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Can you tell the size of a heart and the status of a mitral valve with an echocardiogram?   

My mitral valve prolapse has progressed to more leakage within the span of 2 years of echoes. I'm not sure when this started, but I am sure that I was born with this condition.  That has come to light in the last few years. I am in constant communication with my doctors regarding this condition. It has affected my routine. I have noticed that I'm slowing, and my muscles ache from time to time. I have had an echocardiogram done these past 2 weeks, and came from a visit to see the cardiologist today. They told me that my heart size is normal, but can they actually see this with an EKG? Or is this done properly through a PET scan of the heart? I'm very concerned of the information given me. 

submitted by Robert from Brooklyn, New York on 8/26/2013


Deborah Meyers, MDby Texas Heart Institute cardiologist, Deborah E. Meyers, MD  

Dear Robert in Brooklyn,

I am going to do a bit of teaching if you will bear with me. You have mitral valve prolapse (MVP) and you now apparently have developed mitral regurgitation which is a fancy term for mitral valve leakage. MVP is present in a small percentage of the population - about 1-2% and some, but not all of these patients develop mitral regurgitation.  That means that every time your heart beats and the blood moves forward into the aorta as it should, that some of the blood in the pumping chamber is actually going backwards because the valve (which is normally closed during the forward flow phase called systole) leaks backwards. This situation means that the heart has to "work harder" to pump blood forward because of this leak situation. Over time, this "overwork" can become problematic for the heart and the patient living with that heart.

Cardiologists generally measure the degree of leakage with echocardiography  (heart ultrasounds) and we generally class the leakage as trace, mild, moderate or severe. We also follow the measurements that we see on the echo closely to see if the heart is enlarging or dilating or to see if the ejection fraction (which is a measure of the pumping function of the heart) is diminishing.

That being said it is important to emphasize that contemporary guidelines place a big emphasis on the development of new symptoms and you are apparently noticing changes in what you describe as your "routine".  Sometimes exercise testing can be helpful in sorting out if those new symptoms are from the worsening mitral valve leaking or from other things like lung problems or de-conditioning.  An EKG [electrocardiogram or ECG] will  help you know if an abnormal heart rhythm is present but it will not measure the size or function of your heart. A PET will not do this either. Echocardiography accompanied by a good clinical history of the  increased symptoms you are experiencing is the most important procedure at the moment. 

With mitral regurgitation the timing of therapy is important, as the therapy most often involves cardiac surgery. You would not want to refer to a surgeon "too soon" because no one needs the risk of a surgery until it is actually indicated,  but on the other hand it is very important not to refer "too late", as the overall heart muscle function could be impaired long term.

You need to sit and review your echocardiography test results with your doctor in light of what I have "taught" you.  Ask your doctor to explain your echocardiogram to you and ask what those results mean in the context of what you are noticing in terms of your symptoms. Tell your doctor that you are very worried and that you need to understand what the plan is for your care.

I hope that this has helped. All the very best.

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Updated September 2013
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