Mitral Regurgitation is basically a leaky mitral valve. It’s also known as mitral valve regurgitation, mitral insufficiency or just MR for short. Look at the image of the mitral valve below. The mitral valve separates the top and bottom of the left side of the heart (the main pumping chamber). Usually, the mitral valve stops blood from going backwards and keeps blood going forwards to the body where it is needed. In mitral regurgitation, blood is allowed to leak backwards into the upper chamber of the heart.
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How common is Mitral Regurgitation?
Mitral regurgitation becomes more common with age. This is because of age-related wear and tear of the valve. In the population as a whole around 2% of people have at least moderate mitral regurgitation. In those younger than 40 years of age, it is likely only around 0.5% and in those over 75 years of age it likely approaches 10%. Of course, these estimates are only for moderate or more mitral regurgitation and based on the US population. If we include mild mitral regurgitation this number would be much greater.
Different Types of Mitral Regurgitation
Imagine the valve to be like a double door of a closet, where both doors meet in the middle. If it closes properly blood won’t go backwards, if it doesn’t close properly then blood will leak backwards. Mitral regurgitation can be classed as primary or secondary. In primary mitral regurgitation, there is a problem with the valve itself (like one of the closet doors being defective). In secondary mitral regurgitation, there is a problem with the structures that surround the valve (like the door frame being too big so the doors don’t meet in the middle leaving a gap). In secondary MR often an enlarged heart leads to the valve not being able to meet in the middle.
Trivial, Mild, Moderate, Severe and Torrential Mitral Regurgitation
Based on information from the ultrasound scan of the heart (echocardiogram) the mitral regurgitation can be classified according to its severity.
- Trivial mitral regurgitation is an essentially normal finding and of no concern.
- For moderate and greater mitral regurgitation, there are several features of the heart scan that are taken together to determine the severity.
- In moderate mitral regurgitation around 30% of the blood in the heart is leaking backwards.
- In severe mitral regurgitation about 50% of blood in the heart is leaking backward.
- In torrential mitral regurgitation the majority of the blood is going backwards, this happens in conditions such as flail leaflet.
Causes of Mitral Regurgitation
As explained above, there is primary mitral regurgitation where the valve leaflets are affected and there is secondary mitral regurgitation where the structures holding the valve in place are affected.
Primary mitral regurgitation where the valve leaflets are affected.
- Mitral Valve Prolapse. The most common cause in the US is mitral valve prolapse. In mitral valve prolapse, the leaflets become thickened and spongy and if severe can lead to leakiness through the valve. Click here for a detailed article regarding mitral valve prolapse and regurgitation.
- Chord Rupture. Sometimes the chords, which are the strings holding the valve in place, can snap rendering that part of the valve ineffective. A rupture of a large chord can lead to a condition known as flail leaflet, leading to torrential mitral regurgitation, described here in detail.
- Mitral Valve Endocarditis. Endocarditis is an infection within the valve that directly destroys the valve tissue. This basically leads to a hole being eaten out of the valve and the leak occurs through the hole.
- Rheumatic Fever. This starts with a strep throat infection and years later can lead to damaging the valve due to a reaction in the body that causes it to attack its own valve. This used to be the most common cause in the US although it has now significantly declined due to early treatment of strep infections. Rheumatic heart disease still remains one of the most common causes of mitral valve disease in developing countries. Rheumatic heart disease leads to hardening and limited function of the mitral valve and can cause both narrowing and regurgitation so the valve is too tight and also too leaky!
- Valve Calcification. As we age there can be degeneration of the heart valves, similar to the way in which joints degenerate. In some cases, this degeneration can deform valve leaflets and interfere with valve function leading to regurgitation.
- Drugs. Although much less common now, there have been drugs used in the past, such as weight loss, or migraine headache medications that were found to cause damage to the valve leaflets. These drugs are ergot alkaloids (methysergide and ergotamine), ergot-derived dopaminergic agonists (such as pergolide and cabergoline) and drugs metabolized into norfenfluramine (such as fenfluramine, dexfenfluramine and benfluorex).
Secondary Mitral Regurgitation, also known as Functional Mitral Regurgitation where the structures holding the valve in place are affected.
- Heart failure / Cardiomyopathy. In some conditions that lead to heart failure the heart enlarges and the heart function decreases. The heart can sometimes enlarge so much that the mitral valve leaflets cannot meet in the middle and allow blood to leak backwards.
- Coronary Artery Disease. The coronary arteries supply blood to the heart muscle, including the muscles that control the function of the mitral valve. If the blockages are severe then the heart muscle can fail and lead to a process called remodeling. This remodeling of the heart can distort the mitral valve and lead to malfunction and regurgitation.
- Heart Attack Complication – There are two large muscles in the heart known as papillary muscles that are each associated with one of the mitral valve leaflets. In a heart attack, the blood supply to these muscles can be compromised causing dysfunction and valve regurgitation. Rarely the heart attack can lead to rupture of one of these papillary muscles and basically leave one of the mitral valve leaflets free hanging leading to torrential mitral regurgitation.
- Hypertrophic Cardiomyopathy – In this condition there is a severe thickening of the heart muscle. This can often lead to very turbulent flow in the heart that actually leads to distortion of the mitral valve with every beat and can be associated with significant mitral regurgitation.
Risk Factors for Mitral Regurgitation
A lot of the risk factors for mitral regurgitation are related to the causes above.
- Age is the most obvious risk factor; the elderly are at highest risk.
- Those with a history of mitral valve prolapse and regurgitation are at risk of their disease progressing, The higher the degree of mitral regurgitation the more likely it is to progress.
- Normal cardiovascular risk factors such as blood pressure and cholesterol may be important as they can lead to coronary artery disease and heart failure which in turn is associated with heart enlargement which can lead to mitral regurgitation.
- Intravenous drug use increases the risk of endocarditis, an infection in the heart that can damage the valve and lead to regurgitation.
- Certain genetic diseases such as congenital heart disease in which people can be born with defective mitral valves or hypertrophic cardiomyopathy can lead to an increased chance of significant mitral regurgitation.
How Does the Heart Handle Mitral Regurgitation
In mitral regurgitation, blood is leaking from the bottom chamber of the heart back to the top chamber of the heart. It’s important to realize that all this blood still has to go forward into the bottom heart with the next beat. So basically in mitral regurgitation the heart has to handle more blood. We call this volume overload. They way the heart handles this extra blood is to grow larger to be able to handle the increased volume of blood. The process of enlargement is known as adaptive remodeling. This is both good and bad. It’s good because it allows the heart to handle the extra blood so despite the leakiness, enough blood still goes forward to the body where it is needed. Unfortunately in the process of enlargement the heart muscle becomes weaker over time and eventually fails if not treated in time. That becomes all the more important in the treatment of severe mitral regurgitation. To complicate matters even further, the leakiness allows the pumping function of the heart to appear higher than it actually is. For this reason, it’s important to keep a very close eye on how the heart is pumping when there are moderate or greater amounts of mitral regurgitation.
Symptoms of Mitral Regurgitation
Acute Mitral Regurgitation. Rarely, people present with severe mitral regurgitation that happens all of a sudden. Such as in chordal rupture or papillary muscle rupture. This is known as acute severe mitral regurgitation and is a medical emergency. Patients with acute severe mitral regurgitation will present with:
- Low blood pressure
- Shortness of breath
- Dizziness
- Passing out
- Acute severe mitral regurgitation is life threatening and needs to be treated almost immediately.
Chronic Severe Mitral Regurgitation. This is much more common and basically means the disease is present for years and typically progresses slowly. Valve disease is usually clinically silent for many years and may only be picked up by the presence of a murmur. This is because as described above the heart adapts to mitral regurgitation by growing larger. Ultimately, however, in severe disease, the heart fails and the following symptoms may be present.
- Fatigue
- Shortness of breath
- Decreased exercise tolerance
- Leg swelling
- Irregular heart beat
Tests and Diagnosis of Mitral Regurgitation
Auscultation
This is listening with a stethoscope. In mitral regurgitation, there will be a murmur that lasts throughout the whole of the pumping phase. This is the noise made by the blood leaking backward. It is known as a pan-systolic murmur, or sometimes a late-systolic murmur.
EKG Heart Tracing
- This is not the best test for diagnosis of mitral regurgitation but may give some clues as to the effect on the heart.
- In severe mitral regurgitation, there may be an irregular heartbeat known as atrial fibrillation; this can be picked up on the EKG.
- Enlargement of the top and bottom chambers of the heart may be seen in chronic severe mitral regurgitation. Up to 50% of patients will have EKG evidence of left ventricular chamber enlargement known as hypertrophy.
Chest X-Ray
This is not particularly useful, however, a chest x-ray may show signs of congestion and signs of heart chamber enlargement.
Echocardiogram
- This is basically the test of choice in diagnosing mitral regurgitation and is indispensible.
- Echocardiography can be used to determine the underlying cause of the mitral regurgitation, and provide important information regarding the heart chamber size and the integrity of the valve leaflets in addition to the structures holding the valve together.
- Echocardiography is generally considered the most accurate way of determining the severity of mitral regurgitation.
Transesophageal Echocardiogram – TEE
- The TEE is the most accurate test in assessing mitral regurgitation.
- This is an ultrasound of the heart that requires a small tube being passed into the food pipe to get closer pictures of the heart. The advantage being that it shows the structures in greater detail.
- A TEE may be performed to assess mitral regurgitation that is questionably severe and can identify the exact cause of the mitral regurgitation.
- Most people would perform TEE prior to consideration of surgery, and a TEE is almost always performed in surgery to ensure the valve is repaired.
Heart Catheterization
- In this procedure small tubes are passed into the heart to get information about pressures in the heart and also to look at the coronary arteries.
- Heart catheterization can be performed to see the effect the mitral regurgitation is having on the heart.
- Heart catheterization is almost always performed prior to surgery for mitral regurgitation to ensure that there are no artery blockages that would need fixing at the same time.
Magnetic Resonance Imaging
- Although not used as mainstream, some expert centers use this to monitor the progression of mitral regurgitation and the effect it has on the heart, as it gives superior information on the structure and function of the heart.
- One of the advantages is that it is highly reproducible and so it may be of use in cases where close monitoring is important.
Complications of Mitral Valve Regurgitation
Heart Failure
As the heart enlarges to cope with the increase volume of blood it eventually fails, this usually only happens in the setting of severe MR. One of the keys of treatment is to fix the valve before heart failure sets in and to prevent irreversible damage.
Atrial Fibrillation
The large volume of blood that leaks back into the top chamber of the heart in mitral regurgitation can lead to an irregular heart rhythm that originates in the top chamber known as atrial fibrillation. If uncontrolled it is known as Afib with RVR.
Pulmonary Hypertension
Pulmonary hypertension is the term for increased pressure in the arteries of the lungs. It can occur in mitral regurgitation from the back transmission of pressure from the left chambers of the heart that are dealing with the increased blood volume.
Medical Treatment of Mitral Regurgitation
For severe mitral regurgitation, especially if primary and symptomatic, then fixing the valve is the only way to alleviate the problem. There is currently no medicine that can fully reverse the condition. Some medical treatment may be beneficial, as discussed below.
Primary Mitral Regurgitation
- In primary mitral regurgitation where there is a problem with the valve itself such as mitral valve prolapse there is no medicine proven to reverse the disease, and no specific medicine recommended by the guidelines.
- There is some evidence that beta-blocker medication such as metoprolol can have a beneficial effect in terms of preserving the heart function, however the evidence for this is not strong enough to be making it a strong recommendation.
- Measures should be taken to ensure adequate control of blood pressure as increased blood pressure may lead to increased severity of mitral regurgitation.
- Basically the mainstay of medical management is surveillance, monitoring for stability of disease with clinical visits, and echocardiography, ensuring the disease doesn’t progress too much before considering valve surgery.
Secondary Mitral Regurgitation
- In secondary mitral regurgitation the problem is not with the valve itself, but rather the structures that hold the valve in place and keep it functioning. Unlike primary mitral regurgitation, medicines may have a significant impact on secondary mitral regurgitation.
- Some cases of secondary mitral regurgitation are caused by coronary artery disease that leads to certain areas of the heart not pumping as well, leading to valve dysfunction. In these cases fixing the coronary artery disease, either through medicines, stents, or surgery may be beneficial.
- Secondary mitral regurgitation is often due to heart enlargement, whereby the heart becomes to big for the valve leading to leakiness. In these cases, medicines that can possibly reverse this process in some way, will allow the heart to become smaller and possibly restore valve competency.
- Measures should be taken to ensure adequate control of blood pressure as increased blood pressure may lead to increased severity of mitral regurgitation.
When to have surgery for Mitral Regurgitation?
When to have surgery for primary mitral regurgitation?
Primary mitral regurgitation is when the valve itself is affected such as in mitral valve prolapse. There is no proven medical therapy to make the valve better and the only way to get rid of the mitral regurgitation is by mitral valve surgery. The options are mitral valve repair and mitral valve replacement, which are discussed later in detail. The timing of mitral valve surgery for mitral regurgitation has been the subject of much debate over the years. When deciding to send someone for valve surgery we have to consider the following. We don’t want to send someone too early because heart surgery is a big deal, and if they don’t need it then it’s hard to justify the risk no matter how small. On the other hand, we don’t want to send someone too late because there is the chance that any damage done would be irreversible.
Years ago patients with severe mitral regurgitation would be send for surgery only when the heart showed clear evidence of failure. It was then realized, that many patients would never recover their function and remain symptomatic. So the valve was being fixed too late. The problem is that due to the nature of the condition, it is often hard to know when the heart is reaching that point of failure. Unlike other conditions we can’t just rely on the pumping function of the heart to tell us what’s going on because in mitral regurgitation it initially looks normal and we often only find out its abnormal after the valve is fixed! For this reason, in severe mitral regurgitation, if the pumping function of the heart is at all reduced, even minimally, the valve should be operated on. The same goes for patients who have symptoms such as fatigue and shortness of breath.
Many expert centers are now moving towards mitral valve surgery in patients who have severe mitral regurgitation even if the heart is pumping normally and the patient has no symptoms. The rationale for that is 1) The surgery is performed before heart failure sets in to prevent any irreversible damage 2) The modern day risk of mitral valve surgery in expert hands is minimal and 3) In expert hands it is almost always possible to repair the valve rather than having to replace it. Some centers still prefer what’s called a watchful waiting strategy where they watch patients with severe mitral regurgitation closely for development of symptoms or subtle evidence of heart dysfunction.
In addition to development of symptoms of evidence of heart dysfunction, there are a number of other factors associated with worse outcomes in patients with severe MR. Generally if any of these appear then its time to operate. These are an irregular heart rhythm known as atrial fibrillation, and increase pressure in the lung arteries known as pulmonary hypertension.
Surgery in Primary Mitral Regurgitation – Key Points
- Before considering surgery its important to ensure that the mitral regurgitation is indeed severe in nature.
- In expert centers, its reasonable to consider surgery for severe mitral regurgitation even if there are no symptoms and the heart appears to function normally, as long as there is an almost certainty the valve can be repaired rather than replaced.
- In general patients with severe mitral regurgitation should be monitored closely and surgery should certainly be performed if there is development of symptoms or if there is even subtle evidence of heart dysfunction.
- Other indicators which should suggest the need for surgery in severe mitral regurgitation include development of an irregular heart rhythm called atrial fibrillation or the development of high pressures in the lung arteries known as pulmonary hypertension.
When to have surgery for secondary mitral regurgitation?
In secondary mitral regurgitation, the main problem is not the valve itself, but rather structures that hold the valve in place. The main example of this is in people with severely enlarged hearts, where essentially the heart is too big for the valve. Unlike primary mitral regurgitation, medicines may actually be able to help a lot in those with secondary mitral regurgitation. Before considering surgery in secondary mitral regurgitation, there should be effort to maximize medical therapy.
Often those with secondary mitral regurgitation have severely reduced pumping function and so any operation is of course high risk when compared to the generally healthier population with primary mitral regurgitation. It is unclear whether surgery for secondary mitral regurgitation has any effect on long-term prognosis. The goal of surgery for severe secondary mitral regurgitation is to reduce symptoms, so surgery is generally reserved for symptomatic patients.
Surgery in Secondary Mitral Regurgitation – Key Points
- Before considering surgery for secondary mitral regurgitation its important to ensure maximal use of medicines to see if they can improve the mitral regurgitation.
- Surgery for secondary mitral regurgitation is generally reserved for those who remain symptomatic despite medical therapy.
Mitral Valve Repair vs. Mitral Valve Replacement
When undergoing surgery for mitral regurgitation there are 2 main choices, mitral valve repair and mitral valve replacement.
Mitral valve repair involves making modifications to the existing valve that result in elimination of the mitral regurgitation and restore the valve competency. These modifications include addition of artificial chords to stabilize the valve and also addition of a band around the valve to allow it to function normally. In some cases, when the valve is thick and floppy like in mitral valve prolapse, some of the redundant valve tissue may be cut out.
The other option is mitral valve replacement, using either a metal valve or a tissue valve. A metal valve will last generally lifelong although it will require lifelong use of a blood thinning medication such as Coumadin. A tissue valve does not require the use of the blood thinning medication, however will be subject to wear and tear and therefore have a limited life time, maybe up to 10 years after which further procedures may be required.
When possible mitral valve repair is the preferred course of action if it can last in a durable repair. Expert mitral valve surgeons will generally be able to tell if a valve can be repairable based on the echocardiogram done prior to the surgery. Mitral valve repair is considered superior, when possible, because it may result in improved outcomes and greater preservation of heart function. Unfortunately many patients end up with mitral valve replacement, simply because they were referred to surgeons who aren’t skilled in repair. This is unacceptable, and is one of the reasons to ensure your mitral valve disease is managed in a truly expert center.
Robotic Vs. Open Surgery for Mitral Regurgitation
The standard way to repair the mitral valve is to do this via a sternotomy, which is the term for sawing the breastbone. Mitral valve repair is complex, and an advantage to an open surgical approach is that the entire valve can be visualized and complex repair performed. Some people would argue that the open approach allows the highest chance of success in a high quality repair. A minimally invasive approach that involves a smaller incision may also be an option.
A handful of specialist centers are offering a robotic approach to mitral valve surgery. Some very skilled and experienced robotic surgeons, of whom there are not too many, are able to perform even complex repairs. The advantage to a robotic approach would be that the incisions are much smaller than that of standard open surgery. If opting for a robotic approach, its important to know the surgeon is highly experienced in this and has a good track record of mitral valve repair.
Keyhole Catheter Based Treatment of Mitral Regurgitation
Incredible advances in technology over recent years has led to the development of a way to fix some mitral valves without having to perform open heart surgery. This is called percutaneous repair of mitral regurgitation and involves the use of small tubes passed up to the heart from the groin. The most widely studied method of percutaneous mitral valve repair is known as the Mitraclip. In the Mitraclip procedure there is a clip applied to the mitral valve leaflets (as can be seen in the video below) that can reduce the amount of mitral regurgitation. The advantages to this procedure include minimal recovery time, and avoidance of surgical risk in those patients that would have been at high risk of surgery. It is felt that although the Mitraclip procedure is effective at reducing mitral regurgitation, it not as effective as standard surgical approaches.
Currently in the US, the Mitraclip is limited to high-risk subsets of mitral regurgitation, basically those patients that are felt to be at prohibitively high risk of surgery. It is also reserved for primary, and not secondary mitral regurgitation for the time being. Trials are ongoing that will establish the role of the clip in wider subsets of mitral regurgitation.
One of the biggest revolutions in cardiology has been the development of a catheter-based treatment of aortic valve disease. This involves implanting a new valve through a small tube and has been wildly successful. Excitingly there is progress being made on catheter-based mitral valve implantation and this is likely to change the field significantly over the next decade.
Can a Pacemaker Help Mitral Regurgitation?
In some cases of secondary mitral regurgitation, different areas of the heart beating out of sync cause the regurgitation. This can be diagnosed using a combination of an EKG heart tracing and an ultrasound of the heart. In these cases, it has been shown that the use of a particular kind of pacemaker known as cardiac resynchronization therapy (CRT) can lead to the improvement of mitral regurgitation both at rest and on exercise. This will not be effective for primary mitral regurgitation.
What Questions to Ask Your Cardiologist If You Have Mitral Regurgitation
- Cause. What is the cause of the mitral regurgitation? Basically is this primary or secondary mitral regurgitation. If so what supports the diagnosis?
- Severity. How severe is the mitral regurgitation? What were the methods used to determine the severity and do the measurements add up? For example if the mitral regurgitation is thought to be severe, is the heart enlarged to reflect this? If not, is it truly severe? On the contrary, if the regurgitation is moderate but the heart is clearly enlarged, is it truly only moderate? Other tests may be required to confirm.
- Stability. In patients being followed up for mitral regurgitation, especially those with moderate or greater disease, has the disease progressed? If so what has been the rate of progression. If there has been rapid progression closer follow-up may be warranted.
- Effects on the Heart. Particularly in those with moderate to severe disease. Is there any evidence of heart muscle dysfunction, even if subtle? Is the upper chamber of the heart, the left atrium enlarged? Is there evidence of increased pressures in the arteries of the lung (pulmonary hypertension)? Is there any sign of heart rhythm disturbance (atrial fibrillation)? In severe disease, these are important as they may indicate the need for mitral valve surgery.
- Strategy. What is the treatment strategy? If being monitored, how often should this be monitored and why? If the disease is severe, then are you going for a watchful waiting strategy or an early surgical strategy?
What Questions to Ask Your Surgeon If Undergoing Mitral Valve Surgery
- Can the valve be repaired rather than replaced? If not why not? In some cases the valve itself isn’t amenable to repair, but often people will have mitral valve replacement when they should have had repair instead, simply because the surgeon is not expert in mitral valve repair techniques.
- How experienced is your surgeon in mitral valve surgery? How many do they do per year? What is their success rate for repair? Don’t be scared to ask these questions, it’s important to have the utmost confidence in your surgeon.
- If the surgeon is taking a robotic approach, what is their experience level? How many cases have they done? How many of their robotic surgeries end up as open operations?
- Ask the surgeon the likely approach to fixing the valve, based upon the information supplied by the echocardiogram.
- Discuss the advantages and disadvantages of a metallic versus a tissue valve in the event that you need a valve replacement procedure.
What Can You Do to Improve Your Chances of a Good Outcome?
- Develop an understanding and take an interest in your condition. Learn as much as you can and take an active role in management.
- For those patients with moderately severe or severe mitral regurgitation keep a track for development of symptoms such as fatigue, shortness of breath, swelling, and an irregular heartbeat. If you develop these discuss this with your doctor when possible.
- Don’t get lost to follow up! Ensure you keep a track of your appointment. Make sure you know how often you need to have clinic visits and how often you need echocardiograms.
- See a specialist that is a proven expert in valve disorders and understands the nuances of management of mitral valve disease.
Why it’s So Important to see a Dedicated Valve Specialist
I have patients from all over the world come and see me to obtain opinions on their valve disease. Management of valvular heart disease is complex. Expert management relies on knowledge of imaging, structural heart disease, physiology, surgical techniques and newer interventional techniques. As someone who deals with valve disease day in and day out, I find myself using my knowledge of advanced imaging and intervention frequently. These skills are not commonplace in general cardiology and even though guidelines exist to help management of valvular heart disease, very few of these guidelines are based on a high level of evidence and therefore they are far from perfect. Thus in many ways, management of valvular heart disease such as mitral regurgitation is an art form.
For this reason, the current management of valvular heart disease in the US is far from optimal. A good example of this is that a significant proportion of people sent for surgery for mitral valve replacement will get a valve replacement, rather than the preferred valve repair. This is simply because the skill set of the referring physician and the operating surgeon is limited. The development of post-surgical heart failure is also common when, in fact, much of this may have been avoided if patients had been sent for surgery at a more optimal time. Other nuances, such as simply grading the severity of the regurgitation can often be challenging and once again underline the importance of having this managed by experts who are dedicated to valve disease. If this means you have to travel further to see that specialist, then so be it, as in my mind there is no doubt that the benefits of correct management of the disease will be worth it in the long run.
I have been diagnosed with severe MV regurgitation and expect to have the surgery soon. I have done quite a bit of research on my valve problem in the past but found your article to be much better than most; well written, calm, and informative. Thanks for taking the time to create it.
Informative thank you
Thank you very much for the wonderful article on mitralRegurgitation and its treatment. I am really happy with your scholarly article on this matter. Congratulations.
We appreciate your comment, hope the article was helpful.
I have question
I was diagnosed with both Mitral valve regurgitation and aortic valve severe damage about a year ago. I had an open-heart surgery to replace aortic valve but mitral valve damage was not serious enough requiring surgery. Now as the first year anniversary of heart surgery is here. I need an advice what to do with my mitral valve and I need a professional opinion what to do with Mitral valve issue.
What do you suggest I should do?
Do you have details on the severity of the mitral regurgitation?
Given the large amount of people we have been able to help here, we are starting a twitter to help keep heart patients up to date with advances and relevant information. Mine can be followed at @MustafaAhmedMD
Mild mvp
Grade 1mr
EF greater than 60%
Doctor advice to take antibiotics before doing anysurgical procedures. Having chest pain palpitations headache. Tiredness. Left chin pain. Can you please explain fully any complications and can stress worsen the conditions
https://myheart.net/articles/mitral-valve-prolapse-part-7-do-i-need-antibiotics-for-my-dental-procedure/
Selam Mr Ahmed. I had holter and EKO ,here is my results.：Rare APC 5 times。Rare VPC 6 times。Longest R-R interval 1.82 seconds（during sleeping 3:21 am） EKO：No chamber dilation Good L V dialostic function Mild to moderate MR，rebundant MV Trivial TR，PG：18 mmHg，estimated RVSP：21 mmHg Normal RV systolic function。Doctor said it is not severe ，if i feel exited or having palpitations i can take 10 mg propranolol。Yesterday i had irregular heartbeat for 5 seconds constantly。No pain ，no dizziness ，no fainting。Another doc said i need more medicine treatment。I am sooo confused，is my MR bad or will worsen ？i am 37 years old ，no cholestrol no family heart diease past，i work out regularly。But i feel so bad after i saw mild to moderate MR。Please help me to understand my situation。thank you。
Dear Dr. Mustafa, i have TRIVIAL mitral regurgitation & MILD tricuspid regurgitation. But i already have symptoms of difficult of breathing sometimes even if im lying flat. Is there something that i need to worry about?
Salam Dr.
My son had a heart transplantation due to DCM/ sudden cardiac arrest a year and half ago. A week ago he was diagnosed with dilated aortic and TRIVIAL mitral regurgitation.
I was told by the team that it is not a huge problem but i can’t help it. Knowing that he might not have the classic symptoms.
Assalamalecom
My mother is 56 years old, Hypothyrodisum in thyroxin, and a year ago, she has palpitations.And she diagnosed with Mild Mitral Regurgitation and beta blocker started.
After a year and a half, the palpitations did not subside, and Ishe went to another specialist and she was diagnosed with the same diagnosis and was classified as a third-degree. With a small hole between the Right and Left Venticle, he kept her on the same treatment and fitted with a heart rate monitor.
After reading the article, is it necessary to undergo an operation? To prevent complications.
For only mild mitral regurgitation operations are not recommended.
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Disclaimer: The comment response is opinion and in no way affiliated with my employer. It is a vague response that is not to be used as direct medical advice and in no way should replace the opinion of a medical provider.
Dear Dr. Ahmed, my mother in her late 70’s suffered a N-STEMI MI 14 months ago and has over time developed Mitral Regurgitation (MR). The information provided has been extremely useful, especially ‘the what questions to ask the Cardiologist’ have been noted and should be very useful at the next consult in 4 weeks.
A wealth of info keep the good work going. Will definitely be posting more reviews…
Glad you found it useful.
Dear Dr. Mustafa,
I had Mitral Valve repair last August 2017, the surgery went fine and the valve was repaired with no leak and no heart Murmur, then 2 months later I had shortness of breath and I was admitted to hospital they heard heart Murmur then they did heart echo which shows some leak and then they perform TEE.
the report was :
Trace of artic regurgitation
Mild Mitral regurgitation , tow separate Jets of Mitral regurgitation the first is central Jet(p2 Level) and the second is an eccentric anterior directed jet.
last week my primary care told me you have a louder murmur and my cardiologist is not concert even I’m having shortness of breath episodes and pain in my leg.
Please please advice
The TEE appeared to show the leak was not severe after the repair and unlikely ot explain the symptoms, i would recommend having a second opinion and the imaging reviewed if i were you and still concerned.
you can follow my twitter at @MustafaAhmedMD
Thanks for your kind reply, can you please explain the frequent heart palpitation and if i go upstairs and down stairs or any effort i feel dizzy and the heart beat goes crazy,
knowing I’m soccer player and i didn’t have this before the surgery.
🙁 i have mild mitral regurgation , i am so scare and cry , it will be more? or stay mild? 🙁 i am so worry i cant stop cry life is black , dose it need sergury later? 🙁 i have 28 years , i had panic attack before , because i take ELtroxin i had tumor in my thyroid gland and it removed all of it 🙁
high dose of eltroxin made this panic it happen to me 3 times but it didnt happen again after they reduce for me the eltroxin dose :(((((((( now i complained from slow beat in heart , doctor asked for echo and cbc blood test, cbc show that i have anemia hymoglopin is 10 and normal from 12 to 16 , :(( echo result is (mild mitral regurgation otherwise withini normal echo findings)
Mild mitral regurgitation is nothing to worry about, it is very unlikely to progress and you should consider it an almost normal finding so don’t worry.
Hi Dr Ahmed, I was also found to have mitral regurgitation. I believe the cardiologist said it was mild, not sure. All it said on her notes that she provided me under diagnosis was “Mitral regurgitation.” Since you mentioned above that mild mitral regurgitation is nothing to worry about and it is unlikely to progress / normal finding ; does that still apply to if you were diagnosed with mild mitral regurgitation, BUT you have symptoms, like chest pain, shortness of breathe, fatigue, etc.
The symptoms are not related to the mild mitral regurgitation. So good news as far as that goes.
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Hi there, I have also been diagnosed with mild mitral regurgitation along with mild to moderate tricuspid regurgitation. Should I be concerned?
I am 38 years old and have been recently diagnosed with mild mitral regurgitation with chordae tendonae tear. Rapid new onset of symptoms of chest pain, diff. breathing, fatigue and sudden inability to exercise. Halter monitor show frequent runs of Svt. Is surgery a given in my future?
Hi Karen, mild mitral regurgitation isn’t typical with true chordal rupture, its often more severe so i doubt you have a significant rupture. Would need to see the echocardiogram to give an accurate opinion. The symptoms you have are certainly not associated with mild mitral regurgitation, so either the disease is more severe than thought, or something else is causing these symptoms.
Thank you so much for the prompt response! I really enjoyed your article too. It was very easy to follow and informative
I have mild mitral regurgitation,mild LA enlarge (43mm) and mild lvh most probably secondary to intense high intensity workout for 6 months on my regular check up.i had no symptom.should i be worried and how its progress.is it will regress?i had panic disorder too..
With regards to the mitral regurgitation that is mild, you most likely have nothing to worry about and it is not likely to become a serious issue.
Great article. I have mild to moderate regurgitation. I’m so scared to exercise. Imy having pants attack am I gonna die , have a heart attack. I’m 55
If you have mild to moderate mitral regurgitation as your only heart issue, then you have absolutely no restrictions to exercise and no cause for concern.
meaning nothing worry about this?
My doc says on a scale of 1 to 10 my mv regurgitation is a 4. My EF is 58 %. No other heart isdues. My blood press dips to normal levels 129/79 when i awake pulse 89. But after lunch it rises to 145/95 until late night. What should i do. They say low grade tachy 94.
Typically MR is on a 1 to 4 scale, I’ve not heard of a 1 to 10 scale. I’m guessing they are trying to say it’s low moderate. As for the fast heart rate, has the thyroid and blood count been checked? This is not likely related to the mitral valve.
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My doc says on a scale of 1 to 10 my mv regurgitation is a 4. My EF is 58 %. No other heart isdues. My blood press dips to normal levels 129/79 when i awake pulse 89. But after lunch it rises to 145/95 until late night. What should i do. They say low grade tachy 94.
My doc says on a scale of 1 to 10 my mv regurgitation is a 4. My EF is 58 %. No other heart isdues. My blood press dips to normal levels 129/79 when i awake pulse 89. But after lunch it rises to 145/95 until late night. What should i do. They say low grade tachy 94. May 1 2019…pulse returned to normal. Thyroid ok n blood count ok. Only mvr with heart palpitations once or couple times a day. Should i be worried. In stress test i did 97 % of my target heart rate in 4 mins.
Dear sir ,my mom is going through mild MR and chronic bronchitis, a pacemaker is already installed two years ago ,now her lungs x ray shows clear white fluid ,doctor gave her medication and said everything will be fine ,kindly guide what should be done
Nothing needs doing for the mild MR in general and its unlikely to be related.
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Disclaimer: The comment response is opinion and in no way affiliated with my employer. It is a vague response that is not to be used as direct medical advice and in no way should replace the opinion of a medical provider.
Thank you so much doctor…jazakallahu khayran katheera..rabbuna yubarik
I am 69, female MR (from MVP in 20s) diag. 11 yrs ago, beta blocker nicely controlled bp, heart rate. Very much stress last few yrs. Holter monitor for 2 wks in Jan showing SVT (no further testing but heart can feel tight, pressure, a little pain, flip floppy sometimes, etc.) Also now have high BP, and had TIA(cerebral) 4 wks ago, mild, resolved, but BP was way whacky, 185/124 at one point. Now also on calcium channel blocker, also have atherosclerosis, aorta. (once was told enlarged heart?) They tell me (Kaiser) that MR mild, don’t know re the aorta issue. This all seems like A LOT to have! Very concerned, esp. because it’s Kaiser. Also brain MRI (‘sbnormal) showed white areas in middle (low blood flow). Just need some good advice on having these issues together. Thanks much for article.
Are madam how long you have been diagnosed with MR. I am just 24 and have the same issue.Can MVP peoples live a good life without undergoing surgery.I have mild MR only rest is fine.
I am female, 26, overweight. I had open heart surgery within weeks of diagnosis at Children’s Hospital in DC when I was 15 for severe mitral regurgitation (may or may not be from rheumatic fever). The Australian surgeon repaired the valve using the extra tissue from the outside of the heart. It’s been 11 years and I’m mostly feeling fine- on Pindolol 5mg everyday. I didn’t really experience noticeable symptoms before I had surgery (shocking, I know) and still don’t. Mild palpitations every so often and a high heart rate, despite the beta blocker. My issue is that I am overweight, and my cardiologist has retired! I’ve been struggling to lose weight for ages now, but exercise seems so out of reach for me. My heart has always had a high resting rate, and even going up stairs is a noticeably difficult effort for me. I found this comprehensive overview of my condition informative and extremely helpful. I was hoping you could point me in the direction of advice on living with this condition, post-surgery? I was told that I would eventually have to have it replaced and was curious if this is a common thing- and how to deal with it.
Dr Ahmed,l have recently been diagnosed with slight mitral valve regurgitation,this was picked up on an ultrasound when looking for reasons why l was having episodes of AF which started about six months ago,l have been given beta blockers,blood thinner and blood pressure meds,l never had a blood pressure problem until the episodes of AF which were thought to have been caused by serious stress that I was experiencing,l am not having much success in lowering my blood pressure.My doctor basically told me they will monitor my condition but that an operation will likely be the outcome in time.Can you tell me is the slight leak that my mitrial valve is experiencing likely to get worse and is it better to have an operation sooner rather than later ? Thank you.
Mild mitral regurgitation is very common and if truly mild is not likely to progress to a severe stage unless there is a structural abnormality with the valve noted itself. In the vast majority of cases operation would only ever be recommended if the degree of regurgitation was severe. Mild mitral regurgitation can in most cases be considered relatively normal.
I am a 56 year old woman who recently was hospitalized with pneumonia & COPD, came home
with oxygen. I was also diagnosed with moderate to severe MV regurgitation, and, was asked if I had a cardiologist, and, if not I should get one. I am still on oxygen and have a pulse oximeter, my %SP02 is pretty much within normal limits-but, I don’t know what the normal limit is for the Pr bpr should be on the pulse oximeter. Can you please tell me what it should be or close to what it should be. I still have some shortness of breath, and, can feel the abnormal heart beat at times, but, I really have trouble taking a deep breath, can this also be a symptom of MV regurgitation. Thank you so much for your articles truly informative.
I also have mild to moderate mitral valve regurgitation n mv prolapse. I get trouble taking a deep breath sometimes n when im working fast i get heart palpitations
Dr.Ahmed my daughter is 11 year old and she was complaining about chest pain while playing and getting fever and mouth ulcer again and again we visit the doctor and doctor told for ecg and eco and in the report we get she is moderate mitral regurgitation mildly affected .she is not eating enough and feeling tired soon plz tell me what to do .your opinion is very valuable to me.
Can you post the echocardiogram full results.
I am 26years old. I have mitral valve prolapse trivial mr and mild pht.what are the steps we taken for complete cure?
Sir send a reply immediately
There is no medical treatment for mitral regurgitation with mitral valve prolapse. With mild mitral regurgitation treatment is not required, this will likely never pose a problem for you. Once the regurgitation gets to the severe range then treatment with procedure or surgery may be warranted.
Hi Doc, I have similar situation with with the abovementioned case. I have mitral valve prolapse syndrome with trivial mitral regurgutation and pulmonic regurgitation. Symptoms include palpitation (everyday), heart reate 60%of the time is above 120 even at rest, difficulty in breathing (sometimes),get tired easily, chest pain (atleast once a day), head ache almost everyday, lack of appetite. My doctor did not require surgery but I feel like my heart is raising almost all of the time and it is bothersome especially when I’m talking continuously I need to pause to breathe. I feel like my heart is pushing me when I’m laying in bed. What should I do?
For trivial regurgitation you certainly don’t require surgery and you likely never will. In terms of you heart rate, have you seen an electrophysiologist?
Monica,
Any chance you could be suffering from Lyme Disease? Have you had a tick bite or a target-shaped rash? Recent viral-like illness? Other seemingly unrelated symptoms present or that appeared and then stopped? One of the co-infections causes “air-hunger”. But so can asthma…
Dear Dr. Ahmed,
I love your website. I am a 40 year old female. My doctor told me I have trivial to mild mitrovalve regurgitation. Should I be concerned? Is it likely that it can get worse in the future? My echocardiogram showed no signs of enlarged left ventricul but sometimes EKGs will say ‘possible left ventrical enlargement’. My doctor stated that Ekgs sometimes print that diagnosis out but it is inaccurate. Please inform me if I should be concerned about the regurgitation now or chance it will get worse in the future. Also, should I avoid any type of exercise like jogging or lifting small weights in the upper body?
I don’t think you should be concerned at all about trivial to mild mitral regurgitation, in fact i would consider it a relatively normal finding. There is no exercise you should avoid on account of it.
Hello Dr.,
About 4 years ago I started getting chest pains. With rest for a few minutes they went away. I ignored it until I was shopping one day and had chest pains that wouldn’t go away and they were sincere. I went to the hospital and they did blood work, an echo, chest X-ray and a stress test. The cardiologist found nothing abnormal. He said it was indigestion. I didn’t agree but I went home. Since that time I have had swelling in my ankles and feet. I went to my doctor and was told to decrease my salt intake. I didn’t listen and the swelling went down to normal in a few days. Then the chest pains went away. Now my feet and ankles are severely swollen and are not going back to normal. I went to my doctor yesterday and for the first time I was told I had a heart murmur. He thinks I am having regurgitation and that’s what is causing the swelling. Also for the first time I was told I had fluid in my lungs. At the office he took blood work and have me an ekg which was normal. He is sending me for a chest X-ray, an echo with Doppler and an ultrasound of my lower legs. With everything I have told you how severe do you think my condition is? Thank you.
Do you have a copy of your echo report, that will tell you the severity of the regurgitation, it would have to be in a severe range in general to be the cause of symptoms and swelling.
Lori Q, Make sure the leg swelling is not from elevated blood sugar. You can “pass” the fasting glucose test for a decade while your post-prandial blood sugar reading may be too high. A1C test in addition to fasting blood sugar will help address that.
hi dr. I am 60 years old and have emphysema. about 15 years ago I underwent lung surgery to remove the upper lobe in my right lung. that’s when they found mitrovalve prolapse with mitrl regurg. he said then it was only about a teaspoonful . ive never had a problem with the exception of feeling a slight irregular heartbeat whuch the dr told me then that my heart skipped a beat. now, 16 years later I ws watching tv and I felt the skipped heartbeat and then what felt like a slight flutter. I’m scared . is this ok ? I am overweight and clean houses for a living . please tell me I’m ok . will you please answer me soon. I am bipolar with a panic disorder so I take meds for all that. I take paxil for the OCD then Effexor for depression and lamictal for th bipolar and I take norvasec (?) for high blood pressure which is new. I’m so scared sir please answer soon. thankyou for your time.
If the mitral regurgitation is only mild or moderate, there should be nothing to worry about and it is not dangerous.
how will I know if the regurg is worse? I have no other symtems, no fatigue, shortness of breath but I think that due to the emphysema. or anything else.
About 17 months ago I was diagnosed with “mild to moderate” mitral regurgitation, I’ve turned 50. I am not sure what this means, I read about mild, which seems okay, but moderate sounds bad, so where do I fit? I worry now as I lost my mum last month aged 68 with coronary heart failure.
I was told to come back in 24 months for another scan, but that’s not due yet for about 7 months, shouldn’t ask to be scanned earlier?
If the mitral regurgitation is indeed moderate and the heart function and size are normal, particularly without symptoms, a repeat echocardiogram would only be needed on a yearly basis unless there was a change in symptoms. You might never need anything doing about it.
Hi dr mustafa ahmed! Your website is very informative. I was diagnosed with moderately severe regurgitation in 2015 when I had the 2decho and TEE. I was advised by the doctor to go for 2decho every 3 months. I really do not have any symptoms (only when I exercise too much). My LV size is normal and my EF is 75%. What is your insight about surgery? I am worried that my MR might progress and becomes worse. Can you please advise? I am happy to send you my 2decho report. Thanks
Hi dr mustafa ahmed! Your website is very informative. I am 36, althetic and I was diagnosed with moderately severe regurgitation in 2015 when I had the 2decho and TEE. I was advised by the doctor to go for 2decho every 3 months. I really do not have any symptoms (only when I exercise too much). My LV size is normal and my EF is 75%. What is your insight about surgery? I am worried that my MR might progress and becomes worse. Can you please advise? I am happy to send you my 2decho report. Thanks
There are a number of factors in making this decision. A lot depends on the true severity of the regurgitation and the mechanism. I would need to see the echo itself and not the report to determine further, most reports are not to the accuracy required to make such a decision. If felt to be truly towards a severe range, and also that the valve is repairable so it does not need replacing. If the decision is equivocal then a few other tests that are more nuanced can be used to determine the severity.
I am 45 and have moderate mitral regurgitation. On my most recent echo it says moderate left atrial enlargement. The LA diameter was 3.4. Is this something to be concerned with? There is no measurement listed for LA area or volume. My confusion is that last year my LA diameter was 3.6 and was listed normal, now this year is considered moderately enlarged. Both echos done at same facility about 18 months apart. I have appointment with my cardio doctor in a few weeks, but was very concerned and confused. Any advice would be appreciated.
Hi Kimberly,
Unfortunately most of these numbers are not very accurate and are very operator dependent. I much prefer an integrated approach to the evaluation of mitral regurgitation. Look at factors including end systolic and end diastolic dimensions, volumes, ventricular shape and function, and special attention paid to grading by quantitative and qualitative measures. I actually use the same echo technologist to perform all valve studies for that reason. If however you are felt confidently to be in a moderate range then i wouldn’t worry too much, in general severe disease is that which is operated on. With regard to the left atrial size, i think on echo the measurement is not very reliable as a manner to grade severity.
I have been Diagnosed with Grade 1 MVP and Mild MR with all the other things normal in 2D Echo Report ? Do I need to worry about it ? I’m taking Beta Blockers and its doing good for me. But Sometimes I feel dizzy and tired.
hi Doctor Ahmed.
I had an echo last Thursday. It was my 3rd echo over the past 3 years. My cardiologist never mentioned that i had an leaky valves on my previous echo. This time he said my Mitral valve leak went from mild to mild moderate a little worse from last year and not to worry but to have another check up in 3 months and he will keep a close eye on the valve. I am 62 , just lost 25 lbs on weight watchers…using the treadmill 4 times a week. My questions is….Do i have reason to worry …because thats all that i have been doing since my doctor gave me the news. Also can I still exercise….
You have no cause for concern with that report as your cardiologist states. You can exercise as hard as you want.
Dr. Mustafa Ahmed,
Thank you very much for your wonderful articles on Mitral valve prolapse. It has been amazingly helpful, informative and easily understandable. I have done lot of google search on MVP syndrome. And even i have a a book “Mitral valve prolapse syndrome/Dysautonomia survival guide” to understand more about my suffering due to this. Thank you very much
Dr. Mustafa Ahmed,
I am 40 and have been diagnosed with MVP on 2004, the reason I went to cardiologist was due to heart palpitation, high blood pressure and anxiety. In Echo report it was mentioned as prolapse of AML (Mitral) and doctor told nothing to worry, he advised good exercises and meditation to control anxiety. Later i was prescribed with beta blocker to control my palpitations as well BP. And after 1 year i was diagnosed with Generalized anxiety disorder started taking anxiety medication (Benzodiazepine and Escitalopram) under the prescription of psychiatrist. And I feel my anxiety problem is mainly due this MVP dysautonomia. And 2006 i did one more echo it was showing same AML prolapse. Earlier both test i did in same hospital and my last heart Echo on 2014 did at different hospital. In that report was showing AML myxomatous with no definite prolapse and Trivial MR. (my earlier 2 report nowhere mentioned about mitral regurgitation). Dr. Does it mean that my mitral valve regurgitation is gradually increasing year by year due to the condition of myxomatous degeneration please advice me on this. And nowadays i am feeling more palpitation.
You don’t have a significant valve problem at this time, your valve is prolapsed a little but there is no leak. I would not worry if i were you. Visit a Dr yearly and if you have development of a murmur or new symptoms echo can be performed, otherwise you don’t have much to worry about and there is no reason to think the valve will get worse.
Thank you very much for the advise.
Hi Doc! Can you tell me the treatment options for my 87 y/o grandma, she was just diagnosed with MVR, she is suffering from SOB even from walking to short distances. I was told her EF is 40. Can you tell me more about Mitraclip? Is that something that can be done for her? I’m scared because I live in CA and my grandma lives in NY, per my aunt the attending told them she only has few months to live if left untreated. Can you tell me options for her and how to better her quality of life. I appreciate your response.
Hi Meryll,
Read the post on this site about mitraclip i have extensively detailed the clip and there is an extensive in-depth guide of how this is done that we put together for cardiologists wanting to learn the procedure. At the age of 87 she would be the perfect candidate. Here is the link to one of the patients that is a great example of this. https://www.youtube.com/watch?v=oaQilHHCqGA. I typically send home clips the morning after the procedure. Your grandma needs to be evaluated by an experienced valve team.
Dr. Ahmed, I am very nervous. Yesterday I was told that I had moderate to severe leakage from my mitral valve. They want to do a TEE to confirm the diagnosis. I just turned 50 and my only complaint was that I was having shortness of breath. I thought it was allergies, but they think otherwise. I’m thinking about a second opinion. My doctor is very new to the field and is saying things about me having surgery. I’m really scared. What do you think?
Hi Carol,
I would make sure of the following before you have surgery. A specialist with an interest in valvular heart disease has assessed and determined you to have at least moderate to severe or severe mitral regurgitation. The cause underlying the regurgitation should be clear. If the regurgitation is degenerative that it can be repaired. If it is the case, and you have symptoms and are referred for surgery, then ensure your surgery is performed by a surgeon with a specialist interest in mitral valve surgery that can ensure that a repair can be performed as opposed to replacement if a possibility.
Dr. Ahmed, I’m a 47 year old male, who had bacterial endocarditis, 6 strokes and a mitral valve replacement in November 2004. I’m having a second mitral valve replacement (porcine implant replacing a porcine implant) on August 11, 2016. The surgeon will be Dr. Tirone David at Toronto General Hospital. I have a left atrium that is 53 mm (Dr. David’s big concern), severe bioprosthetic mitral valve stenosis (0.8 cm squared) and mild to moderate mitral regurgitation. My concern: I feel great, I have absolutely no symptoms. Dr. David said to stop doing my 3X/week cardio and workout regimen back in May. I understand what you say: that often, surgery is indicated even where there are no symptoms. But do I really need this less than 12 years after the first operation? Do I really need a full replacement instead of a repair? I even wonder if my cardiologist’s diagnostic equipment has been properly maintained. How can the tests say I’m in such bad shape, yet feel so great? Thanks for your answer.
Im not familiar with your hospital or surgical team, however ensure you are going somewhere with significant experience in valvular heart disease.
A few things to take in to account.
A normal bioprosthetic mitral valve would typically last the 10-12 year range in a good setting, so you have had a typical valve life after which degeneration occurs.
Although you feel great, its important to note the effects of the tight valve on your heart, is there evidence of heart failure, enlargement, elevated lung pressures etc these can be factors that may lead to a decision for surgical intervention
A number of tests should be taken together in making the diagnosis.
If there is a good indication for surgery and an experienced team performing the surgery then you may never be as fit as you currently are to undergo it.
the key is to obtain an opinion you are comfortable with
Thanks for your comments 🙂
Sir , found mild mitral and tricuspid regurgitation on echo and pressure gradient 33.i m 27yr old.i have PAC in ECG.Is it dangerous. .i m worried..pls reply
Its pretty normal, nothing to worry about.
Dear sir,
my mom heart ECO report say “LA large 52mm” can its treatment possible without medicine. My mom age is 44.
Can you provide details of the full echo report
Hi Dr Ahmed
I was Diagnosed with mild MVR I believe in 2009 I was in the hospital for high BP Aug of 2015 they did an echocardiogram but said I was fine they put me on metoprolol and released me I followed up with a cardiologist and he did an Ekg and told me that at this point there was nothing to do but lose some weight and keep my BP under control I’m concerned bc he didn’t give me any follow up instructions as to when I should see him again I don’t hv insurance I paid for my visit so what should my next steps be? I don’t have any new symptoms other than I can feel when the regurgitation happens sometimes I exercise regularly I have lost some weight BP has been pretty normal but I just need to know if I should have at least annual visits…I’m pretty nervous because I am 47 yrs old and no real sure of what’s next I have a primary doctor but he hasn’t mentioned me going for follow up either…Your advice is greatly appreciated
What did the 2015 echocardiogram report about the mitral valve?
hello Dr
My mom made an echo test and the result was
1-Fair LV systolic function ET 59% relaxation type 1 diastolic dysfunction
2-SWMA at rest (apica – lateral hypokinesia )
3- trivial MR
4- no PEF
5- no intracardial masses
what is that mean Dr ? and its important to know ur advice about that too pls
There is a report of normal function that is good. There is also some wall motion abnormality, you should speak to the heart Dr and ask why that would be the case and whether any further work up such as a stress test is required.
Dear Doctor
My 68 year old mom (follows up with doctors every 3 to 6 months for her blood pressure, cholesterol, diuretics, and aspirin meds. Overall was physically active) went for a casual outing around six months ago and the next day woke up feeling extremely tired and out of breath. On our first trip to the ER, a junior doctor prescribed antibiotics for a week suspecting a bacterial infection. She continued to be very fatigued and out of breath and a second trip showed she had a phantom lung tumor that was treated with loop diuretics, which immediately relieved my mom’s breathing issues. As of today, she still suffers from fatigue that varies whenever she does anything physical. Her breathing, sleeping, and eating are normal. Occasionally she has heart palpitations. The cardiologists we visit keep saying to stay on the recommended meds and try to relax. Any opinion on why the fatigue persists would be greatly appreciated as it’s taking a mental toll on her.
Below is the text of her latest medical report:
Medical History:
68 year old female, known case of Hypertension, Dyslipidemia, Chronic AF, moderate MR on medical treatment. Echo study revealed moderate MR, mild PHTN, LVEF = 55%. Last clinic visit was 30/6/2016 where she was stable.
Diagnosis:
Chronic AF
Moderate MR
Hypertension
Dyslipidemia
Recommendations:
1- Regular follow up in OPD
2- Low salt, low fat diet
3- Medical Treatment:
– Rivaroxaban 20mg. once daily
– Zocor Tab 20mg. once daily
– Zestril tab 5mg. once daily
– Atenolol tab 50mg. once daily
– Hydrochlorthiazide 12.5. once daily
Thank you
Next step in this work up would be some form of stress testing.
Thank you
Hi, I’m 18 years old and I have mild mv regurgitation. I have been doing a check up every 6 months. However, recently they found a collapsed artery that has been causing my mvr to get worse. So they put me on IV therapy to try to open the artery up and help me re-hydrate. I have been severely dehydrated for a long time due to my stomach issues and it makes it very hard to soak up any water or nutrientce. This is also why I have anemia because everything I eat or drink goes right through me. They have scheduled me to do this iv therapy for one week 12hrs a day and then after that do it three times a week every week, 12hrs a day. But they never had a set date on when it was going to end or if it was going to end at all. The home heath care nurse said they may want to put a port or a picc line in later. Why would I need this for a long period of time and how would it effect my mvr??
Can you provide a little more information so i can give you accurate answers. What did theY mean by collapsed artery?
Thanks for the really good article. The balance of when to perform surgery is interesting to me. I am 38, had endocarditis 4 years ago (dental work) and have been living with severe MV regurgitation ever since. I am based in the UK and doctors here very much take the wait and see approach. I have 6 monthly echos so they are watching my heart size and function. I am pretty active so don’t present any typical symptoms other than chest pain from time to time. My question which they never seem to be able to answer is my heart rate is extremely low (40bpm when resting). Although active I am no elite athlete so this puzzles me. Have you seen this in anyone else who has had this or the damage cause by the infection? Also what is your view on exercise for someone with severe MV regurgitation? I was initially told I could do pretty much anything except contact sports and powerlifting now they seem to be backtracking and saying I shouldn’t be doing much other than very gentle exercise. Would love to have your view. thanks.
Firstly, grading of mitral regurgitation in potential surgical candidates is somewhat an art form and needs to be done by specialists with a dedicated interest in that. If you have truly severe mitral regurgitation, a watchful waiting strategy vs. early surgery is a long standing debate. I can tell you that in my center, we certainly adopt a more aggressive approach, however that is in the setting of a very high likelihood of repair and minimally invasive approaches. I would not recommend this outside the setting of a reference mitral valve center. Personally when evaluating severe mitral regurgitation i look at the left ventricular chamber closely and for signs of subtle remodeling (i spent several years of my career conducting research about this so I’m a little obsessive about it!). As for the heart rate, mitral regurgitation itself is not really associated with bradycardia (low heart rate). In some endocarditis, particularly aortic, abscess formation can extend to the conduction system and cause bradycardia, I’m pretty sure they would have told you that was the case. If they are limiting your exercise, they need to be explicit why and then probably be more aggressive. Some studies look at exercise echocardiography to evaluate the response of the heart to exercise in severe MR.
I am a 47-year-old woman recently diagnosed with moderate MR. I’m an avid runner, about 40 miles per week on roads and trails. Reading your post and blog responses has made me feel a lot better. I don’t want to stop running, but I admit, since I’ve been diagnosed, I get nervous when I run long distances, I find myself being so much more aware of my heart and wondering what everything I’m feeling means. Knowing that with moderate MR and normal heart function (chambers and pressure good), exercise should not be a problem, makes me feel so much better. I’m glad I found your blog and I’m going to enjoy my trail run much more tomorrow.
I do have two questions. It’s still very hot and humid here in Tennessee so there are times when I’m running hills that I get slightly dizzy and I have to stop for a second or two to catch my breath. This happened long before I was diagnosed (though, no idea how long I was undiagnosed, this was the first year she heard a murmur). Is this likely to be attributed to the MR or could this just be normal exertion due to the heat and hills? I make a point of hydrating well and can run 3 to 4 hours on trails with no problem typically. Should dizziness be a concern? No pain, pressure, shortness of breath.
Secondly, do you suggest that a person who exercises a lot and has moderate MR do a stress echo to see where they stand? My GP suggested that, but I think before I do more tests I will meet with a cardiologist to ask some questions. The cardiologist’s report of my ultrasound last week said “no treatment needed at this time” but I sure don’t want to do anything that could make my heart worse.
I appreciate your help and certainly appreciate you having such an informative website!
Most times the answer would be that if the disease is moderate then just follow up in a year or two for a repeat study and in honesty in most cases that approach is adequate. Since you have intelligent questions on the issue, let me discuss the contemporary management in a situation such as yours (patients that want to exercise to a high level) that we would suggest in the setting of a specialist structural heart and valve center.
In your case I would want to know the following –
Is the regurgitation moderate or severe – Echocardiography is not an exact science. It is very dependent on who is performing the test and who is interpreting the test. In our valve clinic I personally for that reason oversee all studies done for valvular heart disease. If the regurgitation is truly moderate, and this is backed up by a heart that is normal size and shape with normal function then it is very unlikely to be of any clinical significance and you wouldn’t have any concern. In that case you should have an echocardiogram every year to ensure stability.
Does the regurgitation get worse with exercise – If you were to have symptoms overtime you exercise then i would want to know whether the regurgitation is worsening with exertion or not. Its important to recognize that mitral regurgitation is a dynamic condition. In most cases this isn’t an issue, however in some cases, particularly where there are exertional symptoms i have seen the severity of the leak increase and the pressures in the lung artery increase. This is a specialist test however and needs to be done in expert hands by those used to performing this test for this reason. Say you developed symptoms at a high level of exercise, and also there was evidence of worsening regurgitation and other markers supporting that then i would certainly follow you more closely, likely at 6 months intervals. If however, no significant change occurs, that would certainly be reassuring. In patients with confirmed severe mitral regurgitation exercise echocardiography can also be used to look for signs of subtle dysfunction of the heart muscle and make a case for earlier mitral valve repair.
If however your disease is truly mild – mild/moderate, your heart function and size normal, the regurgitation is unlikely to be associated with the symptoms, you likely have no cause for concern and should certainly not limit your exercise.
hello dr i was told bye my dr that i have trivial mitral regurgitation and mild tricuspid regurgitation everything else was normal.. should i be worried that it will get worse over time? im 33 years old and i had a eco done on 9/21/2016 that showed this? whats the chance of it getting better on its own?
Nothing to worry about.
Hello dr. I am 58 year old male. I have been exercising my complete life I do high intensity cardio 2 times week and regular exercise the other days and light weight lifting with no symptoms. max heart rate when doing high intensity in the intense zone is 165 for short periods. I have trace regurgitation in my tricuspid, and mild regurgitation in the mitral valve. I have no symptoms! However my question is will this type of exercise make the regurgitation worse as I age? Should I stop the high intensity work even though it is only 8 intervals of 30 seconds on and 90 seconds of rest. Thanks in advance.
Mild mitral regurgitation should be considered an almost normal finding, no restrictions to activity whatsoever.
Hi dr.ahmed..iam filipina aim not fluent in english.so sorry if i have wrong grammar.pls help me about dads 2d echo wth doppler..conclusion says:dilated left ventricular dimension wth global hypokinesia wth depressed systolic function
Aortic sclerosis
Mitral sclerosis wth moderate mitral regurgitation
Mild tricuspid regurgutation
Normal pulmonary artery wth pulmonic regurgutation…
Doc does result is it too dangerous and need urgent operation?or is it really not urgent operation and medicine maintenance is ok?we hope n pray realky not need operation or surgery cos family only poor..we not afford fr the operation??thanks dr ahmed hope to hear frm u soon..
What is the cause of the depressed function, has someone assessed the blood supply to the heart. The moderate mitral regurgitation in this setting does not require a valve operation. Its important he is placed on good doses of the correct medications (beta blocker, ACE inhibitor) to strengthen the heart, and prevent enlargement, that may even improve the mitral regurgitation in this setting.
Hello…I am 46 years old & I am scheduled for a torn meniscus surgery this Wednesday. Two weeks ago I had a terrible upper respiratory cough & cold & went to urgent care where I was told I have a heart murmur. They then sent me to a cardiologist where they gave me an echocardiogram. I received my results Tuesday that I have Mitral Valve Prolapse with moderate to severe regurgitation. I then took a stress test & was cleared for the knee surgery; however they would like me to have the TEE done shortly following the surgery. I am feeling anxious because part of me feels like I need to take care of this thing with my heart ASAP but at the same time I would like a second opinion in the Miami area (I live in Key West) & I am not sure how to go about finding a reputable cardiologist that is an expert in valvular heart disease as you suggest. Also the cardiologist told me that most likely surgery will be necessary as the trend is to operate before damage is done to the heart & of course if the TEE shows how severe the leak is that I could need it right away. This of course is making me wonder if continuing with the knee surgery is a good idea at this time. Thank you in advance for anymore information that you can give to me.
Firstly, the regurgitation in your case is not an emergency. If the leak is moderate to severe and you are not having any active symptoms (shortness of breath, fatigue, swelling) you certainly don’t need to rush the situation. This should certainly not impede the issue of knee surgery. if thats the main thing limiting your quality of life then i’m sure you get it done.
The next most important step is to ensure the correct diagnosis of severity of MR. The TEE is a good idea. I cant speak for all cardiologists, but as a valve specialist, i take the integrated assessment from the TEE, the TTE and possibly exercise testing to determine the severity and the impact of mitral regurgitation, so all the tests should support the same finding. If the TEE shows that the leak is indeed severe then yes it is reasonable to proceed with surgery ONLY* if there is a very high likelihood of repair. In our heart valve surgery and robotic program we have a >95% (essentially 99%) chance of repair in the setting of mitral valve prolapse as an example. That should be what you are told when you get your opinion. Early surgery basically means operating on severe MR prior to the onset of symptoms. But early surgery should only be entertained if the valve can be repaired. Sadly in the United States, a large proportion of people undergo replacement when they should have repair simply because they go to the wrong centers where the surgeons are not dedicated mitral valve surgeons. If there is clear heart enlargement, drop in heart function, atrial fibrillation, high lung pressures, or symptoms, then the need for surgery is more urgent, but still not emergent. In your case, in the absence of those, there is no rush. But if you indeed have severe regurgitation that is clearly severe, it is reasonable to proceed with mitral valve repair at an expert center at a timing of your convenience.
Thank you so much for your quick response! My knee surgery went well and I have an appointment with a cardiologist on the main land soon!
Hi Doctor, I am 38 years old male and was diagnosed with mitral valve prolapse in 2004. Since then I was controlled regularly by a cardiologist, and my left ventricle was in the range of 54-55 mm. However, I changed country in 2014 and went to a new cardiologist after a year interval. New cardiologist told me that my left ventricle seems to be 62 mm. Which one to believe? In fact in my previous country, I was suspicious of my cardiologist and went for a second opinion from medical school. They also measured it 54-55 cm. Two sources says 54-55 but new one in a new country (ireland) says 62. Both they agree medium to severe regurgitation with ejection value 72%. I have no symptoms and I am slim. is MRI of heart a good option to see the difference between two doctors? which one to believe. Can heart condition change so drastically within a year? Do they use different measurements?
I spent several years conducting research in to just this issue and am a big fan of MRI, particularly in cases where the echocardiogram and other tests do not match up. The key is meticulous attention to detail. The MRI can provide an excellent assessment of remodeling and accurate delineation of ventricular size and shape. Phase measurements through the valves can also assess degree of regurgitation. If there is ambiguity regarding severity of MR i.e moderate vs. severe, a TEE should be performed by someone skilled in that indication. Practically MRI is not necessary in most cases, but is an excellent allied tool in more nuanced cases.
Hi Doc! I was diagnosed with Mitral Valve Regurgitation due to MVP (I guess that’s how my doctor explained it), but I’m confused with the result. My doctor said I’m gonna be okay but I felt the opposite. I experienced chest pain most of the time even when I’m not doing anything that could cause it (like sleeping or sitting). It hurts so much that sometimes its hard to move (but i’m sure its not a heart attack). Most of the time it feels like I have two heartbeats everytime I touch my chest. Most of the time I am having a hard time breathing and I also experienced a severe headache, and when that happens I go to the clinic to have a BP check and turns out I have low BP. Are these things still normal? I’m feeling different than what my doctor said. By the way, he told me to drink Propranolol (Inderal) 10mg for a month aftera my check up.
The chest pain is not from the regurgitation. Read the post about mitral valve prolapse syndrome in this post https://myheart.net/articles/mitral-valve-prolapse-explained/ that is associated with chest pain and atypical symptoms. Some other posts linked at the end should also be useful to you.
Thank you doctor, I will definitely inform you about the MRI results which will reveal which cardiologist measured it correctly.
Sir ,
i am sachin 25 year old report found mild mitral regurgitation on echo but dr. give me medicine INDERAL-20mg why?? please tell me
Im not sure why you were given Inderal, but it was not for the mild mitral regurgitation. Possibly for palpitations. The mild mitral regurgitation itself is nothing to worry about in isolation.
thanks dr!!!!
Hi, I found out today that I have trivial mitral regurgitation, I am 44 yrs old, 84 kgs. I have started to walk on a regular basis as a form of exercise. If I manage to lose some weight approx 10 kgs or a little more, obviously this will help my overall health. But I would like to know can the mitral valve then stop leaking?
thank you
You have trivial mitral regurgitation and you can consider this basically normal. I wouldn’t worry about it at all, it is not of significance. You can exercise and lose weight which may be beneficial to overall cardiac health however there is no evidence that will affect the mitral valve in any way.
Hi there,
I am 44 yrs of age, 84 kgs & was told today that I have trivial mitral regurgitation. I have recently started walking as my form of exercise, I plan on losing 10 or more kilos, my question is, can the mitral valve stop leaking by losing weight? thank you
You have trivial mitral regurgitation and you can consider this basically normal. I wouldn’t worry about it at all, it is not of significance. You can exercise and lose weight which may be beneficial to overall cardiac health however there is no evidence that will affect the mitral valve in any way.
I have recently been checked for Mitral Regurgitation and it was concluded in the report as follows:
“Dilated left ventricle with reduced systolic function. Thickened mitral leaflets with mitral annular calcification and moderate mitral regurgitation. Soft echo sign of diastolic dysfunction”.
I am also diagnosed with HPO thyroid which I currently take the following:
Thyroxin 150mg
Concord 10mg
Acapril 10mg
I was told unless I get surgery, nothing can be done for me. Desperately seeking advice.
Its a little more complex than it seems. It depends whether you have primary or secondary mitral regurgitation. If it is primary then you need further testing such as TEE and heart catheterization to ensure it is not severe. If it is severe and felt the cause of the left ventricular dysfunction then a conversation regarding surgery or other intervention can take place. if it is felt the left ventricular dysfunction is due to an alternate cause then that needs adressing. You need to be on an optimal medical regimen to ensure the function doesn’t improve with that and often the mitral regurgitation with it. The primary vs. secondary issue need to be settled prior to consideration of surgery.
Thank you for your quick response, let me just add the comments which was also included in the report:
Both atria are normal, the inter atrial septum is intact.
The right ventricle is normal, the inter ventricular septum is intact, the left ventricle is dilated with reduced systolic function as evidenced by an ejection franction of 48%, and it demonstrates a relaxation abnormality.
There is mitral annular calcification with thickening of the mitral leaflets. E:A reversal and moderately severe regurgitation. There is moderate pulmonary regurgitation with a pulmonary recoil spectral envelope. The other valves as well as the great vessels, appear normal with mild tricuspid regurgitation; estimated RVSP is 37.8 mmHg. TAPSE is 2.05 cms.
Missing from the report will be the measurements of the ventricles.
I really appreciate any and all advice you can render. My sincerest thanks
Next step would likely be a TEE to asses the mitral valve further and left (or possibly stress testing) and right heart catheterization. Important to explain why the function is impaired.
hi Dr.Mustafa last year 2015 i was confined at the hospital and doctor said i have mitral valve prolapse,acute gastritis and low potassium. but now my blood pressure always low,dizziness,shortness of breath,fast heartbeat,back pain and i feel pain in my thyroid when i swell saliva. i consult the doctor this year.my x ray and ecg is normal. but why does the result of 2d echo is trivial mitral regurgitation,trivial tricuspid regurgitation,and pulmonic regurgitation .does my MVP got critical ??? does subdermal implant and contraceptive pills trigger my disease??why my MVP turns to mitral,tricuspid and pulmonic regurgitation?
You have trivial valve disease and nothing to worry about with regard to those. You don’t have critical MVP.
HI DOC I HAD MITRAL REPLACEMENT WITH A METAL VALUE IM DOING WELL WHAT IS MY CHANCES OF HAVING A BABY AT THE AGE OF 43 AND WITH A METAL VALVE
There are significant risks that need to be understood very carefully. These should be discussed both with a cardiologist specializing in that area and an obstetrician.
hope this is not complicated
I am a very active (half marathons and triathlons) female. 2 years ago during a routine physical my doctor heard clicking while listening to my heart. Sent me for an ECHO. told me all was fine. 2 weeks ago during a half marathon I got very dizzy, not spinning more lightheaded. Dr. tells me to see a cardiologist. Soonest appointment is 3 weeks from now. When I got my reports I read them and I learned I have Mitral valve mildly diffusely thickened, mild tricuspid regurgitation, prolapse (mild)trace aortic regurgitation. mild pulmonic regurgitation. Trace to mild mitral regurgitation. Yikes I was never told any of this 2 years ago after the ECHO I was told all is normal. Now I am scared that I am a walking time bomb. Appointment with Cardiologist is not for awhile. I asked to be on a waiting list but in the mean time I don’t even want to move let alone walk my dog. Just a note on the dizzy aspect, the night before the race I had terrible diarrhea and felt pretty lousy, I thought I was just dehydrated so now I am all confused. Is my primary just being thorough or does my echo show I have big issues. I am about to have my first panic attack. Never should have read those reports. Hope you can respond. Not sure if I should get to an ER right away
You don’t have a significant concerning issue with the valve as things stand. Mild diffuse thickening can be seen with aging and in itself doesn’t require specific treatment particularly given there is no significant regurgitation. The echo sounds pretty normal to me. Certainly no underlying disease that would explain your symptoms. Possible it was due to feeling bad in general. You do not have issues as far as the echo is concerned so certainly no need for a panic attack. Its reasonable to see a cardiologist for reassurance however its likely you will need no further testing and can resume your activity as normal, particularly if it is an isolated event.
Thank you so much for your response. You really put me at ease and I feel so much better now. I see the cardiologist in a few weeks but I no longer feel like a walking time bomb. I honestly can’t thank you enough. What a great service you are doing for people.
Thank you
Caryl
hi Dr.Ahmed,I’m 26 yrs old..last yr I was admitted in the hospital and the doctor told me I have mild prolapse and mild mitral regurgitation.I suffered chest pain,shortness of breath,palpitation etc…it is serious?it can cause heart attack or cardiac?
Your mitral regurgitation is not significant and not cause for concern, it is not associated with heart attack.
thanks sir..I have one question,the doctor said I’m doing a surgery soon,can I live a normal life and how long I do a surgery?
hi Dr.Ahmed..I’m 26 yrs old,last yr I admitted in hospital and the doctor told me I have mild prolapse and mild mitral regurgitation…I’m always suffering chest pain,shortness of breath,palpitation,fatigue,dizziness etc…it is serious?iis this a cause like heart attack or cardiac?
Hello.
you wrote trivial,mild,moderate and severe mitral regurgitation.
you then wrote that trivial is normal and no concern. i want to ask is trivial and mild are the same? or there is a difference? please explain.
thank you
In terms of significance, trivial and mild are essentially the same in that they aren’t really clinically significant. The actual terminology themselves are based on cut off values as described in the article. Mild means it is a very low amount of leak, trivial means you can hardly see it.
thank you.
i did 2 echo tests in 10 days space between. (just because im worried). in the 1st he wrote: minimal mr(without hemodynamic significant). and in the 2nd (by different physician) it sais mild mr.
what is the definition of minimal? is it more like trivial or like mild? thanks
Minimal is an odd term, i don’t use it, i suspect it is like trivial, i would not worry if i were you.
Hi Dr. I was diagnosed with Mitral Valve Prolapse with Mild Mitral Regurgitation 2 years ago (back in October 2014) The 2D echo result shows that I have thickened and long anterior mitral valve leaflets with prolapsed; short posterior valve leaflets. The cardiologist prescribed propranolol to be taken as needed (PRN) for palpitations. I never had 2D Echo since then. However, I’ve been very stressed with work and have been experiencing chest pain and palpitations more often than before. I know these symptoms were not caused by MVP itself. My question is, is there a chance for the regurgitation to progress/worsen? Thank you.
It depends on the degree of prolapse, in general thought mild mitral regurgitation is not likely to progress and is not a cause for concern.
Thanks for the response. How would I know the degree of prolapse? Is it shown in the 2D echo?
I am 85 y female w moderate stable mitral valve leakage.i have an echocardiogram yearly. I have no shortness of breath. I take atenenol 25 mg 2x a day for BP. I walk 3 miles daily. I am 5ft 2″& weigh128. What is my prognosis?
Your prognosis is good.
Hi doc…im 28 yrs old and i have mild prolapse last yr in december..i have a maintenance to control my heart rate,and the doctor said its normal and.nothing to worry…but why im always suffering chest pain,back pain,palpitation,shortness of breath and dizziness?it is normal for my prolapse?
Its not really seen in most people with mild prolapse, you may have dysautonomia. In terms of worrying, its more annoying than dangerous, although in some it can impair functioning due to the symptoms.
If you have a dysautonomia doc it is serious? And what is the treatment?
Doc,
Been told I got Moderate MR? Is there any cause of alarm? What known drugs can rectify this problem? I am 32 years
Moderate mitral regurgitation is not a cause for alarm although it should be followed clinically and occasionally through imaging. In terms of drug, there is no recommended treatment specifically for the MR. It all depends on the mechanism. If the MR is primary, a disease of the valve then it is observed. If the MR is secondary and caused by heart muscle weakness then medication that concentrate on the heart function are preferred. Im guessing your MR is primary and you have no cause for concern, no specific treatment is recommended. If you have no symptoms, no specific restrictions apply. The MR may never present an issue.
Dr. Ahmed, I appreciate this health-management article. I am an RN almost finished with my MSN, working on an IMC unit, and found this piece extremely informative and valuable. Definitely gave me a better understanding of what is going on (and what to expect) with my patients who have been given these types of echo/TEE results. Thank you.
Hi Dr Ahmed at 5 yrs old I had repair of Tetralogy Of Fallot. I am not 46 yrs old my surgeon was Dr. Wayne Isom same surgeon who did surgery on David Letterman only thing my surgery was back in 1975. Last year I was told I had a “possible” TIA it was never really determined even tho on my MRI there was a tiny spot. Mt cardiologist has since diagnosed me with Atrial Fibrillation as the cause of the TIA. Which I do get palpitations from time to time. During my hospital stay they did an echo cardiogram and my cardiologist told me I have residual RV enlargement and reduced systolic function with moderate MR. Now I remember as a kid to an adult I would watch all my echos I got and always saw the Regurgitation but every cardiologist brushed it off as it is because you had the surgery and your heart is a little enlarged bc of the surgery. Now that I had this TIA/Atrial Fib issue should I be concerned with the findings of “residual RV enlargement and reduced systolic function with moderate MR.” I do not want to wait until it is irrepairable. I appreciate your thoughts on this.
Your case is complex and i would need to see images etc to comment accurately. The RV enlargement is seen after yet repair and the key is to monitor it over time to ensure there is no residual pulmonary gradient etc. You may need right heart catheterization and such testing. In terms of the MR, moderate MR isn’t a concern in terms of needing intervention, if there is suspicion of severe MR a TEE may be required to assess the valve more closely. They key for you is to be under the care of a congenital adult specialist who can monitor your situation closely.
I forgot to add I am taking Metoprolol 25mg 2x a day to control my heart rate, Eliquis 5mg 2x a day, Lisinopril 5mg 1x a day and Metformin.
Thanks!!
Wonderful website.
Quick question…I had an echocardiogram and the computer printout said “Mildly thickened mitral valve leaflets. No MVP. Trivial MR. ”
The Doctor’s conclusion was
“IMPRESSION: Mild symmetric left ventricular hypertrophy with preserved global and regional biventricular systolic function. Borderline/mild posterior leaflet mitral valve prolapse. Trace mitral regurgitation. Trace aortic regurgitation. ”
Should “Borderline/mild posterior leaflet mitral valve prolapse” be a concern or not really?
Thanks and happy holidays
Not significant cause for concern going off this report.
Hi Dr. Ahmed,
Excellent coverage on this topic — thank you! I have been diagnosed with severe mitral value prolapse 5 years ago (first diagnosed in my 20s with mild prolapse — now 63 years old) and have been under the care of a cardiologist at a well-known NYC hospital since. I am asymptomatic and see my cardiologist 2-3 times/year including an echo/stress test yearly. We are taking the watch and wait approach. I really feel great and would not have any inkling that I have anything going on with my heart. My doctor always warns me of the signs I should be aware of, and that if my numbers/measures change I could, indeed, be ready for surgery. My question — even though i am in good health with no symptoms, should i be getting another opinion regarding the watch and wait approach? My last echo/stress test showed no changes from the previous year and nothing to indicate surgery at this time. However, the word “severe” is always on my mind. Thank you!
A lot depends on the expertise available. In out center for example, we are known to be a center of excellence for mitral valve disease and are confident that in cases of degenerative disease we can achieve a repair rate that approaches 100% which makes it much easier to send a patient with severe disease to surgery even when asymptomatic. Your tests are reassuring, contemporary management is showing a trend towards an earlier approach however.
Thank you so much for your work
I am 69, RF at 15, murmur with mild MR all my life. Never restrictions. In great shape, feel great, great diet, work out every day. Recently diagnosed by cardiologist with “severe” MR on echo, enlarged LA, and more recently “severely enlarged” LV, all from series of echos. Long story on why, but it just feels like my condition is being exaggerated and I am being pushed toward traditional open hard surgery because that is all they do at the cardiologist’s hospital. His answers to many of my questions just don’t add up to me. I suspect his characterization of “severe” is just to promote his own opinion and treatment plan. I’m not convinced I need surgery at all and would want the robotic surgery anyway because it seems less invasive in all ways. I have been deliberating for six months, even increased the exercise a bit, and have a second opinion scheduled in a couple of weeks. Am I being reasonable?
It all depends on the expertise available. When i see patients, i take in to account that we are a mitral center of excellence, which means high experience, a high repair rate and good outcomes. If a center has low volume and experience the recommendations are very different. In out center we adopt an early surgery approach whereby in reasonable candidates, once the MR is noted to be severe, we would operate, particularly if the valve is repairable. We are almost 100% robotic for degenerative disease. If you do have a large LV and severe MR, there is little to be gained from waiting. Its always important to make decisions on a case by case basis however, every case is different and many factors need taking in to account.
Thanks Doctor.
One thing that you’ve said in your column is to make sure the MR is “severe”. Isn’t it reasonable to double check on this evaluation? And even if it is severe (with no symptoms), do I have much to lose by waiting perhaps another year when I can switch to a Medicare Supplement policy which would increase my access to doctors?
Hi George, in my opinion grading MR is somewhat an art form unless its clearly severe, i would initially recommend asking the cardiologist involved the features of the regurgitation that point towards severe from both a qualitative and a quantitative perspective. These questions should be answered clearly. If not then its reasonable to ask further opinion.
Dear Dr Ahmed,
I’m 47 and have “significant” regurgitation from a bi-leaflet prolapse but not many symptoms (a year ago it was mild to moderate). Normal LV size and no AF. My cardiologist will conduct a TEE to know more and probably refer me for early surgery if he finds a flail leaflet. Would you know who in the United Kingdom you would consider repair “reference” surgeons ?
Paul
Hi Paul, Frank Wells in London is very well known as a UK reference surgeon. Im not sure if he is still operating.
testing comment
I did promised i will post my experience as many forums as possible if i am cured, that i am doing now.
I am a very active 61 year old woman. Triathlons, half marathons, swim daily, walk miles daily. was told several years ago I had Mitral valve prolapse.
This past October I got dizzy during a half marathon. I was able to finish the race albeit mostly walking. I figured I was dehydrated. Followed up with my primary who referred me to a cardiologist. Because of the mitral valve history he ordered a stress echo, that resulted in no findings. He said it was so minor it didn’t even show up. He said no heart concerns at all, 7 day monitor was normal, no family history, perfect cholesterol, blood pressure fine, never smoked. BUT I get chest pains, it has been years and never gave them a thought. All these tests have done a number on me. Every day I think I am having a heart attack. I have had ekg’s blood tests, everything is normal.
I am driving myself and everyone around me crazy. I get chest pains, never severe, it is more discomfort, like more of an annoyance than severe pain, no other symptoms, I was checked 2 years ago for the same symptoms no changes. My question for you is: should I be so scared of having a heart attack if there are no symptoms at all, I am full of anxiety and have been my whole life, the pains last minutes or hours but again this has been going on years, no breathing issues, sweating, I feel absolutely fine. Can you put me at ease or should I get another cardio work up?
Thank you for any info you can give me
Caryl
Look at it this way, you are remarkably active, and fit, you have atypical symptoms, you have a structurally pretty normal heart, you live a good lifestyle, you had a stress test and a cardiology evaluation that was normal. You are the definition of low risk.
Dr. Mustafa Ahmed,
I will appreciate your opinion. Your presentation and blog answers are very informative..Thanks
67 yrs. Male- active retired in med profession but consult full time
120, 5.5”. Nonsmoker. Meds; – 025 Topro, lost 10 lbs.??135-125?
Recently developed unexplained GERD. And now- PAH.- as retirement Christmas gift.
No sob- NO WEEKENSS, before this echo I was very active and 30 min treadmill at 110-120 heart rate.
I have slight pain in chest under ribs- may be due to GERD/ ACIDITY or PAH?
Will start with ace inhibitor this week. Follow up with Mitral-valve specialty at NMH- CHICAGO.
MITRA-CLIP post TEE/CATH?
Any meds suggestions, would I be of with MITRA-CLIP. Should I wait and watch. I stopped walk exercise-
Should I do routinely for now.Reports;-
From Echo;-12/2016
1. Left ventricle: Systolic function is normal. The estimated ejection fraction is 55-60%, by single plane method of disks.
2. Mitral valve: Moderate, late systolicprolapse, involving the anterior leaflet. There is moderate to severe regurgitation.
3. Left atrium: The atrium is markedly dilated.
4. Tricuspid valve: There is moderate regurgitation.
5. Pulmonary arteries: Systolic pressure is markedly increased, estimated to be 75rnrn Hg.
the study of 01/07/2015. Mitral regurtitation appears to have worsened and severe pulmonary hypertension is noted
LEFT VENTRICLE: The cavity size is at the upper limits of normal . Wall thickness is normal. There is no hypertrophy. Systolic function is normal .
The estimated ejection fraction is 55-60% , by single plane method of disks . The study is not technically sufficient to allow evaluation of LV diastolic function.
MITRAL VALVE: The leaflets are mildly thickened: Moderate, late systolicprolapse, involving the anterior leaflet. Doppler: There is no evidence for stenosis. There is moderate to severe regurgitation.
(01/2015 comparision) (Myxomatous thickening of the anterior mitral leaflet with mid and late systolic prolapse of the anterior mitral leaflet with moderate mitral regurgitation.
PULMONARY ARTERY:
Systolic pressure is markedly increased, estimated to be 75rnrn Hg.(30 in 01/2015)
INTERPRETATION- stress test- seems no blockage and ok.
Walking Regadenoson Protocol
0.4mg/5ml Regadenoson injected intravenously over 10-20 seconds
ECG: normal regadenoson stress ECG
Symptoms: no chest pain Significant Arrhythmias : Rare PAC 8/P Response: appropriate.
2nd page next reply if additional info needed.
A few questions. Have you been assessed for conventional surgery? what was the reason that the mitraclip is being considered, are you high risk for surgery?
In terms of technical suitability, i would need to see the images myself to comment. Interesting that the pulmonary artery pressure is so high, i think a right heart catheterization in addition to the left heart cath would confirm that and also assess for there v wave of mitral regurgitation.
MEASUREMENTS:Feb 2017 Echo
Value Indexed Value Max aortic dimension 2.6
Left atrium diameter 3.6 cm (2D)
Left atrial volume 54.8 ml (Area-Length) 35.2 ml/m2 LV ID (diastole) 5.1 cm (2D)
LV ID (systole) 3.0 cm (2D) IVS, leaflet tips 0.7 cm (2D) Posterior wall thickness 0.8 cm (2D)
LV stroke volume 42 ml (2D biplane)
LVOT diam s 1.8
LVOT stroke volume 38 ml 24 .1 ml m2
LV end diastolic volume 63 ml (2D biplane) 40.3 mllm2 LV end systolic volume 21 ml (2D biplane) 13.2 ml/m2 Ejection Fraction 67 % (2D biplane)
AV Peak Velocity 1.3
AV Peak Gradient 7 mmHg
AV Mean Gradient 3 mmHg AV Velocity Time Integral 20 .9 cm LVOT Peak Velocity 1.0 mis LVOT Peak Gradient 4 mmHg LVOT Velocity Time Integral 15.3 cm AV Area Cont Eq VTI 1.8 cm2 AV Area Cont Eq peak 1.9 cm2 MV Peak Velocity 5.1 mis
MV Peak Gradient 104 mmHg
MV Area PHT 4.91 cm2 Mitral E Point Velocity 1.4 mis Mitral A Point Velocity 0.3 mis
Mitra! E to A Ratio 0.23
Pulmonary Vein S/ D Ratio 0.65
TR Peak Velocity 4.4 mis
TR Peak Gradient 77.3 mmHg FINDINGS:
LEFT VENTRICLE
The left ventricle is normal in size. There is no left ventricular hypertrophy.
Left ventricular systolic function is normal. EF = 67 % (20 biplane)
Baseline left ventricular diastolic function is indeterminate due to severe MR.
Wall Motion:
Normal wall motion.
All scored segments are normal.
RIGHT VENTRICLE
The right ventricle is normal in size and function. The right ventricle is normal in size.
The estimated right ventricular systolic pressure is 85 mmHg the right atrial pressure is 8 mmHg.
LEFT ATRIUM
The left atrial cavity is normal in size.
Pulmonary Veins:
The peak pulmonary vein S/ D ratio is 0.65. RIGHT ATRIUM
The right atrium is normal in size. The right atrial cavity is normal in size.
MITRAL VALVE
There is ruptured chord attached at the junction of A1/A2 scallops . There is a flail A2 scallop. There is severe holosystolic mitral valve regurgitation due to flail likely related to myxomatous degenerative disease. There is a posteriorly directed regurgitant jet. The mitral regurgitant effective orifice area (PISA) is 0.50 cm2 • The mitral
regurgitant effective orifice area (PISA) is 48.05 mm2 . The mitral valve regurgitant volume is 68 ml. There is no mitral stenosis.
TRICUSPID VALVE
The tricuspid valve leaflets are structurally normal. There is no thickening . There is no calcification . There is moderate tricuspid valve regurgitation .
AORTIC VALVE
The aortic valve cusps are structurally normal. Tricuspid aortic valve. There is no thickening. There is no calcification. There is no aortic valve regurgitation.
PULMONIC VALVE
The pulmonic valve is not well visualized, but grossly normal. There is trivial pulmonic valve regurgitation .
AORTA
Aorta is normal in size.
Measurements – Sinus 2 .6 cm. Proximal ascending aorta 2.6 cm. CONCLUSIONS:
-Two-dimensional transthoracic echocardiograph y was performed using standard views &
projections with M-mode and Doppler (continuous, pulsed wave , spectral & color flow) .
-The left ventricle is normal in size. There is no left ventricular hypertrophy. Left ventricular systolic function is normal. EF = 67% (2D biplane) All scored segments are normal.
-The right ventricle is normal in size.
-There is a flail A2 scallop. There appears to be a ruptured chord attached at the junction of
A 1/A2 scallops . There is severe holosystolic mitral valve regurgitation due to flail likely related to myxomatous degenerative disease . There is a posteriorly
directed regurgitant jet. The mitral regurgitant effective orifice area (PISA) is 0.50 cm2 . The mitral regurgitant effective orifice area (PISA) is 48 .05 mm2 • The mitral valve regurgitant volume is 68 ml. There is no mitral stenosis .
-There is moderate tricuspid valve regurgitation. The estimated right ventricular systolic pressure is 85 mmHg The right atrial pressure is 8 mmHg.
Northwestern recommendation; – best surgeon repair first –if not replace.
He also wants right heart cath/angiogram. Please explain why we need this- is reparing valve will fix high arterial issues? He told me you don’t need TEE-surgeon will look at the time of surgery- I missed to ask- as he was saying based on echo and stress test heart is strong?. This cardiologist is Mitral Valve Expert- and is very good.-he told me MITR-CLIP IS not for me as I am not in high risk.
I thought he was surgeon- I will either go with McCarthy or Dr. Bakhos closer to my resident.
Please let me know
Do you agree with recommendation-
Are MV issues causing very high arterial pressure? Whit is in last Echo. I know previous echo has jump from 2015(30) 12-2016(80).
Do you recommend nay tests before surgery- all blood tests ok EXCEPT BNP slightly elevated?
Thanks for your time. I know I am going to be in good hand but worries. I never knew I will run in to this problem- just when I am ready to enjoy with retirement.
Thanks- You are excellent!
Its always important to realize that there are limitations to echocardiography in that the science is not exact, therefore numbers themselves are less important than in integrated approach whereby multiple factors are taken in to consideration.
What is clear from your echo is that the mitral regurgitation appears to be severe (although the EDD would be expected to be a little larger if this was longstanding). You have a flail leaflet and therefore almost by definition you have severe leak. The heart appears to be handling this relatively well in terms of function however your elevated pulmonary artery pressure is concerningly high, and a component of this is certainly due to the mitral valve disease.
Im not sure of your age or the rest of your medical history however if you have other existing issues in terms of other (lung,kidney etc) and this degree of elevated PA pressure then your risk is not necessarily low. In our center, i take higher risk people for the mitral clip. If your risk is lower then you should have surgery if considered a suitable candidate. If your coronary arteries are ok, in our center you would undergo a robotic approach, I’m not sure of your local practice pattern.
Your pathology is mitral valve prolapse and flail leaflet and your valve should be repaired and not replaced. If someone recommends replacement, unless they have an incredible reason, you should seek another opinion, your valve should be repaired.
Prior to making a plan you need to undergo left and right heart catheterization. The left is to define your coronary anatomy and the right is to define the pulmonary artery pressures. Also i recommend TEE in all cases prior to the operation to clarify the mechanism, gain further information, and determine the likelihood of repair.
Continuation-3rd posting.
67 yrs. Male- active retired in med profession but consult full time
120, 5.5”. Nonsmoker. Meds; – 025 Topro, I do not have any other health issues.
As mentioned in my first blog- I don’t have SOB with my routine activity- I don’t over do
Due to knee etc.
I am very allergic to irritants- smoke/pollution etc.
Attached is my PFT result summery.
INTERPRETATION:
-Normal mechanics and lung volumes.
-There is an isolated reduction in the DLCO.
-Gas exchange (DLCO) is moderately decreased which was not adjusted for the patient’s hemoglobin .
DIFFUSING CAPACITY FOR CARBON MONOXIDE:
Decreased moderately.
The diffusing capacity was not adjusted for the patient’s hemoglobin.
-The decrease in diff using capacity could reflect the loss of pulmonary capillary surface area, as may be seen in emphysema, interstitial lung disease, pulmonary vascular disease (including pulmonary emboli and pulmonary hypertension), anemia, liver disease, and OSA.
-Resting room air pulse oximetry is 97 %.
-There are no previous tests available for comparison
Questions;-
Can CATH/ANGIOGRAM/TEE can be done with my local cardiologist or surgeon
Needs to have it done at his hospital? Hope they don’t have to repeat?
My BP with TOPRO is borderline, I tried to add LISNOPRIL gave me bad cough-stopped.
Should I take Losartin or Diuretics-
I am ready after CATH/TEE..
I really appreciate your communication- It helped me lot and Khan Academy also.
Thanks
Dr. Ahmed,
Thank You very much for explaining so simple way which is very easy for everyone to understand.
I am 70 years of age, & never suffered any heart problem. Since few days I was having minor breathing uneasiness while sleeping, I visited hospital & cardiologist did an echocardiogram and printed result is,
Normal cardiac chamber dimension, NO RWMA, Good LV Systolic function, MOD MR, another valve normal, NO PAH, NO LV Clot, NO Pericardial Effusion. I request you to guide me for next step so t6hat I could have healthy heart
It does not look like there is any concerning abnormality, it would probably be worth repeating the echocardiogram in a year to ensure the stability of the mitral regurgitation.
dear dr.ahmed
I have mitral valve prolapse syndrome and mild mitral regurgitation since dec.2015..im sufferring shortness of breath,heart pain and chest pain..it is normal for my mvp and mr? or I need to do a surgery?
Mild mitral regurgitation does not require any form of surgery and is not likely related to the symptoms described.
I forgot to add,too much dizzinness also…
hi doc,if you have a dysautonomia it is serious? and what can I do if I have that?
mild LHV with MVP, trivial MR & 58% LV EF
is my echo report. Is it serious?
Looks fairly normal.
Thanks Dr
Dear Dr. Ahmed ,
I am a 61 year old active female (half marathons, triathlons, walk 5- 10 miles a day, swim 1/2 to 3/4 mile. I have had echo, echo stress, 7 day event monitor, blood tests, all normal. These tests were done because of dizziness while doing a half marathon (Seems it was dehydration). I have left jaw pain off and on, no other cardiac symptoms at all. It can happen when walking or just sitting. I would not think anything of it but going through all the testing I spent way too much time looking things up on the internet and learned about too many symptoms. Should I be concerned about this jaw pain? It doesn’t last too long. I am ready to head out for a10 mile walk albeit will be slower than most because I am a little concerned but don’t want to let it get the best of me. The “pain” sensation is different at times, the location is different at times and I know I had this while on the heart monitor. It can stopped for months and then as presently go off and on for a week or so. Because it is on the left side I am making myself (and everyone around me crazy) Could it be heart related? Thanks in advance for all the help you are giving so many people. Enjoy your day
Caryl
You are obviously very fit and in a way you are doing a stress test daily. Your symptoms are what we call atypical and don’t appear to be heart related. Given that you have symptoms however and are 61 and female i think the symptoms shouldn’t be dismissed, even if the likelihood of abnormality is small. I would recommend seeking opinion and obtaining some form of further testing such as a stress test for reassurance and risk stratification purposes.
hi doc,im 27 years old and I have a mild mvp and mild regurgitation since 2014…im always go to my doctor every month because of my symptom..and the doctor said its normal and nothing to worry of my heart..and why im always suffering shortness of breath and chest pain?and I have a medication everyday to control my heart rate and my blood pressure..my symptoms doc can cause a heart attack?
The mild mitral regurgitation is not a concern here. The rest of your symptoms warrant medical assessment and further tests may be needed.
Hi Dr. Mustafa Ahmed, I will ask you, can pulmonary embolism lead to MR 2. grade? I just got big pelvic fracture and in few days after massive pulmonary embolism which lead to dilatation of right ventricle. After 1 year LVED goes from 50mm to 60mm and year after stays at this value with MR 2. grade. My heart rate at rest is 50-60, at walking 80-100. I am significantly lower with condition as before injury (I am 30), although the fact I exercise daily. It is really frustrating for me to live with scrap heart because I wont to do hard workouts in gym and today I am done with 30min of young woman.
Would you be so good and tell me, what can I expect from future?
How to get back to a better condition?
Thank you very much, nice work you share here for people.
The pulmonary embolism shouldn’t lead to MR. The MR grade 2 is relatively mild and not a cause for concern.
Dr. Mustafa Ahmed, Thank you so much for your article and taking questions. So kind and thoughtful. I am 58 y/o female who had a heart attack Jan 4, 2016, I thought it was a sever case of heartburn. The next three weeks I was feeling heaviness and out of breath when I would walk a short distance. I really thought I had caught a viral cold of sorts as I work in a School so did not go in to see my Dr until Jan. 27. After some tests they determined I had had a Heart attack and was taken to a hospital where I received one stint. I now was diagnosed with Severe mitral regurgitation and Dr feels it is time to repair or replace. My father had a heart attack at age 39 and had two open heart surgeries, at age 48 it was found he had a brain tumor and died before his 50th birthday. Now they should go in first to decide which is needed the replace or repair right? If they need to replace then can they still go through the groin or is it open heart?? How much time for recovery in hospital and at home before I could go back to work??
I would need to know a lot more to give specific recommendations. In general a 58 year old, otherwise well would be a conventional surgical candidate and the repair is of course preferred and should be pursued over replacement if possible. Do you know the mechanism of the leak? (primary vs. secondary) In our center we use a robotic approach for the majority of cases. If the leak is severe and the symptoms attributed to that then surgery is generally recommended, just make sure its in a place where they have a dedicated valve team with a good history of repair.
Sir am diagnosed Mild MVP trivial MR at the age of 14 now am reach at 32 am completed most of the heart checkups like angiogram in 2014 (Normal.)TMT 2016 (Negative)Holter 2016 normal .echo 2017 march two times one is Mild MVP mild MR another one is Trivial MR.Every week am visited three times in different cardiologist pblm is every day chest pain and palpitation the cardiologist prescribed medicine INDERAL 40 three times now my heart rate is 66pm.but no change in chest pain.any restrictions for exercise am totally worried plz advice
Your tests show no abnormality, I’m not sure why you are taking Inderal unless it is to try treat palpitations, although its better to characterize the palpitations than treat them. In terms of the restrictions, you have had a normal angiogram and a stress test and so in most cases exercise as tolerated would be advised if discussed with your treating physician.
iam 33 age diagnosed Mild MVP Mild MR in 2016. my problem is above patient same.chest pain palpitation anxity.Am taking INDERAL 40 two times. Taking medines morethan 18 years. Now heart rate is 75 to 78 bpm.Every year am checking TMT(Negative) Echo, Angio in 2014 (Normal).Different Cardiologist are different openion about my heart.Some Dr’s said No problem for your heart no exercise restriction for you.But other Dr.said Only Waking 30Mnts.Am totally confused about excersise.my chest pain contnue walking or rest time.Sir when is my next Angio,TMT and Echo,..Every day am thinking am going to die,die ..my dream is playing cricket,shuttle badminton,plz advice me what is the next step..any pblems for my heart.
Post 03/23/2017 ;- follow up JAN 09/Feb 14 2017
I did cardiac Cath R/L and angiogram.
It looks normal except one minor artery blockage. Pulmonary pressure was not that high.
Summery of CATH REPORT
He had a cardiac catheterization done at Loyola University , which I reviewed. His hemodynamics showed a pulmonary artery pressure of 52115 with a mean of 31, pulmonary wedge pressure of 17, right atrial pressure of 4, systemic saturation of 94%, and pulmonary aiiery saturation of 74%. His estimated cardiac output by Fick was 5.07 L/min. Pulmonaiy vascular resistance was mildly elevated at 2.7 units. I had the opportunity to review the actual tracings from that catheterization . The simultaneous wedge and LVEDP showed a normal left ventricular end-diastolic pressure of
14, a mean wedge of 18, and a large V-wave with a peak pressure of 36 mmHg, consistent with his rnitral regurgitation. His simultaneous pulmonaiy aiiery and left ventricular tracings revealed a pulmonary diastolic pressure gradient of only 5 mmHg. He also had coronary angiography which showed a normal left main coronary artery, a 25% stenosis in the proximal LAD, a 50% stenosis at the origin of the second diagonal, a 20% stenosis at the first obtuse marginal branch, and a 30% stenosis in the proximal right coronary artery.
Question;-
I am going for MVR repair surgery next week.
Please what you think do I need to tricuspid valve annuloplasty from Echo/cath report.
Or surgeon will decide when he looks at surgery time. Please let me know ASAP. i still don’t understand causes of atypical-non-specific chest pain at night? i hope this surgery will take care of that issues?
I really appreciate your communication- It helped me lot with my anxiety etc
Thanks
DR.am 33 age male.diagnosed mild MVP,Trivial MR.in 1999 am taking propano 40 tablets 2 times more than 16 years.My pulse rate is now 74. Every year am cheking Echo Now Trivial MR reach to Mild MR(2016).My problem is Chest pain (Waking and rest time)Palpitation,Anxity.In 2014 Jan-Dr said to check TMT result is negative but no change in Chest paind again Dr said to check Angio in June-2014 result is Normal.Then 2015 oct and 2016 oct check TMT result is Negative but chest pain continue.Am visiting lot of cardiologist Dr’s are said No problem for your Heart and no restriction for Excersise but some other cardiologist said only walking 30mnts am totally confused about Excersise,Plz advice me when is my next TMT,Angoi,Echo checkup???every time am thinking going to die…..what ismy actual problem…….??
Hi I am 18 years old and I have mitral regurgitation and it’s gone from mild to moderate and when I was about 14 years old I had a Sharp chest pain and I went to a doctor and the doctor heard a murmur and then I was referred to cardiologists before my symptoms were chest pain and tiredness and now i get breathless and I feel dizzy
Moderate mitral regurgitation by itself can be tolerated well and is not a significant cause for concern, however you should have a yearly check up, be observant for development of any symptoms and relay that to your physician.
Dr Ahmed,
My husband has what they believe to be secondary mitral valve regurgitation (relatively severe) with enlarged heart (I believe it was increased from 6.something to 7.1 or 7.2 in one year. He is active and asymptomatic. We have been reviewing his case for 2.5 years now. He currently takes blood pressure meds and Spironlactone. They did not put him on beta blockers due to low(er) heart rate (around 52 but yesterday presented with 60).
We had appointment/consult at Univ of CO hospital for what would of been a trial using mitral clip. After seeing him in such good shape and no symptoms (he plays soccer & walks 4-5 miles day), they moved to a need to have him on beta blocker & try to increase to reduce size of heart and would like to place the CRT pacemaker. They stated any surgery for mitral would just make him worse on regurgitation. This would be for at least 6 months to a year.
Everyone is so shocked to see him asymptomatic and seems to be at loss of what to do. He is so active, really never sits still. He is such a big help to his fellow Moroccans and always finding time to help others in need.
Does his good health otherwise help at all here to navigate through all these concepts? Have you seen the CRT pacemaker work on asymptomatic individuals?
Thank you for your time here. Your name reached out to me in this article and I found your information in it very helpful. Forgive me for the long note here.
Khadija
From Khadija: Sorry I forgot to include my husband has non movement on the opposite side which they think is possibly from heart attack (relative size of non movement) but he never felt anything – they believe it could of been even 2 heart attacks. They have thrown around rheumatic also – they just don’t know what caused that area. His arteries are in excellent condition, his weight is 144 at 5’5″ – again in good condition. We eat well. The lists goes on. No family HX of heart disease and he is 58 years old this year.
A few questions;
Do you have details of the echo report?
What is the pumping function of the heart?
The size of the heart is concerning, and if secondary its important that hes on medications such as beta blocker/ ACE inhibitor and others to see if the muscle function can improve
In terms of the CRT, if he has evidence of a left bundle branch block and heart dysfunction it is possible for the heart to get stronger and the regurgitation to lessen in severity in some cases.
His good health is certainly an advantage.
Dr. Ahmed,
Thank you for your reply. I requested the echo report details along with the numbers of his pumping function of the heart. I expect to have them soon and will get back.
Yes, they plan to use Beta Blockers and CRT (if possible). There is no block but the doctor said his heart beats one side then the other (not symmetrical). Although the concept is unconventional, they would need to prove the case to use one for insurance (basically). They did not have him on beta blockers the past 2.5 years due to his heart rate was in the low 50’s most of the time. His exam this week was 60 – we had concerns he would get too low but these docs felt he has to try to have them as heart needs to try to reduce and cannot without.
Again, thank you for being out there. Your expertise and excellent explanation of these issues in your article led me to believe, from experience, you have tremendous knowledge to share. Thank you for doing so.
I will update with the echo and function/pumping as soon as administratively available.
Thanks again. I feel honored and blessed by your response here. May you be rewarded.
-Khadija
Just a correction here Dr Ahmed. The size went from 6.4 about 2.5 years ago to 7.2 now for heart size.
Thank you.
-Khadija
Im glad it was helpful. Given the large amount of people we have been able to help here, we are starting a twitter to help keep heart patients up to date with advances and relevant information. Mine can be followed at MustafaAhmedMD
Hi doctor,
I was diagnostic with mild valve regerutation, mild tricuspid regurgitation and trace pulmonic regurgitation. I live with every day with heart beating 80-110. Also I have short breathing . How risky is my life and does it the norm heart beating like these numbers.
Thanks, Dolly
The valves themselves are not an issue if the leak is only trivial or mild.
Dr. Ahmed,
Please forgive me, this is a lot of information but some of it was out of my understanding arena. I thought it best to not leave anything out. I received this today.
Echo 1/23/2017:
Summary
1. Enlarged left ventricle with normal wall thickness. Moderately reduced
left ventricle systolic function (LVEF 34% by 3D method). Segmental wall
motion abnormalities are present (thinning and akinesis of the
inferolateral wall). Possible grade II LV diastolic dysfunction.
2. Normal right ventricle size and systolic function. RVSP estimated at
least at 33 mm Hg.
3. Left atrial enlargement, intact atrial septum.
4. Mildly thickened mitral valve with eccentric posterior jet of
regurgitation (moderate to severe, in some views seevere0.
5. Trace to mild tricuspid valve regurgitation.
Comparing with the prior study LV diastolic dimension increased and LVEF
appears somewhat lower (prior study had a LVEF at 46% by 3D method.
Adam Betkowski, MD
Echo 1/30/2017: (Done at St Joseph Hospital)
PROCEDURE: The study was performed in the PR 1. This was a routine study. The
transesophageal approach was used. The study included complete 2D imaging,
complete spectral Doppler, and color flow Doppler. Image quality was adequate.
LEFT VENTRICLE: The ventricle was dilated. Systolic function was moderately
reduced. There was hypokinesis of the basal-mid inferolateral wall(s). DOPPLER:
The study was not technically sufficient to allow evaluation of LV diastolic
function.
AORTIC VALVE: The valve was trileaflet. Leaflets exhibited normal thickness and
normal cuspal separation. There was no evidence for vegetation. DOPPLER: There
was no regurgitation. AORTA: The root exhibited normal size. There was no
atheroma. There was no evidence for dissection. There was no evidence for
aneurysm.
MITRAL VALVE: Anterior leaflet exhibits normal excusion. The posterior leaflet
appears to have restricted motion in P2 and P3 segment resulting in incomplete
coaptation and severe mitral valve regurgitation with eccentric jet. Some of
the cordae of the posterior leaflet seem shortened. There is no apparent
valvular vegetation on the mitral valve leaflets.
LEFT ATRIUM: The atrium was dilated. APPENDAGE: The size was normal. No
thrombus was identified. DOPPLER: The function was normal (normal emptying
velocity).
ATRIAL SEPTUM: No defect or patent foramen ovale was identified. Contrast
injection was performed. There was no right-to-left shunt, with provocative
maneuvers to increase right atrial pressure.
RIGHT VENTRICLE: The size was normal. Systolic function was normal. Wall
thickness was normal. DOPPLER: Systolic pressure was within the normal range.
PULMONIC VALVE: Leaflets exhibited normal thickness, no calcification, and
normal cuspal separation. There was no evidence for vegetation.
TRICUSPID VALVE: The valve structure was normal. There was normal leaflet
separation. There was no evidence for vegetation. DOPPLER: There was mild
regurgitation.
RIGHT ATRIUM: Size was normal.
PERICARDIUM: There was no pericardial effusion. The pericardium was normal in
appearance.
The echo tells us that the heart function is reduced, it is around 35%, as opposed to the normal of 55%, and had reduced significantly since the prior study. There is a severe leak of the mitral valve, it appears to be what is known as secondary or functional MR. As things stand the mitraclip is not used to treat pure functional MR unless there is clear evidence of a primary process also which does not appear to be the case here unless the patient is enrolled in the COAPT trial. In this case i would say medical therapy is advised, and if possible CRT a good idea. In the near future, if a severe leak and symptoms remain after the treatment, he may be a candidate for transcatheter mitral valve replacement which should become a reality in the near future.
Thank you Dr. Ahmed. This makes much more sense to me now. Yes, that is the process that has been described. They tried to enroll him in the mitraclip trial but he just didn’t meet the criteria. Three docs came together to use medical therapy and CRT for secondary – there just wasn’t any previous history to know what really happened but the mitral valve sounds secondary as you suggest. I am hoping the transcatheter mitral valve will a reality (when it becomes necessary). We will have to rally for that – everything I read, it sounds it is moving but not everyone is doing it.
You are a blessing to have out there with your layman explanations.
Your time here is extremely appreciated. Again, may you be rewarded for your giving back to the communities. Maybe our paths will meet one day.
Best to you,
Khadija
Hi, my girlfriend has had chest pains and seen a cardiologist. she sent me this text ,” I have mild thickening of mitral leaflets, but no prolapse on exam, trace regurg. Mild regurg on tricuspid valve. ”
Shes going back to see doctor again on the advice of her regular doctor. can you tell me how serious this is?
It is not at all serious and nothing to really worry about.
Also given the large amount of people we have been able to help here, we are starting a twitter to help keep heart patients up to date with advances and relevant information. Mine can be followed at MustafaAhmedMD
Hello sir,
I did 2d echo 10month ago report said mild mvp with trivial TR EF 60%
Having bp 100-150.
2weeks ago it started little pain in my chest, did ekg dr said ok doctor give me pain killer pain go away, but sometimes it occurs not often. He said it is occurs due to wall problem you have to bear it.
My important question is can it possible to become mild to severe MVP in 10 months, how regularly i should done echo 6month/1year/2year.
Mild MR is very common and unlikely to become severe, it would be possible if there was severe prolapse present, also the symptoms would not be chest pain, but rather fatigue and shortness of breath most likely.
Given the large amount of people we have been able to help here, we are starting a twitter to help keep heart patients up to date with advances and relevant information. Mine can be followed at @MustafaAhmedMD
Hello sir,
I have echo 10 month ago. It says mild mvp with trivial MR. I am on beta blocker with bp 100/150. But last week I had little pain in chest come and go after ecg dr said it’s fine and give pain killer, dr said it is due to wall problem.
My question is it possible to become mild to severe MVP in 10 months , how regularly i should have 2d echo 6month/1year/2year
Hello sir iam 59 year old female i go every year for an echo i have moderate aorta regurgitation mild mvp moderately to moderately severe mitral valve regurgitation 160 mm gradient peak ef is 74 % ra 33mm ,LA 25 mm Ao 23 mm i feel very scared i get constant pvcs last year it was not severe . What do you think ?
Do you have more details of the echo report? What is the heart function, and what is the heart size? Do you have symptoms? These are important factors. The leak will need to be followed closely with at least yearly echocardiogram to assess for severity and heart function and size, and you will need to watch for development of symptoms also. If watched carefully and there is no evidence of heart dysfunction or symptoms, watching it over time is a relatively safe strategy until it becomes severe. Follow up with a cardiologist is key.
Given the large amount of people we have been able to help here, we are starting a twitter to help keep heart patients up to date with advances and relevant information. Mine can be followed at @MustafaAhmedMD
In EGC test My wife is diagnostic with Mitral Valve Prolapse – Anterior mitral Leaflet & Mitral Regurgitation (Trivial). Is this serious problem @ the age of 35 ? Does it require surgery treatment ? Kindly help me with information.
It is not a significant issue at this point.
Dear Dr.Ahmed,
Thanks a lot for such an informative website. I am 36 years old male. I have visited a cardiologist due to palpitations. he performed Echo and said Minimal MVR. Rest seems fine with echo. He said nothing to worry. I have panic disorder for years and what cardiologist told me made my anxiety even worse. The problem is I had more than 4-5 echos last 5 years period. None told me I do have minimal MVR. Shall I be concerned for progress of MVR in future? And could you please tell me is there a significant correlation between anxiety and MVR? And you said trivial and mild MVR is very common. My cardiologist told me that you can find such abnormalities in every 3 to 4 people out of 10 if you perform random echos. ???
Minimal MVR (mitral regurgitation) is common and of no real clinical significance in the majority of cases. There is no real correlation known between MR and anxiety although in the past there was a relationship between mitral valve prolapse and anxiety described.
Thanks for prompt response. You are a great doctor. I have one more question. If there is a prolapse, MVR is more likely the progress, right? Or no correlation at all. Once again thanks a lot Dr.
Dear,dr mustafa ahmed,recently i had mvp with no mr through echo ,but still im having shortness of breath in sometimes and chest pain,im feeling depressed and afraid.my age is 25
The MVP is not likely related to the symptoms directly from the valve. A syndrome of chest pain , anxiety and MVP has been described, and although the symptoms are scary the outcome is favorable. Make sure you have a medical evaluation to rule out other causes of these symptoms.
Given the large amount of people we have been able to help here, we are starting a twitter to help keep heart patients up to date with advances and relevant information. Mine can be followed at @MustafaAhmedMD
Hi Dr. Ahmed, This is about my 30 year old nephew, who is recently diagnosed with severe mitral regurgitation and aneurysm.
Angiogram:
No Blockages found
LMCA (Left Main Coronary Artery) had compression from outside.
Advice to do a CT Scan to check what is causing that.
CT Angiogram:
LMCA (Left Main Coronary Artery) had compression from a Aneurysm from Heart (Left Ventricle)
LAD (Left anterior descending artery) also had compression from another Aneurysm from Heart (Left Ventricle)
Echo:
Severe Mitral Regurgitation found
Can I refer set of reports to you and ask for your considered opinion. He is advised surgery to remove aneurysms, which should help in regurgitations.
Thanks.
It sounds complex, i would be happy to look at the films. You would have to use vitalengine.com or go through my office.
Dr. Ahmed, I really appreciate your help. I could not register myself at the site and have asked support to help create an account. I will also reach out to your office on Monday morning to follow-up.
Thanks.
Dr. Ahmed, I have uploaded CT scan, MRI and Angiogram films to vitalengine.com. Please check and advise. Thanks.
Hi Dr Ahmed – I was diagnosed with primary mild to moderate MR 2 months back rest all heart functions came out to be normal in echo performed while I was having chest discomfort, shortness of breath sometimes while stressed and anxiety attacks. My doctor put me beta blocker medicine for 50 mg everyday. I have started gym with some light weight lifting to remain active, is it ok for me to continue the same since my doctor advised to just go for a 30 mins walk as light weight lifting may put pressure on my heart and it can affect my MR to severe. I still feel heaviness on my chest could it be due to MR which was diagnosed?
In my patients with primary mild to moderate MR , in the absence of other significant issues, i do not place restrictions on activity. MR of that severity should not lead to symptoms of chest pressure and that should be investigated separately, likely with some form of stress testing.
Given the large amount of people we have been able to help here, we are starting a twitter to help keep heart patients up to date with advances and relevant information. Mine can be followed at @MustafaAhmedMD
Sir my fiance diagnosis report shows rheumatic heart disease, moderate + eccentric mitral jet regurgitation and normal systolic fraction > 65%. is it dangerous?
It needs to be monitored carefully and will likely require surgery at some point once it becomes severe.
Sir I’m 31 & just found that I’ve mild mitral regurgitation @ the report says
“Mild mitral regurgitation sec to RHD”
I was having a severe chest pain & a high blood pressure 180/110 with a higher Herat rate.
Please suggest is there anything to take action or it will increase over the period of time.
Please advice
The mild mitral regurgitation is not a cause for concern at this point. You should be monitored periodically for progression of heart disease.
If you are interested in cutting edge information and therapy for heart disease then follow my twitter at @MustafaAhmedMD
Sir, Can you please comment whether MR leads to TR in few years. Since i was diagnosed with mild MR 5 yrs back. After 5 five when i had undergone 2D echo, the results indicates both.. pl advice whether it is cause of worry
Mild MR will not lead to TR.
If you are interested in cutting edge information and therapy for heart disease then follow my twitter at @MustafaAhmedMD
thank you..
Dear Dr. Mostafa
Greetings,,
I’m 41 years old female
I have a regurgitation of mitral valve since 2000
The cardiologist advised me to do a Mitral Valve surgery
I want your opinion
I sent all reports to you through : [email protected]
hi,i have a mitral valve prolapse and mitral regurgitation..it us safe if i got pregnant?
How bad is the prolapse and how severe is the regurgitation?
i have mild prolapse and mild regurgitation..but im always sufferring palpitation,heartpain and dizzinness…
The mild prolapse and regurgitation are not likely related to your symptoms, i would suggest a heart monitor to characterize the palpitations to see if medication may be able to improve the symptoms.
If you are interested in information and therapy for heart disease then feel free to follow my twitter at @MustafaAhmedMD
im pregnant now 3months.
when im going labor what happend i suffer? it is not safe for my baby and myself?
Doctor. I have 3 times been shown (by ECG and Holter monitor) to have moderate mitral valve regurgitation, mild aortic valve regurgitation, prolapsed mitral valve, atrial fibrillation (uncontrolled post atrial ablation, but controlled by arhythmic), pulmonary hypertension. I have the following symptoms, shortness of breath, periodic chest pains, fatigue, periodic dizziness, chronic low blood pressure (normally systolic in the low 90’s or upper 80’s; has dropped sometimes into the low 50’s). What’s the likelihood that I will need surgery?
It all depends on the progression of the mitral regurgitation and the effect it has on the heart. Moderate mitral regurgitation doesn’t need surgery in general. Its important to clarify the mechanism of the mitral regurgitation and the severity of the mitral regurgitation. Primary MR will need to be monitored periodically. Secondary MR will need close attention paid to the underlying causes which if treated can prevent progression and possibly improve. Discuss this with the treating cardiologist.
If you are interested in information and therapy for heart disease then feel free to follow my twitter at @MustafaAhmedMD
I’m really worried, and would so appreciate your answer – my echo said I have a “mildly thickened mitral valve” while the leaflets have normal mobility, and no evidence of stenosis. Trivial mitral regurgitation (and mild tricuspid regurgitation). Is this dangerous? I’m only 27, so I don’t understand why it would be thickened now, when previous echos were normal. My mom does have mitral valve prolapse, but previous echos have always said I didn’t. I’m scared. Can this mild thickening cause sudden cardiac death or anything bad? And, why would it happen now?
Its not dangerous and you have nothing to worry about.
If you are interested in information and therapy for heart disease then feel free to follow my twitter at @MustafaAhmedMD
Can someone with Moderate anterior Mitral valve prolapse and bicuspid aortic valve and Trivial TR take accutane for severe Acne?
The valve disease is not a contraindication to acne medicine.
If you are interested in information and therapy for heart disease then feel free to follow my twitter at @MustafaAhmedMD
hi doc,i have mild mitral valve prolapse since 2015…i have so many symptoms,and now im 14 weeks pregnant..im sufferring palpitation and heartache…my doctor said its ok if i got pregnant but i cant take medicine..what is your suggestion about my pregnancy?
Mitral valve prolapse alone, particularly when not associated with valve issue such as leak is not known to cause issues with pregnancy.
If you are interested in information and therapy for heart disease then feel free to follow my twitter at @MustafaAhmedMD
hi doc,i have mild prolapse and mild mitral regurgitation since 2015..and now im pregnant for 14 weeks and im sufferring palpitation,numbness and heartpain..it is safe for me and the baby? and whats your opinion doc about my pregnancy?can i continue this or not?
Mild mitral regurgitation and mild prolapse in and of themselves will not interfere with preganancy.
If you are interested in information and therapy for heart disease then feel free to follow my twitter at @MustafaAhmedMD
im pregnant now 3months.
when im going labor what happend i suffer? it is not safe for my baby and myself?
im pregnant now 3months.
when im going labor what happend i suffer? it is not safe for my baby and myself?
hello doc I am peter lloy, I am 20 years old. Last september 6, 2017 i was diagnosed of mild mitral regurgitation my question is why is it that I have the shortness of breath and when I sleep my heart beats faster I cant sleep well because of it and I feel tired, has my MR gone to mild to severe??? my EF is only 58% can that be considered mild MR???
Its very unlikely for mild to progress to severe like that without a significant alteration in the valve. If your symptoms have changed since that time then i would suggest someone at least listen with a stethoscope to see if there is a murmur or something to suggest a worsening.
If you are interested in information and therapy for heart disease then feel free to follow my twitter at @MustafaAhmedMD
Is it possible doc that I would go open heart surgery even though my diagnosis is only mild? just so that my symptoms would be removed and my MR would not become complicated cause this has bothered my life and I cant focus on my studies anymore,
Mild MR is common and should not be a cause for concern to you.
If you are interested in information and therapy for heart disease then feel free to follow my twitter at @MustafaAhmedMD
hello doctor,
i have mitral valve prolapse with trivial mr….. i get panic attack …. ?
It is generally not dangerous.
Asalamu Alikum Doctor
My mother aged 53 had rhemutic heart and was operated sucesfully 30 years back with baloon valvetomy.
She was on betablockers and asprin
She is on regular follow up and echo upto year showed
Rhemutic mitral valve with adequate mitral valve area
Moderate MR
Mild TR
Ef 75%
7 days back she developed chest paint and was rushed to emergency where ecg showed Atrial fibrilation with FVR.
She was precribed admitted for a short period and dilizeam 3 cc was administered iv which contolled her rate.
She was refered for echocardiogram which showed
Rhemutic mitral valve with adequate mitral valve area
Modetate MR
Mild TR
Mild Ar
Dialated La 51mm
She was put on anticongulant (warfin 2mg)
Beta blocker atenelol 50 mg OD
Dilitezam 30 mg
And spiractone
We had an ecg everyday since than which shows af..but controlled rate of 50 to 70 bpm
What to do next….
It sounds like things are being managed appropriately as per your treating cardiologist.
The atrial fibrillation is well controlled now and not uncommon in those with rheumatic mitral valve disease. It is appropriate to be on a blood thinner like warfarin to prevent the development of clots. The echocardiogram seems to suggest that the mitral valve area is not too tight and adequate for now. If medical treatment such as this fails, surgery may be required one day.
………………………………………………………………………………………………………….
If you are interested in information and therapy for heart disease then feel free to follow my twitter at @MustafaAhmedMD
Sorry to mention in her latest echo she had
Normal LV Systolic Function
And ef of 70%
I am a 38 year old female who had an echo done at 3 months gestation with my fifth child. Echo came back as having a left ventricilar ejection of 65%, moderate mitral and tricuspid regurgitation, mild pulmonary insufficiency, and moderate pulmonary hypertension (46 systolic pressure). I was told at the time that this was die to pregnancy, even though I was still within my first trimester. I just had another echo and the tech mentioned that I still have leaky valves and that she expects that I will still have high pulmonary hypertension levels, but needed to run the numbers. I have a few questions… 1) If I were to get my regurgitation problems fixed, could I reverse the pulmonary hypertension. 2). What can I do at home to help build heart strength?
I want to live. I have 5 children and desperately want to be around to watch them grow. I wantbto be healthy. In reading articles on the internet, I feel I’ve been dealt a death sentence. Please help call my anxieties.
I should mention, it has been a year and a half between echo and I am 1 year postpartum
I don’t see anything here that should make you feel like you have a death sentence!
Moderate valve leakage, if truly moderate is unlikely to be the cause for any significant issue. If the valve disease is moderate in nature there is no indication for repair.
I would advise the following for you to discuss with the treating cardiologist;
Ask for the echo to be reviewed and the severity of the valve disease be clarified
Ask for the pulmonary artery pressure estimate to be clarified and then for a discussion as to whether there are risk factors and reversible potential causes (treatment of intracardiac pressures, sleep apnea, hypertension, obesity etc..)
If you are interested in information and therapy for heart disease then feel free to follow my twitter at @MustafaAhmedMD
Hello doctor, thank you so much for taking time to answer questions from everyone. I’ll try to keep mine simple. Strike that..I’ll try to keep it short….it might not be simple. 42 Male, Marathoner, have zero problems with exercise. Diet is pretty darn healthy. Syncope episodes date back to 2nd grade. Diagnosed with POTS/Ehlers Danlos Type 3. Hydration/plenty of salt has helped the POTS related syncope but I have near syncope that is not pots related, this I’ve felt while driving and while standing up….definately not the typical POTS I’ve known all too well. Unstable BP (mainly diastolic has changed in the past few years) ECHO: Mitral Valve: leaflets thickened-open well. Mild annular calcification, mild insufficiency. Aortic: Moderate Sclerosis-good opening, trace insufficency. Tricuspid: trace insufficency LV: Upper range of normal size. Left Atrium Upper range of normal size. Inflow pattern in diastole across mitral valve suggestive of reduced LV compliance.
I have found no common denominator of what would make my BP be high sometimes and perfect at other times. Occasional stabbing pain in left shoulder, but this is rare. I do feel a flip/flop of the heart like it skips a beat.
I just moved to Atlanta from Chicago and the Cardiologist here is considering a loop recorder after a calcium score, but this is a general cardiologist. Any thoughts? I’d be more than willing to drive to Birmingham (I’ve already considered this to see the connective tissue clinic at UAB as Emory does not see patients with EDS and the Rheum @ Piedmont has never had an EDS patient.
Thank you!
And I should throw it out there that I’m a non-smoker/very rarely drink. And I lost count at the times I’ve been in Tachycardia when I’ve went to my PCP and had no clue. Once I was in SVT but that was likely due to a GI hemorrhage.
POTS and connective tissue disorders as you describe are often coexistent and it sounds like you have a good feel for your reaction to that. The echo is basically normal, i don’t see an issue in the report that would need attention. In terms of near syncope, depending on the frequency a form of monitoring is advised and if conventional monitors aren’t fruitful then a loop isn’t a bad idea . An exercise treadmill test would also be reassuring given the atypical symptoms, even if calcium score is done then the treadmill to me is important, the heart monitor would address any potential arrhythmic cause also. You almost certainly be plugged in with a connective tissue disorder clinic, i don’t work at that particular facility however.
you can follow my twitter at @MustafaAhmedMD
Hi Dr. Ahmed,
Thank you for your quick response on Twitter and this excellent article.
I am a 40yr old male in otherwise excellent health and was diagnosed with MVP with mild regurgitation 10 years ago after I felt ‘flopping’ heart events at rest. After a few weeks of reduced caffeine this sensation went away.
Several days ago I started to feel odd symptoms such as sudden shortness of breath and cold/tingly hands as well as irregular heart beats. Yesterday after a short flight out of state I felt an increase in the intensity and rate of my heart beating and shortness of breath as well as sporadically feeling like I was about to lose consciousness as I lay in bed. I visited the local ER and my EKG & bloodwork were nominal so I was discharged with instructions to visit my primary; the attending guessed it was MVP related. I flew back home immediately.
I have an appointment with my primary tomorrow but highly suspect my mild valve disease has progressed to a point at which action may be required, possibly urgently. In your experience, am I reasonably safe in waiting until tomorrow for a primary appointment and possibly another day or two for an echo or should I take more immediate action? How dire are valve complications from a timeline perspective? Back to my question on twitter, assuming action is warranted, how do you decide between a mitroclip and robotic repair?
Thank you for any insight!
John
Unless a significant new murmur was heard then its unlikely the regurgitation has worsened. As to the timing of medical attention it is very dependent on how you feel and how stable you are, the bottom line is if you are concerned and don’t feel you are ok in terms of breathing or clinically stable then you should seek attention. Its very reassuring however that the treating team felt you were ok to be discharged and you were able to fly. If the mitral valve had drastically and suddenly worsened then you would be very sick right now, not likely able to type this message! Firstly get an echo and an evaluation, then if it turns out you have significant regurgitation that requires attention ill be happy to discuss further. At the age of 40, otherwise well, i would suspect robotic clearly wins. Maybe you are concerned about something you may not have, hopefully so.
After all that worrying, looks like I had a bad case of myocarditis. Echo came back ok. Many bananas and gatorades later I’m starting to feel normal again except for some residual neuropathy that is slowly improving.
You called it – I was concerned about something I don’t have! Still can’t believe it… thank you.
Hi Dr. Ahmed,
I wrote a longer question earlier but it seems to have disappeared. I was wondering how you decide on mitraclip vs robotic repair when a patient has MVP and requires treatment? I am 40yrs old and in excellent shape and I believe I’ll be faced with this question quite soon based on my symptoms.
Thank you,
John K
I have recently been told that I have mild to moderate leakage from the mitral valve.
I am experiencing light heads daily which can be very tough at times feeling as if I’m about to pass out. I am very nauseous with this. I’m exhausted all of the time. I also feel a real heavy tension in my chest at times. Any advice?
The mitral valve, if truly only moderate in leak is not likely to be associated with these symptoms.
you can follow my twitter at @MustafaAhmedMD
My 13 year old daughter was diagnosed with a heart murmur when she was 2. When she was about 2 and half she had an echo. I was told everything was great and not to worry about it. Recently, she has had some changes- she was diagnosed with bilateral SNHL in August and I have noticed her feet will turn purple if she crosses her legs. I am concerned about this, but the pediatrician told me not to worry about it. She said this just ‘happens to some kids’. I don’t know any other 13 year old that turns purple up to her ankles and has blood pooling up in her legs. Anyway, I was reading her echo this morning. I saw that she had trivial regurgitation at 2 and half. I read a lot of the comments and i see that it typically does not change. However, I also read in your article that it can get worse as you age. Is this something she should have looked at again? Should she have an echo more than one time in her life to make sure that there are not any changes?
I am very concerned and I am not confident in the pediatrician’s ‘Don’t worry about it approach’.
I would appreciate any thoughts you have on the subject.
If it was trivial, in general it is not a concern for progressing. I would suggest that if there is no development of a worsening murmur and the pediatrician is not worried then there is not likely anything to be concerned about. If she does have a significant murmur its reasonable to obtain an echo to see where things stand.
you can follow my twitter at @MustafaAhmedMD
I typed a long question and it appeared to have disappeared.
Basically, my question is- My daughter has a heart murmur that was checked at the age of 2, we were told it was fine and not to worry about it. Now at the age of 13, she was just diagnosed with bilateral snhl, and blood is pooling up in her legs if she sit with her legs crossed or if they dangle from a chair. Her pediatrician has advised us that this is ‘normal’ and not to worry about it. I am concerned that we should have her complete another echo or at least see a cardiologist. I read the echo report from when she was 2 this morning. She had mild regurgitation at the time. Is this something that we should have looked at again? Or just assume that it will always be fine? The pediatrician does not seem concerned at all or think that there is any link between the sudden hearing loss and her heart murmur.
See the prior answer, also i doubt there is any link between the SNHL and the murmur.
Hi dear Dr. Ahmed,
Thanks for your kindly answers,
About 20 month ago I did an echocardiography and the only problem in the answer was about mitral valve as below:
Mitral Valve (MV): PML prolapse , Trivial MR
GLOBAL EF: 60%
and the final conclusion was :GLOBAL LVEF: NORMAL, LV SIZE IS NORMAL , E>A , TRIVIAL MR/PML BILLOWING NO THICKENING , NORMAL OTHERS FINDING.
But last weak a General practitioner checked my heart with his Stethoscope and said to me that my MR is more than usual and I should be checked by an cardiologist for ”MVP+MR”!
I said to him that I even play football every weak and I have no problem but he said playing football for me is strange and maybe dangerous, although I play amateur not professional!
Now I’m really worried about my mitral prolapse and if it get worse after my last echocardiography!
Please help me about this! Is football harmful for it and should I do another echocardiography now! What can I do to stop my illness progress?
Thanks,
Sina Kazemi
What did the Dr hear? If there is the development of a murmur then there is a possibility of worsening leak and an echo would be reasonable. If mild, then there should be no issue with playing football recreationally.
you can follow my twitter at @MustafaAhmedMD
Hello Dr Ahmed
My father age 58 had an echocardiography 2 months before and said LA LV enlarged…
than doctor referred to another hospital for angiography test and there all tests have done and doctor told us coronoray normal
but echo shows Severe MR moderate AR and suggested for “double valve replacement” surgery
so is that possible in 2 months MR becomes severe
or we should ignore that 2 months before echo as it was done by general physician not cardiologist
reports are-
LA,LV dilated
severe MR with eccentric jet(area-9.2 square cm)
Moderate AR
fair LV function
LVEF-52%
so Sir,
what u suggest
Its not possible to comment without seeing the images.
Dear Dr. Mustafa,
I did Mitral Valve repair back in August 2017 and the repair was successful and the heart Murmur was gone and only taking Aspirin , 2 months later I was admitted ER. for shortness of breath light headed. the perform Echo after hearing Heart Murmur and Echo shows some valve leakage and then decide to do TEE.
the results: Trace aortic regurgitation, Mild Mitral regurgitation there are tow separate Jets of Mitral regurgitation (Mild in summation)the first is central Jet(ps Level) the second is and accentric anterior direct Jet.
know after this happens I’m on medication.
kindly advice
sorry I forget to mention that I have palpitation too.
Dear Dr Ahmed
I have had mild mitral regurgitation and at one point had pulmonary hypertension.Now I only have mild mitral regurgitation can it progress as well as cause pulmonary hypertension?
Dear Dr Ahmed
I have had mild mitral Regurgitation and at one point had pulmonary hypertension. Now I only have mild mitral Regurgitation can this progress and lead to pulmonary hypertension?
Mild mitral regurgitation in general is not a cause for concern.
Thank you for your reply Dr Ahmed.
Hi :
My father is having mild to moderate MR. He is experiencing high heart beats at times. Is it something to worry ?
Mild to moderate MR should not cause symptoms or issues.
Hi Dr. Ahmed,
Below is my echo results that i have done 8 months ago and lately I have been noticing palpitation at random time of the day which has been going on for 3 weeks now. Should I be worried and see a cardiologist soon? Please advise.
Transthoracic Echocardiogram – Adult
_______________________________________________________________________________________________________________
Name: PARVIN, TANJINA MRN: 903801165 Performed By: Maci Masterson,
RCS
Study Date: 02/11/2017 09:24 AM Acct #: 2040177818
DOB: 06/24/1987 Age: 29 yrs Gender: Female
Ordering MD: BENDI, INDUMATHI Patient Status: Outpatient
Referring MD: BENDI
_______________________________________________________________________________________________________________
Reason For Study: PALPITATIONS
Height: 61 in Weight: 125 lb BSA: 1.5 m2 HR: 90 BP: 120/80 mmHg
PROCEDURE: A complete two-dimensional transthoracic echocardiogram was performed (2D, M-mode, spectral and
color flow Doppler).(93306). Platform: Siemens. A contrast injection of Definity was performed to improve
assessment of LV. Contrast was injected in the left arm. The study was technically adequate . No previous
study available.
_______________________________________________________________________________________________________________
CONCLUSIONS
LV is normal in size.
LV EF is normal.
LV EF is 60-65%.
RV is normal in size and function.
LV relaxation is normal. LV filling pressure is normal.
NO significant valvular abnormalities.
LEFT VENTRICLE:
LV EDVi = 46.6 mL/m². LV ESVi = 17.3 mL/m². LV EDDi = 2.6 cm/m². LV ESDi = 1.7 cm/m². LVOT diameter = 1.8 cm.
LV stroke volume = 57.1 ml. LV is normal in size. LV EF is normal. LV EF is 60-65%. LV wall motion is normal.
IVST = 0.45 cm. PWT = 0.43 cm. Normal wall thickness. GLS = -21.13%. GCS = -24.73%. MV E velocity = 92.5
cm/sec. MV A velocity = 60.2 cm/sec. MV E/A ratio = 1.5 . Lat E/E` = 4.5 . LV relaxation is normal. LV filling
pressure is normal.
RIGHT VENTRICLE:
RV basal dimension is 2.7 cm. TAPSE = 1.9 cm. RV S’ velocity = 13.4 cm/sec. GFWS = -25.28%. RV is normal in
size and function.
LEFT ATRIUM:
LA volume index = 14.8 mL/m². LA is normal size.
RIGHT ATRIUM:
RA area = 8.8 cm². RA size is normal.
AORTIC VALVE:
AV is trileaflet and opens well. No AR.
MITRAL VALVE:
MV is normal. Trace MR.
TRICUSPID VALVE:
TV is normal. Trace TR.
VEINS:
The IVC is normal in size, and collapses normally with respiration.
RIGHT HEART/PULMONARY HEMODYNAMICS:
Insufficient TR jet to assess PA systolic pressure. Estimated RAP = 5.0 mmHg. PV VTI = 17.9 cm.
PULMONIC VALVE:
PV is normal. No PR.
ARTERIES:
Aortic root = 23 (mm). Aortic root is normal size.
PERICARDIUM/PLEURA:
No pericardial effusion.
The echo itself appears basically normal.
Hi doctor,
I was diagnostic with mild valve regerutation, mild tricuspid regurgitation and trace pulmonic regurgitation. I live with every day with heart beating 80-110. Also I have short breathing . How risky is my life and does it the norm heart beating like these numbers.
Thanks, Dolly
Hi Dr. Ahmed,
I was diagnosed with MVP with trivial MR almost 3 years ago, my most noticeable symptoms are high heart rate (when without beta blocker) and skipped beats.
I found that my heart rate would sky rocket to 110-115 when standing up after eating a large meal with carbs, event when I’m already taking beta blocker. Is this still normal?
Hi, its difficult to tell you if thats normal or not. Have you discussed this with your physician, have you worn a monitor to characterize the heart rhythm. The trivial MR is considered basically a normal finding.
you can follow my twitter at @MustafaAhmedMD
Hi Dr. Ahmed,
I underwent medications a month ago due to acid reflux. I told my Doctor that i had series of palpitations so she advised me to do ECG (normal) and 2D Echo (diagnosed with trivial mitral regurgitation). I sometimes felt scared/nervous at night and sometimes experience as if i can’t breathe or there is slight discomfort in my chest after every meal. Is it normal? I’m really scared of operations etc. This article of yours is really helpful.
The trivial mitral regurgitation should be considered a normal finding and is not of concern. Your dr should evaluate the symptoms and find out the underlying cause as they are doing.
you can follow my twitter at @MustafaAhmedMD
Dear Dr. Ahmed,
Firstly thank you for the long and well explained article. As a mother of a child of 10 years of age diagnosed with MVP with regurgitation I have been desperately trying to find our more information. As usual the internet can be full of shocking and terrifying information written by incompetents or reassuring written by professionals like your good self.
My story is a follows. Approximately 4 years ago, when my daughter was 5 1/2 years old, I started to hear a noise coming from her chest. It would happen briefly, (a few seconds), whenever she cried, coughed, hiccuped or got excited. Even just turning onto her side whilst sleeping.
I took her to the local ER on a number of occasions, where they found/heard nothing. Until one day (2 years ago), I decided to take my daughter to a pediatric cardiologist.
After an ultra sound and and ECG the cardiologist showed me MVP with light to moderate regurgitation.
However, thankfully she has no symptoms.
I have some questions that I want to ask, but I am afraid to ask them to the doctor with my daughter present as I do not want to scare her and cause anxiety. However, this is causing me great anxiety, especially as on the rare occasions that I hear her “Squeak”, I go into a panic. For clarification, yes I do hear the noise from a distance with my own ears and without need of a stethoscope.
My questions are the following:
1. Is it possible that she can remain stable all her life without intervention or medication? (given that she was diagnosed so young I am worried that the heart will get damaged)
2. Is pregnancy a danger for her?
3. Why does she start squeaking for no apparent reason, for example when she gets dressed in the morning?
4. Lately she has started to notice that occasionally when she strains on the toilet or stretches, that she has a wooshing noise in her left ear. Does this have anything to do with the MVP?
5. I do not let her do physical education at school as I am worried about the regurgitation. Thinking that the more the valve regurgitates, the more likely it is to damage the heart. Am I doing more harm than good?
Thank you again and I apologize for the long explanation.
I would recommend you are seen by a pediatric cardiologist to ensure the information you were given is accurate and up to date if you are worried.
Mild mitral regurgitation can remain stable for a very long time, would recommend routine check ups only, typically nothing else, no specific treatment required for mild MR.
Mild MR is not an issue for pregnancy as it is not considered a significant medical condition
The noise you are hearing is nothing to do with the heart or the valve.
The noise in the ear is likely completely unrelated to the heart or MVP
For mild MR, physical activity is no issue.
Again, I would recommend you are seen by a pediatric cardiologist to ensure the information you were given is accurate and up to date if you are worried.
you can follow my twitter at @MustafaAhmedMD
Hi Mr.Ahmed, i am 38 years old male. i want to share my holter and EKO results. ：Rare APC 5 adet。Rare VPC 6 adet。Longest R-R interval 1.82 seconds（uykuda gece 3:21 civari） EKO：No chamber dilation Good L V dialostic function Mild to moderate MR，rebundant MV Trivial TR，PG：18 mmHg，estimated RVSP：21 mmHg Normal RV systolic function.
i really very worry about mild to moderate MR. what is the difference between moderate and mild to moderate. My doctor said problem is not big and he recommend me to take 10 mg propronalol during exited times such as anxiety etc. i know that i have a panic disorder and afraid of any heart trouble. i had PAF attack 4 years ago, i was very nervous that day and than suddenly my heart beat rose up to 200 and than in the emergency it turned into AF but 2 days later during fulll body check up doctors couldn’t find anything. After that day i do full check ups every year. i even get EKO in every 4-6 months. i do normal work out such as jogging gym (not heavy weights or hard training) my doc in Turkey said i can forget PAF because it is been a long time. However i still doubt about my heart and always thinking my heart checking my pulse all the time. sometime i have extra beats. yesterday had 5 seconds arrhythmia.i didn’t feel dizzy or fainted , it was like suddenly my heart started to move with out rhythm. i afraid climbing stairs in these days and also don’t like mountains climbing etc. i afraid cable cars too. a doctor said that my medicine is not enough ? i am confused. I found your website and saw your passion to you job and patients. i want to know my situation. i don’t have cholesterol, i am fit , no heart disease in family , no smoking ,no alcohol, no caffeine.i did efor test too 2 weeks ago , it was normal. I really need your help now. Thank you.
Your echocardiogram is relatively normal. You have a small amount of leakiness of the mitral valve that is certainly not in a severe range. You have mild to moderate regurgitation and that in isolation isn’t a cause for concern. You should have periodic check ups, such as a yearly physical to assess murmur and an echo every few years to monitor the valve. If you develop new symptoms such as shortness of breath or fatigue then you should seek evaluation. As things stand, unless you have been told otherwise there is no cause for concern with regard to the valve. The next step here would be a monitor to assess the palpitations and characterize them. In some cases a routine use of a beta blocker may be of help.
you can follow my twitter at @MustafaAhmedMD
Thanks for your reply Mr.Ahmed. it is written on my EKO: LV diastolic function impaired relaxation.I forgot to write it last message. Afterwards while i was playing with my daughter i did a sudden move and my heart lost rhythm started beating faster with irregular beats in the middle. i was panicked, i was about to call ambulance or taxi but it came back to normal in 2 minutes. i don’t know that ,i afraid of AF situation. i wasn’t dizzy or anything, just irregular hear beats after that move. Than i took rest and started work out but very light, a bit jumping soft jogging . i didn’t feel bad !! I didn’t have any written record of that day thats why doctor can’t say anything either. he gave me 1.25 mg concor. i take 1 after breakfast. Psychology said if i have palpitations i can add 10 mg propranolol , if still no effect than i can take xanax. In these days i still have extra sudden beats in my heart but not so many, maybe 10-15 times a day. In Some places i feel i can’t breathe and pressure on my stomach area. i am confused is it heart related or anxiety related? i afraid work out in these days too. i know i have small issues with heart but now my situation is can’t make any clear statement about my body. That’s why keep reading on internet and you are the only person i wrote this message, i am just looking for a better treatment way. i live in Taiwan, very developed in medicine but i can’t find my answer, makes me sad and nervous about my heart. Don’t wanna die of heart at this age.I afraid. i just want to know the problem and than fix it. 24 hours holter can’t catch my whole weeks or months. Thanks.
I’m 28. I had an echo done, because of panic attacks, and it said that there is a “mildly thickened mitral valve with normal mobility, no stenosis, and trivial regurgitation”, as well as “mild tricuspid regurgitation, and mild concentric left ventricular hypertrophy.” I don’t have high blood pressure or smoke or anything. I do have blood pressure spikes and a high pulse during panic attacks, but they are short-lived. In fact, my blood pressure is low-normal when I’m not anxious (like 105 top number). I am, however, overweight, but trying to lose it. A second cardiologist (at a bigger hospital in a bigger city) agreed to review my images after this echo result, and only told me I don’t have LVH, and that everything was normal, to not even follow-up about it. I’m still really scared, because I feel like I’ve had these mixed messages, with the person who read my echo saying these scary-sounding things, and this cardiologist saying I’m fine. I’m terrified of dying, and this has made my anxiety so much worse. I am scared all of the time that my heart will stop. I would so appreciate you offering guidance on this – do you think this sounds fine? Is thickening normal in someone in their 20s/does it not progress, and can LVH be misread? Thank you so much.
LVH can be a misread, it needs tO be calculated. Your echo report does not seem to show any high risk features. If there was something to worry about, in most cases your dr would be sure to point it out.
you can follow my twitter at @MustafaAhmedMD
Thank you so much for taking the time to answer. Is the mitral valve thickening something to worry about, if it’s there? Can it turn into stenosis or anything bad? I’m 28, and I’m afraid it all means I won’t live very long.
It is not likely to be significant. Thickening in isolation isnt a concern.
you can follow my twitter at @MustafaAhmedMD
Hello,
My ECHO came back as normal heart function, but with trivial regurgitation of three valves. Do you have any recommendations to prevent it from getting worse over time?
Also, will adderall make this worse?
Thanks,
Casey
I had a mitral valve REPAIR 7 years ago by one of the US pioneers in this field, who did a very fine job by all accounts, although I had post-op delirium with psychosis and finally ICU PTSD, all complicating my overall recovery course, which can happen, and is just the luck of the draw. It is still a fine and fortunate thing that I could have had such surgery. Today’s cardiac echocardiogram had some sub-result of 24 mmHg “across the mitral valve” (I think….I may have misunderstood some of that). I have been wondering about my overall prognosis, as I approach my 70th birthday, and yet this seems to be a topic that never goes beyond “you can never tell”. Of course not, but there must be Some generalizations that can be made, some knowledge of how these repairs endure, yes? Or not….? I do understand no one can predict the future for any one person, nor am I asking that. I am asking what people can generally expect…. Thank you for the obvious trouble you put into your informative site. That is very kind of you to do.
In more cases that not i would say the repair will last life long.
you can follow my twitter at @MustafaAhmedMD
Hi, I have moderate mitral valve regurgitation. Could pregnancy make the valve get worse? Also, am I able to lift heavy things or could it make it worse? Thanks
Pregnancy can enhance flow and output, however in general moderate mitral regurgitation is well tolerated in pregnancy. Its important to have a specialist monitor and define the severity at baseline.
you can follow my twitter at @MustafaAhmedMD
Thankyou for your reply, could you please explain what you mean by ‘specialist monitor to define the severity of baseline?’
Also can I lift anything heavy or could it make it worse?
Thankyou
could the valve go from moderate to severe because of the extra blood flow during pregnancy? Or just after pregnancy? Thanks
Hi, I have moderate mitral valve regurgitation. I wondered if it could get worse during preganancy. Also if it could get worse if I was to lift anything heavy? Thankyou
Hi doctor my wife aged 31yrs is diagonised with “Moderate prolapse of anterior mitral leaflet with mild mitral regurgitation,Good systolic function,No regional wall motion abnormailty of LV”
The doctor says this is coz of her collosal body property her valve has elastic tendency which causes thia problem and its inborn,she is fine for all these years,recently she had 4 to 5 occurances of pulpatation over a week and now she is normal,
Iam very much worried ,is it something to be worried about,will it worsen in future ,does she need to undergo a surgery in future ,should she be on rest or can she do normal daily activities,is it safe to plan for a pregnancy,kindly advise me doctor on wat to be done pls
These questions should be answered by a healthcare provider that has full access to records and tests and history. In general moderate prolapse with mild regurgitation is not an immediately concerning issue and needs monitoring over time only. It may stay stable for a long time. Moderate MV prolapse with mild MR is not a contraindication to pregnancy. No surgery or treatment of that alone is needed.
you can follow my twitter at @MustafaAhmedMD
Hi Doctor,my wife age 31 has “Moderate prolapse of anterior mitral leaflet with mild mitral regurgitation,good LV systolic function,No regional wall motion abnormality of LV”
Echo cardiogram report
LVtiech(M) direct
1)IVSd 8.2mm LVIDd
2)LVPWd 6.3mm IVSs
3)LVIDs 29.7mm LVPWs
4)EDV 86.8mL ESV
5)SV 52.6mL EF
6)FS 32.19% LV mass
7)LV Mass-c 95.6g
AV/LA (M) (DIRECT)
1)AOd 28.1mm LAs diam
2AOd/LAs 0.89mm LAs/LOd
MITRAL VALVE DIRECT
1)MV E Pt 0.64m/s MV A Pt
2)DEC TIME 113ms Dec slope
3)MV PHT 33ms E/A
4)A/R 0.55 MVA(PHT)
AORTIC VALVE (DIRECT)
AV Vmax 0.91m/s AV PG max
TRICUSPID VALVE (DIRECT)
TV E Pt 0.59m/s TV A Pt
E/A 1.74
PULMONARY (DIRECT)
PV Vmax 0.78m/s PV PG max
Our doctor said she ia born with this and she has got a collosal tendency or more elastic propery ,thats why her valve is floppy,
Dr.Ahmed Is it sometimg to be worried of,
Can she do normal daily activities
Can she exercise
Is it safe to plan for a pregnancy
Is tr any cure for this,
Will this become severe over age
Iam very much worried doctor ,pls help me
Thank u very much docor for ur time in explaining,here in my country no one ia giving a proper reply doctor,kimdly help me ,she doesnt hve any previous history of this instance ,she only felt some pulpatation and shortness of breath may be for 5 times and that too when she was stressed thats all ,this is the first time we found out she has this problem,and i hve attached her echo results below,kindly have a look and let me know is it something to be worried about,
She is my everything doctor ,pls study the report and kindly inform me of her current state the best u can with the available echo,pls,all i want to know is,is it something life threatening or is it something to be worried
“Moderate prolapse of anterior mitral leaflet with mild mitral regurgitation,good LV systolic function,No regional wall motion abnormality of LV”
Echo cardiogram report
LVtiech(M) direct
1)IVSd 8.2mm LVIDd
2)LVPWd 6.3mm IVSs
3)LVIDs 29.7mm LVPWs
4)EDV 86.8mL ESV
5)SV 52.6mL EF
6)FS 32.19% LV mass
7)LV Mass-c 95.6g
AV/LA (M) (DIRECT)
1)AOd 28.1mm LAs diam
2AOd/LAs 0.89mm LAs/LOd
MITRAL VALVE DIRECT
1)MV E Pt 0.64m/s MV A Pt
2)DEC TIME 113ms Dec slope
3)MV PHT 33ms E/A
4)A/R 0.55 MVA(PHT)
AORTIC VALVE (DIRECT)
AV Vmax 0.91m/s AV PG max
TRICUSPID VALVE (DIRECT)
TV E Pt 0.59m/s TV A Pt
E/A 1.74
PULMONARY (DIRECT)
PV Vmax 0.78m/s PV PG max
Hi Doctor,my wife age 31 has “Moderate prolapse of anterior mitral leaflet with mild mitral regurgitation,good LV systolic function,No regional wall motion abnormality of LV”
Echo cardiogram report
LVtiech(M) direct
1)IVSd 8.2mm LVIDd
2)LVPWd 6.3mm IVSs
3)LVIDs 29.7mm LVPWs
4)EDV 86.8mL ESV
5)SV 52.6mL EF
6)FS 32.19% LV mass
7)LV Mass-c 95.6g
AV/LA (M) (DIRECT)
1)AOd 28.1mm LAs diam
2AOd/LAs 0.89mm LAs/LOd
MITRAL VALVE DIRECT
1)MV E Pt 0.64m/s MV A Pt
2)DEC TIME 113ms Dec slope
3)MV PHT 33ms E/A
4)A/R 0.55 MVA(PHT)
AORTIC VALVE (DIRECT)
AV Vmax 0.91m/s AV PG max
TRICUSPID VALVE (DIRECT)
TV E Pt 0.59m/s TV A Pt
E/A 1.74
PULMONARY (DIRECT)
PV Vmax 0.78m/s PV PG max
Our doctor said she ia born with this and she has got a collosal tendency or more elastic propery ,thats why her valve is floppy,
Dr.Ahmed Is it sometimg to be worried of,
Can she do normal daily activities
Can she exercise
Is it safe to plan for a pregnancy
Is tr any cure for this,
Will this become severe over age
Iam very much worried doctor ,pls help me
Hi Doctor,my wife age 31 has “Moderate prolapse of anterior mitral leaflet with mild mitral regurgitation,good LV systolic function,No regional wall motion abnormality of LV”
Echo cardiogram report
LVtiech(M) direct
1)IVSd 8.2mm LVIDd
2)LVPWd 6.3mm IVSs
3)LVIDs 29.7mm LVPWs
4)EDV 86.8mL ESV
5)SV 52.6mL EF
6)FS 32.19% LV mass
7)LV Mass-c 95.6g
AV/LA (M) (DIRECT)
1)AOd 28.1mm LAs diam
2AOd/LAs 0.89mm LAs/LOd
MITRAL VALVE DIRECT
1)MV E Pt 0.64m/s MV A Pt
2)DEC TIME 113ms Dec slope
3)MV PHT 33ms E/A
4)A/R 0.55 MVA(PHT)
AORTIC VALVE (DIRECT)
AV Vmax 0.91m/s AV PG max
TRICUSPID VALVE (DIRECT)
TV E Pt 0.59m/s TV A Pt
E/A 1.74
PULMONARY (DIRECT)
PV Vmax 0.78m/s PV PG max
Our doctor said she ia born with this and she has got a collosal tendency or more elastic propery ,thats why her valve is floppy,
Dr.Ahmed Is it sometimg to be worried of,
Can she do normal daily activities
Can she exercise
Is it safe to plan for a pregnancy
Is tr any cure for this,
Will this become severe over age
Iam very much worried doctor ,pls help me
Thank u very much docor for ur time in explaining,here in my country no one ia giving a proper reply doctor,kimdly help me ,she doesnt hve any previous history of this instance ,she only felt some pulpatation and shortness of breath may be for 5 times and that too when she was stressed thats all ,this is the first time we found out she has this problem,and i hve attached her echo results below,kindly have a look and let me know is it something to be worried about,
She is my everything doctor ,pls study the report and kindly inform me of her current state the best u can with the available echo,pls,all i want to know is,is it something life threatening or is it something to be worried
“Moderate prolapse of anterior mitral leaflet with mild mitral regurgitation,good LV systolic function,No regional wall motion abnormality of LV”
Echo cardiogram report
LVtiech(M) direct
1)IVSd 8.2mm LVIDd
2)LVPWd 6.3mm IVSs
3)LVIDs 29.7mm LVPWs
4)EDV 86.8mL ESV
5)SV 52.6mL EF
6)FS 32.19% LV mass
7)LV Mass-c 95.6g
AV/LA (M) (DIRECT)
1)AOd 28.1mm LAs diam
2AOd/LAs 0.89mm LAs/LOd
MITRAL VALVE DIRECT
1)MV E Pt 0.64m/s MV A Pt
2)DEC TIME 113ms Dec slope
3)MV PHT 33ms E/A
4)A/R 0.55 MVA(PHT)
AORTIC VALVE (DIRECT)
AV Vmax 0.91m/s AV PG max
TRICUSPID VALVE (DIRECT)
TV E Pt 0.59m/s TV A Pt
E/A 1.74
PULMONARY (DIRECT)
PV Vmax 0.78m/s PV PG max
Hello . My name is Ajay. 33 years male from India.
Recently I read this page which is very helpful in understanding CV problems and the treatments .
I recently found out that I have Mild MR and Trivial TR .
Last year when I went to an annual checkup my MR was Trivial..this year my reports suggested that I have a Mild MR .
All the other parameters like M mode sizes LVEF , BP etc are in the normal limits .
But I noticed that my LA size increased from 3.4cms last year to 3.8cms this year .
LVD, LVS sizes decreased slightly but in the normal range .
I think my doctor just saw at the eco and decided that my MR is mild unlike the docs in USA where they are doimg some volume measurements to decide MR to be Mild or Moderate or Severe .
I have a huge physical frame 6’4″ and maintaining my BMI.
I am worried about my Mild MR and Trivial TR , will they progress to the next stages ?
Is my LA size increase from 3.4cm to 3.8cm (although with in the normal range) is indicating any to worry soon .
Plz, can u help me by replying with cautious and future treatment planing for my problem .
Thank u mate.
Mild MR is not generally considered a concerning issue.
You may have prolapse of mitral valve where your mitral leaflets don`t close properly and force your blood going back into left anterior. If you have it, it is normal that mr little progresses over the time. In case of not having any other symptoms like dispnea or sudden power loss(l think you don`t have), there is no reason to worry. You hasn`t mentioned if you have prolapse or something else.
Hello Doc. Iam 33 years male.
I recently found out that I have Mild MR and Trivial TR .
Last year when I went to an annual checkup my MR was Trivial..this year my reports suggested that I have a Mild MR .
All the other parameters like M mode sizes LVEF 65% , BP etc are in the normal limits .
But I noticed that my LA size increased from 3.4cms last year to 3.8cms this year .
LVD, LVS sizes decreased slightly but in the normal range .
I think my doctor just saw at the eco and decided that my MR is mild unlike the docs in USA where they are doimg some volume measurements to decide MR to be Mild or Moderate or Severe .
I have a huge physical frame 6’4″ and maintaining my BMI.
I am worried about my Mild MR and Trivial TR , will they progress to the next stages ?
Is my LA size increase from 3.4cm to 3.8cm (although with in the normal range) is indicating any to worry soon .
Plz, can u help me by replying with cautious and future treatment planing for my problem .
Thank u doc.
hi sir i have one probelm that when i check go for check my bp from left hand its alwyas show low or some time normal when i check my righ hand side its show some time normal nd when i had a problem my right hand bp always show high mean if my left side bp is 110/70 then my right side bp is will be 120/80 if my left side bp is 120/80 so then my right side bp goes high 145/95 its hurt me plz tell me why this happen to me nd now a days i have Erectile dysfunction also nd also i have mild mvp with mild MR plz tell me
Hi Doctor,my wife age 31 had pulpatations 2months ago and when we checked she has “Moderate prolapse of anterior mitral leaflet with mild mitral regurgitation,good LV systolic function,No regional wall motion abnormality of LV”
Is this something to be worried of
And yesterday She felt tired and when we checked her BP,she has a low BP 85/60,and 2nd time 90/60 ,is this something to be do with MVP and anything to worry about ,what steps should we take
Mild MR from prolapse in general is not considered a significant issue.
Hello Doc, So far I found this to be the most useful article on Mitral Regurgitation. Thank you for your efforts. My dad is 68 years old and had a stent put in the LAD 20 years ago. Couple of months back he had acute renal failure and was on dialysis. He is no longer on dialysis as his kidney functioning is coming back. During dialysis, he went into cardiac arrest and was revived by CPR and defib. Currently they did TEE and echo and found that he has moderate to severe MR and a couple of new blocks RMCA 90% extending to LAD.
TEE results:
Left Ventricle- Basal inferior Hypokenetic, Mid anterior septum apical septum akinetic, no lv clots, LVEF 35-40%
Echo Cardiographic-
Left ventricle -dialated LV, mid anterior septum, distal septum thinned and akinetic, basal inferior wall hypokinetic, No LV Clot, 2D EF-37%
Mitral flow E=1.3m/sec, A=0.9M/SEC, DT 211 MS,
MR GRADE 3+, MR J/A-9.2 SQM MR VC -1.1CM
LA, LV DIALATED
MODERATE LV SYSTOLIC DYSFUNCTION
HIGH MODERATE
Can he do without valve surgery? Is this primary or secondary MR? Can it be cured with medicines. How bad is his condition?
Thank you.
Next step here is a full valve eval. In general this is a complex decision and needs to be determined with an expert team. The severity and mechanism of the MR need to be determined first. If potentially severe a TEE would be required to see the severity and mechanism. The status of the heart arteries need to be determined. In this case, for sure, its important to have optimal medicines for heart failure and coronary artery disease as that alone can often improve symptoms and the leak.
you can follow my twitter at @MustafaAhmedMD
Hi Doctor,my wife age 31 had pulpatations 2months ago and when we checked she has “Moderate prolapse of anterior mitral leaflet with mild mitral regurgitation,good LV systolic function,No regional wall motion abnormality of LV”
Is this something to be worried of
And yesterday She felt tired and when we checked her BP,she has a low BP 85/60,and 2nd time 90/60 ,is this something to be do with MVP and anything to worry about
Dear Dr. Ahmed:
I went from a mild mitral valve regurgitation to moderate to severe in one year’s time. I have CAS and with this most recent echo, I now also have mild tricuspid valve damage due to my 4th MI. I developed anaphylaxis to many antibiotics and hydrocodone after the first 2 MIs. I’m a chronic migraine sufferer. Other than that, I am healthy and middle-aged. My doctor merely wants to do another echo about 4 months from now. Would it be wiser to be more proactive about this and do the TEE echo to rule out severe regurgitation. I am having a few symptoms, but I walk 100 minutes a night and just wonder if my symptoms are mild merely because I am quite active and take care of myself. (BP normal to low; cholesterol normal) I’m not a smoker or drinker and do not have diabetes.
It depends on many factors, if the MR is secondary in nature then it is a complex issue. I would ensure there is attention paid to maximal medical therapy for heart failure and then if persistent symptoms may need TEE to define the mechanism and treatment options.
you can follow my twitter at @MustafaAhmedMD
Hi Dr.
Thank you kindly for all the information.
I was recently diagnosed with moderate mitral leaking, everything else was normal.
I had an echo 9months earlier and everything was normal.
Is it unusual to show up that quickly?
I walk a lot , is it ok for me to continue.
My Dr said they are not concerned and will monitor over time.
Thank you.
Mary
If not symptomatic and you have been cleared by a specialist the activity is likely beneficial.
you can follow our twitter at @MustafaAhmedMD
Hi Dr.Ahmed, I am 41 years old and have had chests pains, heart palpitations and severe migrate headaches for years now. I have had 4 echo cardiograms, two of them wrote I have mitral valve prolapse and two of them wrote there is no evidence of MVP. I had my 5th echo last week. Below are the results:
Mitral Valve The mitral valve leaflets appear thickened. There is no evidence of mitral valve prolapse. Non-rheumatic mild
mitral regurgitation. MR Regurgitant Fraction is 27.9 %. MR Regurgitant volume is 20.8 ml. MR Vena Contracta is 0.35
cm.
Tricuspid Valve The tricuspid valve is normal. Non-rheumatic mild tricuspid regurgitation. Right ventricular systolic
pressure is less than 30mmHg which is considered within normal limits.
One thing new that I have seen in this new report from my last (2010) is “The mitral valve leaflets appear thickened” and my LVEF went down from 80 to 65 range. Is this something is progressing over the years?
By the way, your article is very informative.
Currently the mitral regurgitation appears to be at a low moderate range its important it is monitored closely, i would doubt that the EF has gone from 80 to 65, both are normal and i would suggest that the treating physician review both scans.
you can follow our twitter at @MustafaAhmedMD
Dr. Ahmed,
You’re very kind to interact with people as you do. I’m somewhat curious as to your motivation for being so helpful. Does it have something to do with religious faith?
At any rate, I’ve been treated for high blood pressure for many years (I’m male, 48 years old); bp is under control through medication, and generally has been under control for some time. I had an echocardiogram done as a precautionary diagnostic, after my mother was diagnosed with Hypertrophic cardiomyopathy. My doctor (a general practitioner) said the echo was “fine” but on looking at the results I see “mild mitral annular calcification”, “Mild mitral regurgitation”, “Trace tricuspid regurgitation”, and “Sclerotic trileaflet aortic valve without significant stenosis or regurgitation”. Perhaps there are other things present as well, that I’m missing. I’m rather concerned by these findings. There seems to be abnormalities here and I’m a bit perplexed that my doctor would say everything is fine. I’m also wondering whether my years of high bp — though it has been treated — have resulted in damage to my heart. Beyond this, I have no clear physical symptoms that I’m able to regularly notice.
I’ve posted my echo results below. If you’re able to have a look and respond, I’d be grateful. I guess I’m wondering how concerned I should be and whether I should follow up with a specialist, in spite of my doctor’s apparent lack of concern. Thank you.
Type of Study
TTE procedure: 2D / M-mode, complete, with Doppler.
Indications: Cardiomyopathy, hypertrophic.
—– Conclusions —–
Summary
The pulmonary artery systolic pressure is normal at 17 mmHg above CVP. The
CVP is estimated at 5 mmHg based on IVC morphology.
Normal LV systolic function with a visually estimated ejection fraction of
60-65%.
Normal left ventricular cavity size.
Normal left ventricular wall thickness.
Findings
Mitral Valve
There is mild mitral annular calcification.
Mild mitral regurgitation.
Aortic Valve
Sclerotic trileaflet aortic valve without significant stenosis or
regurgitation.
Tricuspid Valve
Normal morphology and function of tricuspid valve.
Trace tricuspid regurgitation.
The pulmonary artery systolic pressure is normal at 17 mmHg above CVP. The
CVP is estimated at 5 mmHg based on IVC morphology.
Pulmonic Valve
Pulmonic valve not well visualized. Doppler interrogation suggests no
pulmonic stenosis is present.
Left Atrium
Normal left atrial size.
Left Ventricle
Normal LV systolic function with a visually estimated ejection fraction of
60-65%.
Normal left ventricular cavity size.
Normal left ventricular wall thickness.
Normal diastolic filling indices.
Right Atrium
Normal right atrial dimensions.
Right Ventricle
Normal right ventricular size and function.
Pericardial Effusion
No pericardial effusion is present.
Aorta
Normal ascending aortic root.
The findings on the echocardiogram are relatively mild in nature and at this point not clinically significant. The valvular mild regurgitation can be considered relatively normal.
With regards to answering people on here, it just seems a dutiful and useful thing to do and an opportunity to help people, many of which have barriers to getting the information they need.
Doctor, thank you. I’ll say again, you’re a fine man to interact with people here as you do. It’s a kind thing.
I will ask a follow-up and it may seem selfish of me to do so, but I believe it will be of help to others. In your response to me and to others, you use the term “relatively”. Does this have a medical meaning? I’m just wondering why you use this term when offering your opinion.
Thank you.
Hi Doctor,my wife age 31 is getting pulpatations and sloght chest pains and when we checked she has “Moderate prolapse of anterior mitral leaflet with mild mitral regurgitation,good LV systolic function,No regional wall motion abnormality of LV”
Is this something to be worried of
And yesterday She felt tired and when we checked her BP,she has a low BP 80/40,and ,is this something to be do with MVP and anything to worry about,is it safe to plan for a pregnancy
Zehin 34 yrs,Male,my weight is ,80Kg and height is 5’6″ Guwahaty ,Assam………………… I have facing problems like heart beating fast for 2/3 seconds in a week/weekend/month,chest pain some times,and when went to sleep in d first when my two eyes paired i feel shocked and awake due to stop of my breath, after consultations with a cardiologist ,he asked me to do Echo cardiogram TMT and blood exam..but in Echo cardiogram it showes I have a MILD MR,after knowing that I have very scared and very tenz,is it dangerous to life threatening or not,plz inform me sir…
Mild MR is not something you should worry about in isolation.
you can follow our twitter at @MustafaAhmedMD
Hello Doctor, My Daughter is 1 Year old. On a regular vaccination checkup doctor mentioned he heard a murmur. So we have taken a 2D-ECHO. The result came as “Trivial mitral regurgitation”. Can you please suggest what is the best we can do to address this. Also I am wondering how this murmur is heard only after an year of birth, since we had regular checkups. Thanks in Advance.
This is not a worrying finding.
you can follow our twitter at @MustafaAhmedMD
Hello Dr. Ahmed – Thank you for this forum and article both are helping me a lot with recent news I received from an Echo.
I do have symptoms of shortness of breath and dizziness at times. I have mild MVP and have been told by a pulmonary doc that I have mild asthma. I am overweight (currently working on losing weight through diet and exercise) and am overall generally healthy 38 yo female.
My shortness of breath does not always seem to go away with inhaler so the pulmonary doc sent me for this echo – all other lung related test came out with no issues.
However Echo did show the following:
Echo EF Value of 75%
Diastolic Dysfunction
Mild Tricuspid Regulation with Normal Pulmonary Artery Systolic Pressure, 30 mmHg
Right Atrial size is at the upper limits of Normal
No significant valvular abnormalities
I have had high blood pressure for about 10 years now controlled with meds of Metoporal and Amlodipine and generally feel well but now I am worried about these findings especially the 75% EF value with I read is a cause for sudden death at times with exercise.
Can you shine any light on these findings for me?
Thank you!
Your echo is basically normal. there is some mention of abnormal relaxation but that ok, just be careful to control blood pressure, exercise, and diet.
you can follow our twitter at @MustafaAhmedMD
Hello,
I am a 46 year old male. I had an echocardiogram done recently. The doctor wrote the following interpretation comments:
There is mild concentric left ventricular hypertrophy
Ejection Fraction=>55%
There is trace mitral regurgitation
Moderate aortic valve sclerosis
Moderate aortic regurgitation
Mild valvular aortic stenosis
A bicuspid aortic valve cannot be excluded
Trace pulmonic valvular regurgitation
Borderline left atrial enlargement
The doctor said I need monitoring once a year. I was nervous during the visit so I’m not sure I understood what he was telling me. He talked about something being at 1cm and something else being at 2cm and when it gets to a 4cm I may need a valve replacement. I like to lift weights. Is it safe to do so?
The yearly monitoring is likely to check for stability
He was likely talking about grades of severity, for example grade 1 is mild and grade 4 severe.
In terms of lifting weights, isolated moderate valve disease isn’t usually an issue, however you should check this with the Dr that ordered the test.
You can follow our twitter at @MustafaAhmedMD
Disclaimer: The comment response is opinion and in no way affiliated with my employer. It is a vague response that is not to be used as direct medical advice and in no way should replace the opinion of a medical provider.
Hello Dr. Ahmed! First off thanks for the great article.as it did shed some light on my current situation. I am 61 yo male who had heart attack in feb 2016. Diagnosed with coronary artery disease CABGX4 with 100% blockage of LAD. I’m feeling decent back to exercising and running but have episodes of near fainting with exertion and short of breath while running but I really don’t seem fatigued. mild left ventricular diastolic dysfunction; mild mitirial valve regurgitation; moderately dialated left atrium noted in my test results and I see this can cause some of the symptoms?? Should I be concerned or stay the course. Your opinion is greatly valued.
Steve
Mild mitral regurgitation is unlikely related, maybe a treadmill test is a good place to start.
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Disclaimer: The comment response is opinion and in no way affiliated with my employer. It is a vague response that is not to be used as direct medical advice and in no way should replace the opinion of a medical provider.
Hi Dr
Thankyou so much for this article it is so informative. I am 34 years old, 2 years ago an echo – due to palpitations and dizziness on standing up showed mild mitral valve regurgitation. My most recent echo last week shows that this has progressed to moderate regurgitation and atrial dilation in just over 2 years? I am seeing a cardiologist next week but is this a cause for concern? My symptoms are daily palpitations, lightheaded ness on standing and fatigue.
Thankyou for your reply in advance
Hello Dr Ahmed
I am a 34 year old female. 2 years ago an echo picked up mild regurgitation in the mitral valve and two weeks ago I was told that it was now moderate with atrial dilation. Should I be concerned? It seems like it has progressed quite quickly?
Thankyou in advance
Start by having someone review the echocardiograms and make sure the results were reported accurately as this is often not the case. If rapid progression then further investigation may be needed however this may well not be the case in my experience.
You can follow our twitter at @MustafaAhmedMD
Disclaimer: The comment response is opinion and in no way affiliated with my employer. It is a vague response that is not to be used as direct medical advice and in no way should replace the opinion of a medical provider.
Thankyou for your response, my cardiologist has referred me for another echo, (as my other one was done through a charity) a treadmill ecg and a two week zip patch. He advised me to give up caffeine straight away as he felt this may well have been causing my palpitations. Unfortunately they are still very regular every night and during exercise,
Mr. Doctor, thank you very much for the excellent article.
I had a question:
I am a 28 year old man and I have prolebs for three years.
I went to the doctor with an eclipse under my heart and restlessness and echoed and found out that I have Prolabuss.
I want to know what kind of sports are you doing for ProLabs? Is bodybuilding bad for me?
I have 8 fish I have a heart beat. I’ve got an electrocardiogram eight months old. They said that your heart is heartbeat.
Now that I’ve come to the psychiatrist for eight months now, I still have my heart beat but I’m less demanding to know if there is a problem with ProLabs or stress.
Hi doctor thank you so much for your wonderful article on mvp
I’m 23 year old girl..while I was 8 years I have diagnosed with mvp with mild mr and trivial tr…i didnt have any of the symptoms as of… but before 2 months I have experienced with shortness of breath,dizziness,fainting and chest pain..my cardiologist had told that my valve is leaky and prescribed some of the medicines to follow…is there anything serious …whether I had to undergone any surgery in future… and I had another doubt whether mitral regurgitation will increase day by day…
Kindly please reply doctor..
What was the echo report described as showing?
You can follow our twitter at @MustafaAhmedMD
Disclaimer: The comment response is opinion and in no way affiliated with my employer. It is a vague response that is not to be used as direct medical advice and in no way should replace the opinion of a medical provider.
Done Echo Yesterday (11-Jun-19) the impression as follows:-
1. Concentric LV Hypertrophy
2. Good LV Function
3. Impaired Dialostic Compliance
4. Trivial MR
Hope except the 2nd of point of above (all 3 points is not favuring me) mean some issues in my health. Please help me to understand the status.
Done Echo Yesterday (11-Jun-19) the impression as follows:-
1. Concentric LV Hypertrophy
2. Good LV Function
3. Impaired Dialostic Compliance
4. Trivial MR
Hope except the 2nd of point of above (all 3 points is not favuring me) mean some issues in my health. I am 39 years young Please help me to understand the status.
ReplyI am 39 Years Young
The trivial MR is not an issue. The 1 and 3 points would suggest to improve blood pressure control.
You can follow our twitter at @MustafaAhmedMD
Disclaimer: The comment response is opinion and in no way affiliated with my employer. It is a vague response that is not to be used as direct medical advice and in no way should replace the opinion of a medical provider.
Sir,
I am 35 yrs old male. Recently did echo test showing results as mitral valve prolapse AML grade 1 and mild mitral regurgitation… Is it safe or
any medication is required since doctor advised to have good food habits with exercise.
Thanks
Karthik
I have contacted you before regarding my mitral regurgitation. On my ECHO 3 years ago it showed moderate regurgitation and mild left atrium enlargement. I was told not to worry and repeat ECHO in 2 years. Well 2 years later and now the results still show moderate mitral regurgitation and now mild concentric left ventricle hypertrophy. i was again told not to worry and repeat ECHO in 2 years. Should I be more concerned and possibly see a different cardiologist? I just don’t understand how 2 echos can be so different. There was no mention of the atrium enlargement this time just the LVH. Is the concentric LVH caused by the mitral regurgitation? Any advice would be appreciated.
I am a 64 year old white female, hypertension controlled with medication since age 40, high cholesterol, high triglycerides. I have mitral valve regurgitation and mild pulmonary hypertension. My question is: sometimes I can be standing and all of a sudden it feels like I have just lost my breath. I feel short of breath for a few minutes and very fatigued. I am not able to do as much work around the house as I once did and tire very easily. I do not sleep well and am just tired all the time. Is there any reason to be concerned by this? Thank you for your time
I have trace MR and Mild TR iam suferrin papitatiins
Assalaam Alaikum Doc !
I’m 19 years old girl and in Oct 2019 i was diagnosed with mvp grade 1 and trivial MR ..again i had checkup in June 2020 and mvp with mild MR . Other all reports are normal .. I don’t have any symptoms except palpitations ( i can clearly feel heart murmur sometimes) , arrhythmia and increased heart rate . For this I’m taking a beta blocker .
is this ok ? Or should i worry about it
I’m feared of strokes and heart attacks
MVP with trivial MR is typically not associated with concerning complication and in general patients can be reassured.
You can follow our twitter at @MustafaAhmedMD
Disclaimer: The comment response is opinion and in no way affiliated with my employer. It is a vague response that is not to be used as direct medical advice and in no way should replace the opinion of a medical provider.
I’m a 50 year old male. I have a history of blood pressure, PVC’s and PAC’s. I take medication for my B/P and beta blockers to slow down the heart. I have had a recent Transthoracic Echocardiography (TEE) of my heart. The overall result of the test was normal. But, my Mitral/Tricuspid/Pulmonic valves show trace of regurgitation. Should I be concerned about this? Please provide your expert opinion.
Thank you so much for the resources. I would like your opinion:
Age: 41 F. No diabetes or BP. For >10yeras higher Chol.(230) & TG(300). No history of heart ailments.
TSH Nov. 2020: 3.9. I am undergoing fertility treatment and was asked to take 50mcg LevoT which after 3 months was reduced to 37.5 mcg as TSH was at 1.21. After 9 months of 37.5 mcg TSH was 1.71. From Nov. 2021 I took 25mcg for a month and TSH was at 3.7. Hence went back to 37.5 mcg from 2nd week of Dec. 2021. TSH now at 1.7. No other medications.
Early Dec 2021 I started getting palpitations only while lying down in the night for consecutive days, sometimes the heart rate being very fast. My cardiologist checked my pulse, SPO2 and BP – all normal and suggested 24 hr holter monitoring and 2D ECHO. The 2nd and 3rd week of Dec. I had mild palpitations and during the 24 hr monitoring the palpitations were mild. Since this week I have again with heart rate going fast when I lay down and can feel my heart pounding.
The 24 hour report:
Min. heart rate was 45BPM and max 108 BPM. 3hr24m15s of bradycardia, slowest single episode lasted 1m55s at 45BPM. Supraventricular ectopic activity had 13 beats – 1 late beat and 12 single PACs. Longest R-R was 1.4s and N-N was 1.4s. No significant arrthymia moted
2D ECHO:
Evidence of mild MR prolapse of PML of MV with mild MR
Normal biventricular function
No resting RWMA (visual EF 60%)
No diastolic dysfunction of LV
No evidence of LVH
No pulm. hypertension
Stress TMT (Dec. 2019)
Borderline positive as mild upsloping ST changes at peak anterior leads which reverted soon.
Cardiologists opinion: Nothing to worry, palpitations could be due to stress/anxiety. If it is too bothersome then asked me to take Aten 25 but doesn’t think I need to do anything.
Would like to know your opinion.
Is the MR prolapse worrisome?
Is it safe to get pregnant?
I also worry about the decade long higher Chol. & TG and if there are any blokages but can’t take any medication while trying to conceive. However, I have been taking Omega 369 regularly for last 6 years as my dermatologist had suggested that.
Please let me know your thoughts. Thank you for your support.
I think to answer all of the above, a cardiologist would need to evaluate in person and review the tests. In general mild MR is not a problem and no intervention needed.
You can follow our twitter at @MustafaAhmedMD
Disclaimer: The comment response is opinion and in no way affiliated with my employer. It is a vague response that is not to be used as direct medical advice and in no way should replace the opinion of a medical provider.
Hi Dr Ahmed,
I had a murmur reported in early 2019 at a job medical. I saw a cardiologist and had ECO performed showing Mild to Moderate Regurgitation with Posterior MV leaflet prolapse. LVEF 64% with normal LV Systolic Function. Doc sad to watch and wait with 6 monthly ECO’s. Could be years he said. However in January 2020 I had MV Leaflet chordal rupture after exhaustion at work. Felt failure, this happened on the 11/01/2020. (January). I called cardiologist that day and was told to see GP. He was on leave so I saw another GP in same practice. She rule out heart issues and said I had phenomena. Short story my Symptoms got and finally I saw my GP on the 6/02/2020 (February).
He agreed it was my MV and arranged urgent ECO with my cardiologist which found: Severe eccentric MV Regurgiation with Posterior MV leaflet prolapse with leaflet failure. LVEF 65%. I was sent to have open heart surgery to repair the MV. Was successful and I’ve been done well. I was 45yo.
Some background to this story is in 2014 I had treatment for APML leukaemia (treatments ATRA and ATO) NO radiation. I was 39yo.
Diagnosed on 14/05/2014 and had Pre-Treatment ECO on the 16/05/2014; as early treatment issues (Rare) of differential syndrome (DS) caused by treatment can cause lung issues, Heart LV Systolic Function issues with reduced LVEF% and kidney failure in the worst cases.
The baseline ECO taken on the 16/05/2014 before treatment showed the following:
LV: Normal LV size and systolic function, EF61%
MV: Systolic buckling of the posterior mitral valve leaflet. Mild to Moderate MV regurgitation.
Treatment was stopped when I developed severe DS. Renal failure, heart failure and lung issues.
Focusing on the heart a ECO was done which showed the following:
LV: Normal LV size with moderately reduced Systolic function. EF42%.
MV: (No change). Mild MV regurgitation.
Several ECO’s followed showing fast LV systolic function improvement back to normal and LVEF of 57% in November 2014.
So 2014 LVEF trends of: 61 (Baseline before treatment), 42 (Heart Failure), 46, 52 (Treatment restarted), 54 and 57%.
The mitral valve never changed from the base line ECO before 2014 treatment up until 2020 with the cord ruptured.
No mention of concern ever raised. Only focus was on LV function and LVEF. Which even when treatment re commenced it never to this day has been abnormal. Was only below normal for less than a month or two max.
My cardiologist didn’t have all these details (ECO’s at the time) I only just received on request of history as I have some other new issues now with AL Amyloidosis. However I told him about it, he didn’t think any cancer or treatments caused the MVR. He thought I likely had it for years.
Seems he was right now having these results.
My question for you, now knowing all ECO results the LVEF dropped and revived do to treatment and the MV had regurgitation before treatment and didn’t change during heart failure (Systolic function of LV).
In your opinion my mitral valve rupture due to heart stress and history of MVR and prolapse? Not my leukaemia or the treatments of?
Kind Regards,
Dennis Page
Yea I now have plasma cell IgD Multiple Myeloma and also AL Amyloidosis with GI, gallbladder and liver involvement. Possibly slight Cardiac involvement. On DVD (Dara, Velcade and Dex) treatments and working well. Going for Stem Cell Transplant in a month.
Hi Dr Ahmed,
I had a murmur reported in early 2019 at a job medical. I saw a cardiologist and had ECO performed showing Mild to Moderate Regurgitation with Posterior MV leaflet prolapse. LVEF 64% with normal LV Systolic Function. Doctor said no need for concern and to watch and wait with 6 monthly ECO’s. Could be years before surgery could be required he said.
However in January 2020 I had Mitral Valve (MV) Leaflet chordal rupture after exhaustion at work. I Felt the failure, this happened on the 11/01/2020. (January 2020). I called cardiologist that day and was told to book appointment to see GP. My normal GP was on leave so I saw another GP in same practice. She rule out heart issues and said I had phenomena. To shorten the story my Symptoms got worse and finally I saw my GP on the 6/02/2020 (February).
He agreed it was my MV and arranged urgent ECO with my cardiologist which found the following:
Severe eccentric MV Regurgiation with Posterior MV leaflet prolapse with leaflet failure. LVEF 65%. I was sent to have open heart surgery to repair the MV. Was successful and I’ve been done well.
Note: I was 45yo.
Some background to this story; In 2014 I was diagnosed and had treatment for APML leukaemia (treatments ATRA and ATO) “NO radiation”!
I was 39yo at the time of diagnosis.
Diagnosed on 14/05/2014 and had Pre-Treatment ECO (baseline) on the 16/05/2014; as early treatment issues (Rare) of differential syndrome (DS) caused by treatment can cause lung issues, Heart LV Systolic Function issues with reduced LVEF% and kidney failure in the worst cases.
The baseline ECO taken on the 16/05/2014 before treatment showed the following:
LV: Normal LV size and systolic function, EF61%
MV: Systolic buckling of the posterior mitral valve leaflet. Mild to Moderate MV regurgitation.
Treatment was stopped when I developed severe DS. Renal failure, heart failure and lung issues.
An ECO was done on the 12/06/2014 which showed the following:
LV: Normal LV size with moderately reduced Systolic function. EF42%.
MV: (No change). Mild MV regurgitation.
In the next few weeks/ months, Several ECO’s followed showing fast recovery of LV systolic function back to normal 26/08/2014 LVEF of 52% and LVEF of 57% in November 2014.
So 2014 LVEF trends of: 61 (Baseline before treatment), 42 (Heart Failure), 46, 52 (Treatment restarted), 54 and 57%.
During this time the mitral valve never changed from the base line ECO before 2014 treatment up until 2020 with the cord ruptured.
No mention of concern was ever raised about the Mitral Valve. Only focus was on LV function and LVEF. Which even when treatment re commenced it has never, even to this day been abnormal. Was only below normal for less than a couple of months max.
My cardiologist didn’t have all these details (ECO’s at the time) I only just received on request of history as I have some other new issues now with AL Amyloidosis. However I told him about the issues I had in 2014. He didn’t think any cancer or treatments caused the MVR. He thought I likely had it for years before.
Seems he was right now having all these results.
My question for you Doctor, now knowing all ECO results the LVEF dropped and recovered during further treatment and the MV had regurgitation before treatment started and didn’t change during heart failure (Systolic function of LV) or since.
In your opinion is my mitral valve rupture due to heart stress and history of MVR and prolapse? Not APML leukaemia or the treatments of?
Kind Regards,
Dennis Page
Yea I now have plasma cell IgD Multiple Myeloma and also AL Amyloidosis with GI, gallbladder and liver involvement. Possibly slight Cardiac involvement. On DVD (Dara, Velcade and Dex) treatments and working well. Going for Stem Cell Transplant in a month.