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Forum Name: Valvular Heart Diseases

Question: Trace mitral regurgitation and trace tricuspid insufficiency


 grapho - Thu Oct 30, 2008 12:26 am

Hi,

I had an echo in Jan 2002 for shortness of breath, pounding heart, palpitations.

The results were:

Aorta: 2.7 cm(<3.7cm)
L,A 2.7 cm (<4.0cm)
L.A/Ao 1.0 (1.0+.13)
R. Vent 1.8 cm (<2.3cm)
MV SLP -- mm/S (>70mm/S)
MV -- mm
IVSd .8 cm (<1.2cm)
IVSs 1.1cm
LVDd 4.5cm (<5.6cm)
LLVs 3.0 cm
LVPWd .7 cm (<1.2cm
LVPWs 1.2 cm

It was normal with trace mitral regurgitation and trace tricuspid insufficiency.

My symptoms lasted for a very long time, ie; a few years (along with many others involving gastointestinal issues) They would come and go until summer 204 when I got a very bad case of poison ivy and was put on Prednisone and all symptoms went away until now. The racing heart, chest pain, horrible anxiety, pounding chest, shortness of breath have returned over the past month. These episodes always seem to correlate with indigestion and last for months.

I have mild scoliosis, pectus excavatum, flat feet, hypermobility, I have had IBS and GERD intermittently. I am generally healthy, female, 41, 5'5" and 120lbs.
My question is: looking at my echo, can I develop mitral valve prolapse? I have a history of positive ANA (I got very ill in 2001 and my Dr thought I had an autoimmune disease.)

I have had anxiety since I was a teen, my hands are frequently cold and I am very sensitive to things like caffeine, medications, etc. I know this is sort of rambly, I am just throwing it out as I think of it. Could it just be anxiety?
My heart rate goes from very low 60's to high 90s for a long time. I don't have any pain with exercise but I do get out of breath with little exertion. I go up stairs fine but after I get to the top then I am huffing and puffing. I don't smoke but used to. I haven't smoked for 4-5 years. I have been a bit stressed lately.
I sigh a lot as if I can't get a good breath in.
Should I be worried about my heart or the leaky valves progressing into something serious? Thank you.
 John Kenyon, CNA - Thu Oct 30, 2008 8:38 pm

User avatar Hi there -

First, your echo came back looking good. The trace regurgitation in either of those valves is commonly seen in otherwise healthy people. The only reason you might require periodic re-examination is because you sound as though you may have some anatomical markers for possible Marfan's syndrome, a disease of the connective tissue, and so could develop progressive valvular problems such as mitral valve prolapse (MVP), although normally you would already have that at this point in your life.

In general it sounds as though the causes of your symptoms are those that cause them in most otherwise healthy people and they shouldn't be related directly to the very trivial valvular regurgitation you have right now. Such things as GI issues, IBS and GERD can all contribute to the triggering of palpitations (usually premature ventricular contractions -- PVCs -- and sometimes premature atrial contractions -- PACs -- as well). This can be extremely uncomfortable and may be associated with functional symptoms such as you describe, which may be attributable to timing of the premature beats and/or chronic anxiety, the latter being responsible for a lot of ancillary symptoms such as a sense of shortness of breath (usually along with markedly good exercise tolerance). The habit of sighing can actually also not only trigger premature beats but can create a chronic sense of shortness of breath by throwing off too much CO2, the very thing that tells the brain to tell the person to breathe. This results in a lack of stimulus to breathe, which, in cyclical fashion, leaves on feeling one can't breathe properly, leading to more sighing. If you can stay aware of it and try to work at not doing that, eventually you'll find the sense of shortness of breath will tend to go away. It sounds backward, but trust me on this one.

The one thing which I find unusual -- though not necessarily in a bad way -- is the fact that your symptoms subsided when you were given steroids. Usually people who suffer the same symptoms you describe will report they get worse when on steroids. However, there is always the paradoxical effect, and in this case that seems to be what happened. At any rate, it worked to your advantage, which is a good thing.

Because of the anatomical anomalies you have, which are often associated with MVP and other valvular heart problems, you'd do well to have at least an annual echocardiogram, but given your age, it would seem your body has gotten comfortable with the arrangement and is actually doing well. I don't think you have any heart problems at this time, and you may be able to actually help reduce the frequency of palpitations and other anxiety-related symptoms. The outlook would seem to be very good overall.

I hope this is of some help. Best of luck to you, and please do follow up with us as needed.
 grapho - Thu Oct 30, 2008 11:02 pm

Thank you for your in depth response. I will look into all the things you have mentioned and just monitor myself.
 grapho - Thu Oct 30, 2008 11:24 pm

I just wanted to say, I am pretty sure I don't have Marfan Syndrome. I believe my mild scoliosis is from one leg being shorter than the other (car accident), my pectus excavatum is very mild, not noticeable except on x-ray, and I am very tiny and don't have any other physical markers or symptoms that of course I just went and looked up. I am also not generally fatigued after exercising either. In fact I generally feel better when moving around. Thanks.

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