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What Is Mitral Regurgitation ?
Question: I was hoping to get an opinion from a cardiologist or someone with a high knowledge of the heart. I am 23. no real big symptoms other than the occasional shortness of breath and a typical chest pain. I have never had a heart problem other than a murmur when I was a kid, but the cardio wanted me to have some tests done. he said he didnt suspect any significant heart disease so i had a echo and a stress test. I did the stress test he said that my resting BP was OK 120/62. but when i excercised it went up maybe an indicator I will have high BP in the future. now the results of my echo is what is really scary because I am reading online about it. the summary is as follows:
Left ventricular ejection fraction is 50%
Left ventricular cavity is mildly increased
Mild concentric left ventricular hypertrophy
RESTRICTIVE PATTERN OF LV DIASTOLIC FILLING
that is the one that is really scaring me! everything I read is that is in advanced severe cases. why would I have this and not have any symptoms? is it reversable and what is the prognosis? I will also include the parameters
MV Peak E- 1.09 m/s Lat e', MV ann- .19 m/s
MV Peak A- 0.35 m/s Lat E/e' Ratio- 6
E/A Ratio 3.11 Sep e' MV ann-0.14 m/s
Sep E/e' ratio 8
Avg e' 0.17 m/s
Avg E/e' Ratio 7
Te'-TE 14.50
IVRT/TE 3.72
LV IVRT 54 msec
MV DT- 363 msec
Sorry so long but any information would be greatly appreciate. What heart diseases do you see these in? what heart disease would I be suspected of having and the prognosis. thank you
Left ventricular ejection fraction is 50%
Left ventricular cavity is mildly increased
Mild concentric left ventricular hypertrophy
RESTRICTIVE PATTERN OF LV DIASTOLIC FILLING
that is the one that is really scaring me! everything I read is that is in advanced severe cases. why would I have this and not have any symptoms? is it reversable and what is the prognosis? I will also include the parameters
MV Peak E- 1.09 m/s Lat e', MV ann- .19 m/s
MV Peak A- 0.35 m/s Lat E/e' Ratio- 6
E/A Ratio 3.11 Sep e' MV ann-0.14 m/s
Sep E/e' ratio 8
Avg e' 0.17 m/s
Avg E/e' Ratio 7
Te'-TE 14.50
IVRT/TE 3.72
LV IVRT 54 msec
MV DT- 363 msec
Sorry so long but any information would be greatly appreciate. What heart diseases do you see these in? what heart disease would I be suspected of having and the prognosis. thank you
Hello Dulik XXXXXXX
Thank you for your query.
You have provided with good information but I would like to know a few more things as this would help me in suggesting you better and I believe the more information a person gives the better is the doctor's reply and thus satisfaction.
Hence please answer the following:
1) How much exercise can you do before you get breathless?
2) At what age did these symptoms start?
3) Do you have any details of the type of murmur that was detected?
4) Are there any descriptive findings in the echo about the nature of the valves, regional wall motion abnormalities, chamber enlargement, etc?
5) What was the conclusion given in the echo?
6) Was a Chest Xray taken at any time?
7) Are there any biochemical/other blood tests done?
8) What was the result of the stress test? What type of stress test was done?
Please give me these answers in detail, as also any other information that you feel relevant.
I would also like to know your height, weight, body built (thin built, average built, heavy built, etc).
Are there any previous echo reports with which I can compare the current values?
From the given details, it appears that there is some problem with the relaxation of the heart after each pumping. There are many causes for this which need to be looked into.
I would be happy to give you a further detailed answer after hearing from you.
Awaiting your reply.
Regards,
Dr RS Varma
Thank you for your query.
You have provided with good information but I would like to know a few more things as this would help me in suggesting you better and I believe the more information a person gives the better is the doctor's reply and thus satisfaction.
Hence please answer the following:
1) How much exercise can you do before you get breathless?
2) At what age did these symptoms start?
3) Do you have any details of the type of murmur that was detected?
4) Are there any descriptive findings in the echo about the nature of the valves, regional wall motion abnormalities, chamber enlargement, etc?
5) What was the conclusion given in the echo?
6) Was a Chest Xray taken at any time?
7) Are there any biochemical/other blood tests done?
8) What was the result of the stress test? What type of stress test was done?
Please give me these answers in detail, as also any other information that you feel relevant.
I would also like to know your height, weight, body built (thin built, average built, heavy built, etc).
Are there any previous echo reports with which I can compare the current values?
From the given details, it appears that there is some problem with the relaxation of the heart after each pumping. There are many causes for this which need to be looked into.
I would be happy to give you a further detailed answer after hearing from you.
Awaiting your reply.
Regards,
Dr RS Varma
Above answer was peer-reviewed by :
Dr. Shanthi.E
I can do quite a bit of excersise, thats not really an issue.
I have had the shortness of breath since I was a kid always been told it was anxiety and asthma cause it came on at rest not really with excersise.
I dont know waht kind of murmur it was but I've had it since I was a kid and been told it was bening.
the only other thing was trivial trisuspid regurgitation and mild mitral regurgation.
there was no conclusion in the echo, just stated the findings.
No I didnt have a chest xray.
Blood test to check my cholestorol and triglycerides. all were normal, I do have a faty liver which i get serial testing for my ALT is usually very slightly above normal and i have had leukosytosis all my life WBC at abot 11,000.
I havent read the results of the stress, just what the Dr told me when i did it. I got to the end of stage 4 about 11 minutes before he said he has seen enough, he said I didnt need the nuclear agent because he didnt suspect any signifigant heart disease.
I am 5'11 270, i am muscular, stocky build. always been strong.
I had an echo about 6 years ago, I never saw the results, but the Dr said everything was fine and the sonographer even said I had a very photogenic heart and everything looked good.
Thank you
I have had the shortness of breath since I was a kid always been told it was anxiety and asthma cause it came on at rest not really with excersise.
I dont know waht kind of murmur it was but I've had it since I was a kid and been told it was bening.
the only other thing was trivial trisuspid regurgitation and mild mitral regurgation.
there was no conclusion in the echo, just stated the findings.
No I didnt have a chest xray.
Blood test to check my cholestorol and triglycerides. all were normal, I do have a faty liver which i get serial testing for my ALT is usually very slightly above normal and i have had leukosytosis all my life WBC at abot 11,000.
I havent read the results of the stress, just what the Dr told me when i did it. I got to the end of stage 4 about 11 minutes before he said he has seen enough, he said I didnt need the nuclear agent because he didnt suspect any signifigant heart disease.
I am 5'11 270, i am muscular, stocky build. always been strong.
I had an echo about 6 years ago, I never saw the results, but the Dr said everything was fine and the sonographer even said I had a very photogenic heart and everything looked good.
Thank you
Hi,
Thank you for the details that you have given.
As I understand it, you are practically asymptomatic with good exercise capacity and probably a negative stress test (hypertensive BP response during stress test).
You have a murmur which is probably a systolic murmur secondary to the mild mitral regurgitation that you have.
Mitral regurgitation means that there is some back leak into the left atrium from the left ventricle across the mitral valve. The valve is supposed to close during the time when the left ventricle pumps blood into aorta, and if the valve is not fully competent (as usually happens with mitral valve prolapse and similar conditions), there is some leak.
Since it is of mild degree at present, it does not warrant any specific treatment. But you have to be aware of this small leak and if you do get any infection of any kind, please be prompt in getting treated for the same.
Also, if you undergo any procedures like tooth extraction, please be sure to inform the treating doctor about this, so that he can give you antibiotic prophylaxis to prevent any infection of the valve (infective endocarditis prophylaxis).
Annual echo is recommended to study the degree of leak and ensure that it is not getting any worse. You need not worry on this count since many people go through life without any worsening of the leak. In case there is a worsening, there are certain medicines that can be taken and very rarely, surgery to repair the valve is also possible. Medicines and surgery are reserved for severe valve leaks only.
Left ventricular hypertrophy means that the walls of the left ventricle (the main pumping chamber) are thickened. This means that the heart is pumping against an increased load (pressure). I would advise you to monitor your BP closely and consider an ACE inhibitor if BP readings are >140/90 mmHg. Your physician will help you with the exact brand and dosage.
Further, I would advise you to desist from lifting heavy weights and similar weight-related gym work. Aerobic exercises, jogging, swimming etc are recommended.
Though the mitral E and A velocities suggest that there may be diastolic dysfunction with restrictive filling, the tissue doppler velocities E' and the ratio E/e are normal. From the E/e ratio, it is possible to calculate an estimate of the pulmonary capillary wedge pressure and in your case it is around 9 mmHg. Anything less than 15 is normal. The average E/e ratio of 7 is normal and any value <8 is specific for a normal PCW pressure.
In my experience, the mitral E and A values are often found to be similar to yours in many young individuals. In conjunction with the LV hypertrophy, it could be interpreted as restrictive LV filling.
However, the normal tissue doppler values and normal stress test with good exercise capacity are reassuring and suggest that we don't need to worry too much about those values. Further, the mild mitral regurgitation also means that we cannot rely too much on E and A velocities alone.
All we need to do is to monitor BP, do daily exercise as indicated above, and take the precautions outlined above regarding mitral regurgitation. Diet with a low fat, low calorie plan and aim to reduce your weight. 270 lbs is a little too much for your height. You definitely need to pay some attention to this also.
I hope I have clarified your doubts. Feel free to contact me for any further queries that you may have.
I wish you all the best for a healthy life
Regards,
Dr RS Varma.
Thank you for the details that you have given.
As I understand it, you are practically asymptomatic with good exercise capacity and probably a negative stress test (hypertensive BP response during stress test).
You have a murmur which is probably a systolic murmur secondary to the mild mitral regurgitation that you have.
Mitral regurgitation means that there is some back leak into the left atrium from the left ventricle across the mitral valve. The valve is supposed to close during the time when the left ventricle pumps blood into aorta, and if the valve is not fully competent (as usually happens with mitral valve prolapse and similar conditions), there is some leak.
Since it is of mild degree at present, it does not warrant any specific treatment. But you have to be aware of this small leak and if you do get any infection of any kind, please be prompt in getting treated for the same.
Also, if you undergo any procedures like tooth extraction, please be sure to inform the treating doctor about this, so that he can give you antibiotic prophylaxis to prevent any infection of the valve (infective endocarditis prophylaxis).
Annual echo is recommended to study the degree of leak and ensure that it is not getting any worse. You need not worry on this count since many people go through life without any worsening of the leak. In case there is a worsening, there are certain medicines that can be taken and very rarely, surgery to repair the valve is also possible. Medicines and surgery are reserved for severe valve leaks only.
Left ventricular hypertrophy means that the walls of the left ventricle (the main pumping chamber) are thickened. This means that the heart is pumping against an increased load (pressure). I would advise you to monitor your BP closely and consider an ACE inhibitor if BP readings are >140/90 mmHg. Your physician will help you with the exact brand and dosage.
Further, I would advise you to desist from lifting heavy weights and similar weight-related gym work. Aerobic exercises, jogging, swimming etc are recommended.
Though the mitral E and A velocities suggest that there may be diastolic dysfunction with restrictive filling, the tissue doppler velocities E' and the ratio E/e are normal. From the E/e ratio, it is possible to calculate an estimate of the pulmonary capillary wedge pressure and in your case it is around 9 mmHg. Anything less than 15 is normal. The average E/e ratio of 7 is normal and any value <8 is specific for a normal PCW pressure.
In my experience, the mitral E and A values are often found to be similar to yours in many young individuals. In conjunction with the LV hypertrophy, it could be interpreted as restrictive LV filling.
However, the normal tissue doppler values and normal stress test with good exercise capacity are reassuring and suggest that we don't need to worry too much about those values. Further, the mild mitral regurgitation also means that we cannot rely too much on E and A velocities alone.
All we need to do is to monitor BP, do daily exercise as indicated above, and take the precautions outlined above regarding mitral regurgitation. Diet with a low fat, low calorie plan and aim to reduce your weight. 270 lbs is a little too much for your height. You definitely need to pay some attention to this also.
I hope I have clarified your doubts. Feel free to contact me for any further queries that you may have.
I wish you all the best for a healthy life
Regards,
Dr RS Varma.
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Above answer was peer-reviewed by :
Dr. Ashwin Bhandari
Answered by
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