Valve Insufficiency: Symptoms, Diagnosis, and Management

Valvular insufficiency

Hello, I have been experiencing severe arrhythmia for the past two years, accompanied by palpitations and dizziness.
An EKG showed ventricular premature contractions (VPC), and a 24-hour Holter monitor revealed over 5,500 occurrences.
I have a history of asthma, and my doctor prescribed Rytmonorm, but my heart rate sometimes drops to only 45 beats per minute.
An echocardiogram showed prolapse of the aortic, mitral, and tricuspid valves, and there is also slightly elevated pulmonary artery pressure.
My doctor keeps advising me to relax, but I still have to work.
I'm unsure about my condition and whether it is serious.
Thank you.

Meijia, 50~59 year old female. Ask Date: 2021/09/04

Dr. Li Han reply Cardiology

Hello, regarding your inquiry about the objective examination indicating valvular abnormalities and arrhythmias, the relationship, severity, and risk associated with the symptoms you mentioned require more detailed and integrated information for a proper response.
I personally recommend discussing this matter in person with your attending cardiologist, and if necessary, consider a referral for further consultation.
Wishing you well, Changhua Hospital, Ministry of Health and Welfare.

Reply Date: 2021/09/04

More Info

Valve insufficiency, also known as valve regurgitation, occurs when one or more of the heart's valves do not close properly, allowing blood to flow backward instead of moving forward through the heart. This condition can affect any of the heart's four valves: the aortic, mitral, tricuspid, and pulmonary valves. Understanding the symptoms, diagnosis, and management of valve insufficiency is crucial for effective treatment and improved quality of life.

Symptoms of Valve Insufficiency
The symptoms of valve insufficiency can vary depending on the severity of the condition and which valve is affected. Common symptoms include:
1. Palpitations: Patients may experience irregular heartbeats or a sensation of the heart racing, which can be distressing.

2. Dizziness or Lightheadedness: This can occur due to reduced blood flow to the brain, especially during physical activity.

3. Shortness of Breath: Patients may feel breathless during exertion or even at rest, particularly if the left side of the heart is affected.

4. Fatigue: A general feeling of tiredness can result from the heart's decreased efficiency.

5. Swelling: Fluid retention can lead to swelling in the legs, ankles, or abdomen, especially in cases of right-sided valve insufficiency.

6. Chest Pain or Discomfort: Some patients may experience chest pain, which can be mistaken for angina or other cardiac issues.

Diagnosis of Valve Insufficiency
Diagnosis typically involves a combination of patient history, physical examination, and diagnostic tests:
1. Physical Examination: A healthcare provider may detect abnormal heart sounds (murmurs) during a physical exam, which can indicate valve problems.

2. Electrocardiogram (EKG): This test records the electrical activity of the heart and can identify arrhythmias or other heart issues.

3. Echocardiogram: This ultrasound test provides detailed images of the heart's structure and function, allowing doctors to assess the severity of valve insufficiency and its impact on heart function.

4. Chest X-ray: This imaging test can show the size of the heart and any fluid in the lungs, which may indicate heart failure.

5. Cardiac MRI or CT Scan: These advanced imaging techniques can provide additional information about the heart's structure and function.

Management of Valve Insufficiency
Management of valve insufficiency depends on the severity of the condition and the presence of symptoms. Options include:
1. Monitoring: For mild cases without symptoms, regular follow-up with a healthcare provider may be sufficient.

2. Medications: Diuretics can help reduce fluid retention, while medications like beta-blockers or ACE inhibitors may be prescribed to manage symptoms and improve heart function.

3. Lifestyle Modifications: Patients are often advised to adopt a heart-healthy lifestyle, including a balanced diet, regular exercise, and smoking cessation.

4. Surgical Intervention: In cases of severe valve insufficiency or when symptoms significantly impact quality of life, surgical options may be considered. These can include valve repair or replacement, depending on the specific valve affected and the extent of damage.

Conclusion
In your case, the presence of mitral, aortic, and tricuspid valve prolapse, along with elevated pulmonary artery pressure, suggests that you may be experiencing significant valve insufficiency. The symptoms of palpitations, dizziness, and fatigue you describe are concerning and warrant further evaluation by a cardiologist. While your doctor has advised you to relax, it is essential to address your symptoms and concerns, especially given your history of arrhythmias and asthma.

It is crucial to have an open dialogue with your healthcare provider about your symptoms and the impact they have on your daily life. They may consider additional tests or referrals to specialists to ensure that you receive appropriate management for your condition. Remember, understanding your heart health and being proactive in your care can lead to better outcomes and improved quality of life.

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