HEALTH MATTERS: Given advice for leaking heart valves seems appropriate

Q. I have mitral and tricuspid valve regurgitation, rated 2+ to 3+. This seems quite serious to me, but my doctor has told me that it will be fine. Because I also have lots of skipped beats, I had a full cardiac workup last year, including an echocardiogram and a stress test. I have been told to lose weight, have an echo every year for the rest of my life, and another stress test in five years. Does this advice seem appropriate? Thanks.

A. Let’s break this question down into two parts.

First, let’s look at the valve issue. Our hearts have four valves that are designed to allow the blood to move forward through the heart. When damaged, the valves may block the flow of blood, which is called stenosis or they may leak, which is called regurgitation. Two of your valves leak, probably because of laxity of the valve tissue (some people are diagnosed with mitral valve prolapse or MVP). Leaking is graded on a four-point scale, with 1+ being minor and 4+ severe. So you have moderate leaking. This often is well-tolerated for years and years. It is only severe (4+) leaking that causes problems.

Periodic echocardiograms (ultrasound images of the heart) are needed to ensure two things: that your leaking has not become severe, and that your heart is not enlarging or weakening. The only real treatment for severe valve leaking is surgery, with repair or replacement of the valve. Unless the leaking increases, you will not need this. If the leaking does become severe, surgery needs to be considered, especially if you develop any symptoms such as shortness of breath or exercise intolerance, your heart becomes enlarged, or its pumping ability becomes impaired. Even if surgery is required, the long-term results usually are excellent.

As far as the skipped beats, they may or may not be related to your leaky valves. Without seeing you as a patient, I can’t be sure. The skipped beats that people feel are actually due to an extra beat that they may or may not sense, but the pause that follows the extra beat is often symptomatic. The extra beats may come from the top part of the heart (the atria) or the bottom part (the ventricles).

Both types may lead to various problems, including symptoms such as palpitations, but also more serious problems like strokes, fainting, and even death. The problem is that extra beats are very common, usually benign, but occasionally serious. The way we differentiate the benign from the serious is through just the workup that you’ve had — a complete history and physical examination, an echocardiogram and often other testing like a stress test. If all of those are in order, the extra beats are usually just a nuisance, but nothing worse. Medication may help reduce their frequency, but usually, people can learn to live with them.

The bottom line is that the advice that you’ve been given — periodic office visits and echocardiograms — sounds quite appropriate to me. Whether the echo needs to be done every year is something that you should discuss with your doctor. I’ve found that after several stable annual echocardiograms, I’ll often schedule the echos further apart, unless symptoms change.

Wynne is vice president for health affairs at UND, dean of the School of Medicine and Health Sciences, and a professor of medicine. He is a cardiologist by training.

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