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SOMEONE PLEASE HELP! Preferably from a cardiologist
I have had abnormal EKGs and Echo's. I have trace tricuspid, mitral and pulmonary regurgitation. No cardiologist seems to be too concerned however, I am having continuous symptoms of shortness of breath, fatigue, minor chest discomfort, etc. I also have sleep apnea. I had a partial hysterectomy done a year ago and all of these symptoms began after the surgery. Any opinions?! Help!
COMMUNITY LEADER
Hi there, trace regurgitation is well within the normal variant and should be no concern, nothing to worry about.
Not a Cardiologist, not sure if any post here. There are a few I suspect are Doctors, but unsure if Cardiologists per se. You'll have to take the opinions of Cardiology Techs, Nurses and Engineers if you want the professional take here.
That said;
Every valve leaks, on every person on the planet. Sometimes it's hard to see/find but it's there. Bear in mind these are basically flaps of tissue inside your heart, it would be unreasonable to expect then to form a perfectly watertight seal!
IN FACT! Echo techs actually have to locate where a particular individuals 'regurg' is located on some of their valves in order to make key calculations! It would actually kind of be a PROBLEM if they could not find any regurg!
Of course regurg can be concerning if there's too much of it! Several techniques are employed in echo to judge severity.
1. Blood flow is translated into a color flow image; this allows the operator to physically see the blood flow backwards. The size of the stream is measured using several techniques.
2. Doppler recordings are taken of each valve. What these basically are is a recording of the sounds the blood is making. Blood moving backwards through a small hole has distinctive characteristics vs blood moving forward through a larger hole. Imagine blowing air through a whistle (small hole). Now imagine doing the same thing to a piece of pvc plumbing pipe. The air flow will sound compeletely different through each of these holes. The echo machine makes a recording of these sounds and charts them on a screen as waveforms to be interpretted.
3. Indirect measurements are taken using pressures in each chamber of the heart. For example, if my tricuspid valve is leaking alot of blood from my right ventricle, into my atria, the additional fluid in the atria will cause the atria to have more fluid pressure inside of it. This pressure can be estimated through my venacava by observing whether or not this giant vein still collapses when I 'sniff' or inhale.
4. These measurements are taken from different angles. All in all these valves are 'interrogated' (checked using all these methods), at least 5 times; each from a different angle or window. There are 4 valves to be interrogated, which means this process is repeated at least 20 times in every study.
5. This all makes it very difficult to "miss" something like severe regurgitation. It is possoble to underestimate it, however evenin the absolute worst case scenario of dreadful image taking... Theres going to be at least 1 value thats out of parameters. That value will be sufficient to warrant a repeat study or additional testing.
In order for something to be underestimated to the point where a cardiologist would not be worried it would have to be on the lower end of moderate and not necessarily something immediately threatening (in the next 1-2 yrs) to your health.
As for your EKG's, its impossible to move forwars without knowing the precise manner in which the EKG ws abnormal. Additional information on what exactly the cardiologist graded the regurg at is helpful.
Your symptoms and Medical history, all sound suspicious for cardiac disease on their own. Sleep Apnea has a connection and shortness of breath, chest pain etc are all potential indicators. Even if cardiac conditions are ruled out I certainly think youd benefit from having annual or biannual surveillance (Ekg+ Echo+ Office Visit) with your cardiologist.
Its also worth mentioning that there are other causes of these symptoms aside from the heart. One of the more dangerous mistakes people make is they kind of get focused on the heart and forget the other organs. Once the workup for the heart is done its important to go back to your primary care and seek out their opinion as to the next clinic to see.
I see the heart anxiety on a daily basis mind you, and frankly I feel alot of it stems from the popular perception on the importance of the heart.
I mean if the heart stops you die right? So it is naturally this critical component you treasure and can't live without.. BUT
Truth is if ANY of your organs stop you die! Each and every one of them, with the exception of that extra kidney is every bit as important as your heart! What's more?!! The heart is leagues away from being the most fragile organ in your body! Its actually very resilient, powerful and not quite as vulnerable (albeit statistically mor burdened) to a disease process as others.
My point here is, don't focus on the heart at the expense of seeking care for something like your lungs!
That said;
Every valve leaks, on every person on the planet. Sometimes it's hard to see/find but it's there. Bear in mind these are basically flaps of tissue inside your heart, it would be unreasonable to expect then to form a perfectly watertight seal!
IN FACT! Echo techs actually have to locate where a particular individuals 'regurg' is located on some of their valves in order to make key calculations! It would actually kind of be a PROBLEM if they could not find any regurg!
Of course regurg can be concerning if there's too much of it! Several techniques are employed in echo to judge severity.
1. Blood flow is translated into a color flow image; this allows the operator to physically see the blood flow backwards. The size of the stream is measured using several techniques.
2. Doppler recordings are taken of each valve. What these basically are is a recording of the sounds the blood is making. Blood moving backwards through a small hole has distinctive characteristics vs blood moving forward through a larger hole. Imagine blowing air through a whistle (small hole). Now imagine doing the same thing to a piece of pvc plumbing pipe. The air flow will sound compeletely different through each of these holes. The echo machine makes a recording of these sounds and charts them on a screen as waveforms to be interpretted.
3. Indirect measurements are taken using pressures in each chamber of the heart. For example, if my tricuspid valve is leaking alot of blood from my right ventricle, into my atria, the additional fluid in the atria will cause the atria to have more fluid pressure inside of it. This pressure can be estimated through my venacava by observing whether or not this giant vein still collapses when I 'sniff' or inhale.
4. These measurements are taken from different angles. All in all these valves are 'interrogated' (checked using all these methods), at least 5 times; each from a different angle or window. There are 4 valves to be interrogated, which means this process is repeated at least 20 times in every study.
5. This all makes it very difficult to "miss" something like severe regurgitation. It is possoble to underestimate it, however evenin the absolute worst case scenario of dreadful image taking... Theres going to be at least 1 value thats out of parameters. That value will be sufficient to warrant a repeat study or additional testing.
In order for something to be underestimated to the point where a cardiologist would not be worried it would have to be on the lower end of moderate and not necessarily something immediately threatening (in the next 1-2 yrs) to your health.
As for your EKG's, its impossible to move forwars without knowing the precise manner in which the EKG ws abnormal. Additional information on what exactly the cardiologist graded the regurg at is helpful.
Your symptoms and Medical history, all sound suspicious for cardiac disease on their own. Sleep Apnea has a connection and shortness of breath, chest pain etc are all potential indicators. Even if cardiac conditions are ruled out I certainly think youd benefit from having annual or biannual surveillance (Ekg+ Echo+ Office Visit) with your cardiologist.
Its also worth mentioning that there are other causes of these symptoms aside from the heart. One of the more dangerous mistakes people make is they kind of get focused on the heart and forget the other organs. Once the workup for the heart is done its important to go back to your primary care and seek out their opinion as to the next clinic to see.
I see the heart anxiety on a daily basis mind you, and frankly I feel alot of it stems from the popular perception on the importance of the heart.
I mean if the heart stops you die right? So it is naturally this critical component you treasure and can't live without.. BUT
Truth is if ANY of your organs stop you die! Each and every one of them, with the exception of that extra kidney is every bit as important as your heart! What's more?!! The heart is leagues away from being the most fragile organ in your body! Its actually very resilient, powerful and not quite as vulnerable (albeit statistically mor burdened) to a disease process as others.
My point here is, don't focus on the heart at the expense of seeking care for something like your lungs!
3 Comments
Thank you so much for your response! The information you provided was very helpful :) I am following up again with my PCP next week. I have been having test after test and seeing doctor upon doctor to try and get the relief of this SOB which I cannot seem to get even with the strongest of inhalers/anxiety meds. So I guess I will just keep trucking on. Do you have any input as far as the pulmonic insufficiency? Do you think that would be a big cause for SOB? I know the underlying issue needs to be decided before treating but wondering if that may be a factor for the breathing? (Note: my SOB is constant, not just when exercising, walking, etc)
All depends on the degree of Pulmonic Insufficiency.
Mild PI is normal, and should be present in every individual. **Severe** PI could certainly cause your problem however.
Similarly mild Tricuspid regurg is normal and should be present in every individual, however severe regurg would indicate lung disease as well.
Mild PI is normal, and should be present in every individual. **Severe** PI could certainly cause your problem however.
Similarly mild Tricuspid regurg is normal and should be present in every individual, however severe regurg would indicate lung disease as well.
Also I seem to have forgotten to mention something very important that may be misunderstood here.
Regurgitation and Insufficiency mean EXACTLY the same thing. They're completely synonymous.
Regurgitation and Insufficiency mean EXACTLY the same thing. They're completely synonymous.
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