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Forum Name: Valvular Heart Diseases

Question: Moderate Mitral Regurgitation?


 seveoneanon - Sun Nov 08, 2009 3:08 am

I am a 24 year old male, about 160lbs, 5'11, in excellent "running shape."

About 10 months ago I started having unexplained, intermittent high blood pressure (it was high, once, at the store or something when I randomly decided to check it on one of those machines. After that, every doctor's appointment revealed high blood pressure.). Most doctors were not at all concerned with it. I attended a police academy and excelled physically: I can run for miles and never really get tired (my shins start hurting of course, but my lungs/heart feel like they can go forever).

About 2 months ago I went to the dentist and, of course, my BP was high. I decided to go to my new PCP (new insurance) and it was high there, too (like 150/100). He put me on a beta blocker. I take my blood pressure obsessively now at home, and over about 100 separate readings it has only twice been over 120/80 (and never above 130/80). 99% of the time it ranges from 90/50 to 111/70. I am suspecting white-coat hypertension, but that's another issue.

I had a stress echo done recently to rule out any secondary hypertension causes. The cardio said I had "trivial" tricuspid (sp?) regurgitation and "moderate" mitral regurgitation. He did not dx me with any sort of disease, and said I did not need antibiotics. He really did not seem concerned, but said for me to get another echo done in a year. These were the results of my echo:

1.) Normal stress echocardiogram with normal hyperdynamic LV response to stress.
2.) Normal LV chamber size and systolic function with an EF estimated at 55-60%
3.) There is moderate mitral and tricuspid regurgitation. Pulmonary artery systolic pressure is within normal range.
4.) There is normal antegrade flow across all cardiac valves.
5.) Resting BP was 118/72; peak blood pressure was 158/76.

I am really worried about the "moderate" mitral regurgitation. If it progresses or requires surgery or whatever, realistically I could lose my job. I am asymptomatic I think... my chest hurts sometimes, but I am sure it is anxiety which I have always had since a child. When I am relaxed my chest never hurts.
 seveoneanon - Mon Nov 09, 2009 11:09 pm

Upon review of his notes, he graded my MR and TR as 2+.
 John Kenyon, CNA - Tue Nov 10, 2009 11:36 pm

User avatar Hi there -- Your echo report came out beautiful. The term "moderate" mitral regurge is such a common notation as to mean very little, and currently nothing is being affected by this. You sound very much like a typical anxious patient, which is just what some of us are dealt as a hand in life, but it can be managed. Often the anxious patient does have a less-than-textbook-perfect exam and this, though extremely common, is productive of more anxiety. You also mention possible White Coat Syndrome, which is very common and seems likely given the story you've provided here. You even mention your "obsessive" checking of blood pressure, which is something which you can render meaningless that way, because our BP varies so much during the course of a day and different emotional states, etc., and trying to achieve an almost laminar charting of it would be self-defeating. Taking it once in a while, at specifice times, is the best way if one must do this at all. Once it appears stable and predictable within certain times and situations, it's then best to just leave it alone unless there is a hint of essential hypertention, in which case it can be checked once in a while to be certain it's not getting high enough to warrant medical management.

Right now the mitral valve is functioning well with "moderate" (may mean negligible) regurge, so all that's required is that it be rechecked on perhaps an annual basis. This is because it was not textbook perfect and could conceivably become more pronounced -- or not. Either way you'll want to know so as to manage it -- or not -- as needed. Chances are excellent it won't progress and many times these findings actually improve or disappear over a year's time, just as mitral valve prolapse (MVP) often shows up on one exam and is not visible the next time. So it's not anything worthy of your concern. The tricuspid valve is totally within nornal limits, and the main thing is your left ventricle is functioning 100% normally, which is the bottom line where heart health is concerned. So long as that's the case you really have no basis for concern. A practical person will follow up a modestly abnormal finding such as the moderate mitral regurge in about one year's time. The only exception would be if there were to be specific and pronounced symptoms suggestive of progressive malfunction, which is extremely rare in the course of a year's time anyway. So all in all your exam was pretty good and if it were me I'd take it and be really pleased.

I hope this is helpful to you. Good luck and please follow up with us here as needed.
 seveoneanon - Sun Nov 15, 2009 5:03 pm

The doctor rated it at "2+" (sorry it took so long to reply, that's how long it took me to decipher his handwriting;))

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