Brief Answer:
I would advise as follows:

Detailed Answer:
Hello!

Welcome on HCM!

Regarding your concern, I would like to explain that in general aortic valve regurgitation is well tolerated and compensated the late stage of the disease when irreversible changes have occurred.

That's why you need to be careful in following a periodic and repeated cardiac evaluation by means of a comprehensive physical evaluation, ECG, cardiac ultrasound and additional lab tests.

As diastolic flow reversal is seen in the descending aorta, aortic regurgitation is considered severe.

In such circumstances, it is necessary to repeatedly check progressive changes in cardiac chambers dilation, increase in pulmonary artery pressure, progression of aortic root dilation, concomitant valve disorders, etc. which when coupled with the evaluation of physical exercise capacity may give a more reliable conclusion whether and when the surgical correction of the aortic valve (aortic valve replacement) is optimal.

For such reasons cardiologist's close followups are necessary.

Loosing body weight could be of some beneficial effects as it would improve your physical capacity and relieve the cardiac working load.

But, from the other side, drinking more than small amounts of alcohol could aggravate your cardiac conditions and trigger potential cardiac arrhythmias, which may lead to heart failure decompensation.

Also, alcohol may impair the appropriate blood pressure balance, leading to increased systolic pressure and aggravating aortic regurgitation.

In this regards, I would advise you following a healthy life-style and diet; also considering antibiotic prophylaxis in case of an invasive diagnostic or treating procedure for prevention of potential endocarditis.

You need to discuss with your attending cardiologist about a detailed medical follow up schedule.

Hope to have been helpful to you!

In case of any further questions, do not hesitate to ask me again.

Kind regards,

Dr. Iliri

---

Brief Answer:
My opinion as follows:

Detailed Answer:
Hello again,

With my first explanation, I wold like to explain that in chronic aortic valve regurgitation, exaggerated clinical symptomatology is obviously developed late; in general on the late stages of the disease (when irreversible myocardium impairment and adverse remodeling [left ventricular dilation] occurs).

So, in other words, the clinical condition is well compensated (no shortness of breathing, no limbs edema, no excessive fatigue while exerting, etc.)

The fact that you have severe aortic regurgitation (as stated by cardiac ultrasound - Diastolic flow reversal seen in descending aorta), doesn't mean that you are in the late stage of disease.

When concluding on the severity of the disease, it is important to consider the clinical symptomatology (fortunately you have only occasional heart palpitations) and other cardiac imagine parameters (cardiac echo and other eventual cardiac imagine studies).

But, as your left ventricle EF (ejection fraction) is within normal values (60-65%), this means that you are not in the conditions to require surgical valve replacement yet.

In general, when no obvious clinical symptomatology is present (as in your case), the decision of surgery is considered when LVEF is </+ 50%, LVEDD (left ventricular end diastolic diameter) is >70 mm, or LVESD (end systolic diameter) is >50 mm or >25 mm/m2 (when indexed for body surface area).

As you do not satisfy these criteria, you are not eligible for surgery yet (you are not in the late stage of the disease).

So, just relax!

The only strategy to follow, as I have mentioned you before is a careful and periodic medical follow up; that is medical physical evaluation and cardiac ultrasound every six months.

Hope to have clarified your uncertainties.


Regards,

Dr. Iliri

---