Question: Hi, I am 36 years old. After my father died at 54 years of age of sudden cardiac death most likely caused by a heart attack, I decided to see a cardiologist to rule out anything genetic that could make me have a predisposition to a heart attack or SCD at a young age like my father. I feel healthy and have had no problems, but I still wanted to rule out undetected problems. I had an EKG, an echocardiogram, and an exercise stress test. My EKG was completely normal. I did 14.1 mets on the stress test and everything was normal. However, my echo says normal heart structure but mild tricupid regurgitation with normal leaflets and mild left atrial enlargement according to volume measurements. The left atrium volume/index measured 48 ml/29m2. There is also trace mitral and pulmonic valve regurgitation and mildly redundant mital valve leaflets. However, I was told that it is very common when they are able to get clear echo images in thin people so I have not been concerned about all of the results. My history: I am 36 years old. I am 130 pounds and pretty athletic. I have been running 3-5 times a week since I was 18. I have had five children via c-section. Last year, I suffered a miscarriage at 17 weeks gestation. I have had some heart palps since that time but it is always during mid-luteal phase of my menstrual cycle. My blood pressue while I am upright ranges between 115/70 to 97/68. While I had my echo it was 86/47 but I was laying down. I have never had any symptoms with my low blood pressure. I have never been light headed or faint. I feel great actually and only did the tests to rule out something genetic. I would like to add that my mother is healthy and alive and my grandmother is 84 and very healthy. She also had hormone induced palpitations in her earlier years. My other grandmother is 80 and also very healthy. But these results have me somewhat concerned about my future. Should I be? Or are these results within normal range and not necessarily indicative that they will get worse? Could my atrium be normal for me? Would any followup be suggested? Please share your thoughts. I do have the entirity of the echo report if any other details are needed. Thank you for your time.

Hi, Dr. XXXXXXX Thank you for reviewing my questions. I am 36 years old, my height is 5'4, and I am 130 pounds. I do not have diabetes or any other health problems. I feel very healthy and very strong. As I said above, I only had these tests to rule out a possible genetic defect after my father's early death. Especially, since I frequently run and engage in high impact cardiovascular exercise. To clarify,. I have never actually had any symptoms of heart problems except for occasional hormone related palpitations. They are very light though and do not bother me and they do not cause any symptoms other than a harder heartbeat. I did very well on my cardio treadmill stress test and have a good EKG. My concerns are only the issues on the echocardiogram report. I have uploaded the report for your review. Thank you again for your time and knowledge. I look forward to hearing from you again. Sincerely, XXXX

Thank you for your clear answer. My only remaining concern is whether or not mild tricuspid regurgitation is known to always worsen with time. Does it always worsen? Or can it be stable throughout a lifetime in the absence of high blood pressure? And will the elevated pressure during exercise worsen it? Thanks again for your time. This is my last concern.

Dr. XXXXXXX I just want to say thank you for answering my concerns with so much knowledge and clarity. I appreciate your time and expertise. Take care. Sincerely, XXXX