Feb 09, 2003 2:48 pm

User avatar Dear Gabby,

Thank you very much for using our website and welcome.

Using fen/phen combination was found to be associated with problems with the heart valves in the form of aortic, mitral and tricuspid involvement (less than aortic and mitral valve though).

In most of the patients, it was found that the lesions of the valves become stable and even regress.

Your echocardiogram shows that you have aortic regurge, pulmonary hypertension and tricuspid regurge.

The cause of aortic regurge could very well be caused by the fen/phen combination. In aortic regurge the ejection fraction is affected very late. The important things on the echo (in addition to the ejection fraction that they mentionned) are quantification of the regurge (and i assume that they did that based on the degree of regurge that they mentionned on the report) and the second thing is the size of the left ventricle which you did not mention in your message but that i am sure is present in your report. If the size is bigger than normal then most probably unless you have another disease that could affect the heart like coronary disease or others then this means that the aortic regurge is affecting your heart.

The tricuspid regurge could be because of the pulmonary hypertension
Pulmonary hypertension in itself can be caused by many causes.

My advice to you is to be under medical supervision. If you have any sypmtoms, you should be seeing a doctor the sooner the better because aortic regurge has to be treated by medications. These symptoms actually you might already have some of them like shortness of breath on exertion, some swelling of your ankles, some headaches and low energy levels.

In addition, if you are about to have any invasive medical procedure including but not limited to dental procedures, you have to take antibiotics before any of these procedures to protect posible infection of the valve if bacteria reaches the blood by any chance. In addition you have to have follow-up of your aortic regurge by echocardiogram every 6-12 months to make sure it is not progressing. Also, the cause of pulmonary hypertension has to be investigated and found and treated if possible to decrease the chance of progression of the pulmonary hypertension.

Once more, thank you very much for using our website http://doctorslounge.com and i hope you find this information helpful and waiting for your update.

Yasser Mokhtar, M.D.
 Anonymous - Sun Feb 09, 2003 3:53 pm

Hello again Doctor,

I am sorry that I didn't mention the Left Ventricle function, which is normal at this point. I am having symptoms. I have swelling in my ankles and my calves get hard as a rock, but I attributed that to sitting at my computer for long periods of time.

I have complete tiredness, and am sleepy much of the time during the day. A sleep study was performed a few years ago, that was basically uneventful, so the doctor I had at the time said I didn't have sleep apnea. So I take naps that leave me feeling refreshed for a short while. I am having breathing difficulties, especially with climbing stairs and fast walking. My chest feels tight, and when I am lying down and turn to lay on my left side, my heart just pounds. I do have headaches more frequently also.

Pre Fen Phen I had no heart murmer, because I was given an EKG, before being treated with Fen Phen. Post Fen Phen use, I was found to have a systolic ejection murmer which was put on my report at the time, which would be spring 1997, as probably benign.

In Oct. of last year I had an asthmatic like episode, that sent me to a clinic to see an FNP. She said I had very little air circulating in my lungs. When she had me breath deeply I got very faint. She thought it was an asthma attack, but I have never had asthma in my life, and there is no family history of it either, but what I learned Doctor, from other women who have been diagnosed with Pulmonary Hypertension, is that most of them were diagnosed with Asthma to start with, before they had further testing to determine that they indeed had Pulmonary Hypertension.

I will be calling my state's Department Of Social Services, to see if I can qualify for some sort of medical coverage. I hope so!

Thank you so much for replying to my post. It was a great help to me. :)

Gabby
 Dr. Yasser Mokhtar - Sun Feb 09, 2003 6:40 pm

User avatar Dear Gabby,

You mentionned the function of the left ventricle in your previous reply. i meant someting else, the size of the left ventricle, is it enlarged or normal.

Regarding the symptoms that you have, they could be because of physical unftiness, obesity itself, your heart condition or an undiagnosed lung condition.

Lung conditions that can give rise to pulmonary hypertension are many and here are some few examples:
1. Emphysema (in cases of smokers). Are you a smoker?
2. Repeated blood clots of the lungs.
3. Fibrosis of the lungs.
4. Prolonged severe asthma.
5. Sometimes pulmonary hypertension is found and a reason is not found for it and is then termed primary pulmonary hypertension.
6. Sleep apnea.

You have to be medically evaluated in order to determine where is the origin of your symptoms and then treated accordingly.

Once more, thank you very much for using our website http://doctorslounge.com and i hope that this information helped and waiting for your update.

Yasser Mokhtar, M.D.
 Anonymous - Sun Feb 09, 2003 11:24 pm

Hello again,

My echo reports these measurements.

LA 30

Ao 27

LVEDD 40

LVESD 29

IVS 13

PW 12

LA 2D

LA 50 -length

RV 24


Is this what you mean by SIZE of Left Ventricle?

Regards,
Gabby
 Anonymous - Sun Feb 09, 2003 11:28 pm

I am not a smoker and a previous sleep study as I mentioned before revealed I don't have sleep apnea. So like you said it could be that obesity and being unfit are the cause of my symptoms.

Regards,
Gabby
 Dr. Yasser Mokhtar - Sun Feb 09, 2003 11:47 pm

User avatar Dear Gabby,

Thank you very much for using our website.

Yes, this is what i meant about the size.

The size of your left ventricle is normal. Though, the thickness of the posterior wall of the heart and of the septum between the two ventricles is a little bit over the limit and this means that there is a strain or pressure against which the heart is pumping which usually means that the person has high blood pressure (you did not mention anything about it) or aortic stenosis (you have regurge as you mentionned).

About sleep apnea, it can develop at any time especially if you have not lost weight. And it is a good thing that you do not smoke (unless you were in the past).

Once more, thank you very much for using our website http://doctorslounge.com and good luck and please, do not hesitate to post any more concerns.

Yasser Mokhtar, M.D.
 Anonymous - Mon Feb 10, 2003 12:58 am

Yes I was found to have high blood pressure in 1996 and have been on medication every since, which I take regularly, and no I have not ever smoked. I am glad to hear that the size of my left ventrical is normal. Will weight loss, also mean I will no longer have sleep apnea, if indeed I do have it?

Regards,
Gabby :D
 Dr. Yasser Mokhtar - Mon Feb 10, 2003 8:58 am

User avatar Dear Gabby,

If you have sleep apnea, some times losing weight helps but there are people who are really not that obese and have sleep apnea and people who are very obese and do not have sleep apnea. The thing that was found to be most consistant though was the neck circumference, meaning the thinckness of the neck. So, it depends on how thick is your neck.

There are several treatment modalities for sleep apnea but the most widely used one is a mask called cpap mask.

Thank you very much for using our website http://doctorslounge.com and i hope that this information helped.

Yasser Mokhtar, M.D.

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