Uncovering Undiagnosed Heart Valve Insufficiency: A Patient's Journey

Previously undetected valvular insufficiency?

Hello Doctor, I experienced arrhythmia for about a week last October.
By the time I had a cardiac ultrasound and a 24-hour Holter monitor, the symptoms had disappeared, and the doctor said the results were normal, advising me to adjust my lifestyle.
In April of this year, I experienced arrhythmia again, which lasted for a month.
I went to a different hospital for examination, and after the cardiac ultrasound, the doctor informed me that I have mitral valve prolapse, mitral regurgitation, and tricuspid regurgitation.
I would like to ask the doctor: 1.
Is the valve issue congenital? Why was it not detected last October? Could it be due to the symptoms being subtle? 2.
Since I need dental surgery (root canal treatment) soon, should I ask the dentist to prescribe antibiotics? 3.
My current cardiologist has prescribed Concor 1.25 mg; is there any interaction with local anesthesia used in dentistry? Attached are the two cardiac ultrasound reports.
Thank you for your patience in answering.
1.
Last October's cardiac ultrasound report: Blood pressure: 117/68 mmHg, Height: 172 cm, Weight: 67 kg, BSA: 1.79 m² Sinus Rhythm ● M-mode Measurement: Ao Diam: 25.77 mm, LA Diam: 29.67 mm, LA/Ao: 1.15 IVSd: 5.73 mm, LVIDd: 45.81 mm, LVPWd: 7.03 mm IVSs: 8.33 mm, LVIDs: 28.89 mm, LVPWs: 11.71 mm EF(Qui,U): 60.2%, LVd Mass(ASE): 87.78 g, LVd Mass Ind(ASE): 49.01 g/m² ● Auto EF (4C): EF: 64.34%, ESV: 27.18 ml, EDV: 76.22 ml ● 2D Measurement: LVOT Diam: 20.61 mm LALdA4C: 4.37 cm, LAAdA4C: 14.56 cm² LALdA2C: 4.54 cm, LAAdA2C: 14.9 cm² LA vol: 42.2 cm³, LAVI: 23.56 cm³/m² ● LVOT: LVOT Max Vel: 1.06 m/s, LVOT Mean Vel: 0.65 m/s, LVOT Max PG: 4.49 mmHg, LVOT Mean PG: 2.06 mmHg, LVOT VTI: 20.21 cm, HR: 60.77 BPM LVSV(Dopp): 67.39 ml, LVSI(Dopp): 37.63 ml/m² LVCO(Dopp): 4.09 l/min, LVCI(Dopp): 2.29 l/min/m² ● Aortic Valve: ● Mitral Valve: MV PHT: 69.73 ms MV E Vel: 0.89 m/s, MV A Vel: 0.29 m/s MV Dec T: 240.44 ms, MV E/A Ratio: 3.07 S’ Sept: 9.85 cm/s, E’ Sept: 14.35 cm/s, A’ Sept: 9.3 cm/s, E/E’ Avg(2016): 6.1 MV PHT: 69.73 ms, MVA By PHT: 3.16 cm² P Vein S: 37.15 cm/s, P Vein D: 52.38 cm/s, P Vein A: 24.68 cm/s, E’ Lat: 14.67 cm/s, ASE 2016 ● Tricuspid Valve: Normal Valve TR max Vel: 1.94 m/s, TR max pressure gradient: 15.05 mmHg IVC: 5-10 mmHg, RVSP: 25.05 mmHg ● Pulmonary Valve: Normal Valve PA Max Vel: 1.15 m/s, PA Max PG: 5.29 mmHg PR EDPG: 3.65 mmHg, PADP: 13.65 mmHg, PA Max Vel: 1.15 m/s PA Max PG: 5.29 mmHg ● Pericardial Disease: ● LV wall motion: A= apical, B= basal, M= middle, a= anterior, i= inferior, l= lateral, s= septum 2015 ASE Bas = 1, Ba = 1, Bal = 1, Bil = 1, Bi = 1, Bis = 1 Mas = 1, Ma = 1, Mal = 1, Mil = 1, Mi = 1, Mis = 1 As = 1, Aa = 1, Al = 1, Ai = 1, A = 1, WMSI = 1 ● Right Ventricle: TAPSE: 19.13 mm ● Summary: 1.
Adequate left ventricular systolic function without wall motion abnormality.
2.
This April's cardiac ultrasound report: Examination items: 18005_Cardiac Ultrasound 18007_Color Doppler Echocardiography C.C.: Palpitation occasionally for 2 weeks PH; Arrhythmia (VPCs) FH; NP P.E OR LAB: BP 134/79 HR 114/min Heart; regular-irregular systolic click; late systolic murmur over apex EKG; VPCs IMPRESSION: R06.02_Shortness of breath I34.1_Nonrheumatic mitral (valve) prolapse I34.0_Nonrheumatic mitral (valve) insufficiency I36.1_Nonrheumatic tricuspid (valve) insufficiency Referral data: 18005_ 18007_ -------------------------------------------------------------------------------------- Report content: Normal cardiac chamber size.
Normal cardiac wall thickness.
Mitral valve prolapse.
Trivial MR.
Mild TR estimated RVSP=35mmHG.
Normal LV diastolic function.
E/A>1 Preserved LV systolic function.
EF=75.2%.
No obvious regional wall motion abnormalities.

Awei, 20~29 year old female. Ask Date: 2022/05/12

Dr. He Dongjin reply Cardiology

Hello, based on my review of the reports, it appears that two different hospitals conducted the examinations, and there isn't much difference between them; both indicate very mild issues.
It's just that the physicians expressed it differently.
For such a mild valvular issue, I would also explain that observation is sufficient.
Is it necessary to ask a dentist to prescribe antibiotics? If you have concerns, just inform your physician to prescribe them.
Kan-Ken 1.25 mg and local anesthesia will not have any interactions, so please rest assured.
Changhua Hospital cares about you.

Reply Date: 2022/05/12

More Info

Your journey through the diagnosis of heart valve insufficiency raises several important questions regarding the nature of your condition, the timing of its diagnosis, and the implications for your upcoming dental procedure. Let's address your concerns systematically.

1. Why Wasn't the Valve Issue Detected Earlier?
Heart valve problems, such as mitral valve prolapse and insufficiency, can sometimes be subtle and may not present significant symptoms until they progress. In your case, the echocardiogram performed last October showed no significant abnormalities, which can happen for several reasons:
- Subclinical Condition: Valve issues can be present but not severe enough to cause noticeable symptoms or be detected on an echocardiogram. If the regurgitation is trivial, it may not have been evident during your previous examination.

- Variability in Symptoms: Symptoms can fluctuate based on various factors, including stress, physical activity, or even hydration levels. If your symptoms were absent during the echocardiogram, the condition might not have been apparent at that time.

- Technical Limitations: While echocardiography is a powerful diagnostic tool, it is not infallible. Factors such as patient positioning, acoustic windows, and the operator's experience can influence the results.

2. Do You Need Antibiotics for Dental Procedures?
Given your diagnosis of mitral valve prolapse and insufficiency, it is prudent to consult with your dentist regarding the need for prophylactic antibiotics before dental procedures, especially invasive ones like root canal treatment. The American Heart Association (AHA) guidelines suggest that patients with certain heart conditions may require antibiotics to prevent infective endocarditis, a serious infection of the heart valves. Since your condition involves valve insufficiency, it would be wise to discuss this with both your cardiologist and dentist to determine the best course of action.

3. Interaction Between Medications
You mentioned that your cardiologist has prescribed Carvedilol (康肯) at a dosage of 1.25 mg. Carvedilol is a beta-blocker commonly used to manage heart failure and hypertension. When it comes to dental procedures, local anesthetics are generally safe to use in patients taking beta-blockers. However, it is essential to inform your dentist about all medications you are taking, including Carvedilol, so they can choose the appropriate anesthetic and dosage.

Conclusion
In summary, your experience highlights the complexities of diagnosing heart valve conditions, which can sometimes be missed during routine examinations. It is crucial to maintain open communication with your healthcare providers, ensuring that all aspects of your health are considered, especially when planning for procedures like dental work.
As you prepare for your dental treatment, ensure that both your cardiologist and dentist are aware of your heart condition and any medications you are taking. This collaborative approach will help manage your health effectively and minimize any risks associated with your valve insufficiency.
If you continue to experience symptoms such as palpitations or shortness of breath, or if you have any concerns about your heart health, do not hesitate to follow up with your cardiologist for further evaluation and management. Regular monitoring and proactive management are key to maintaining your heart health.

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