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Is slowing heart rate a sign of worsening MVP or regurgitation? What should we know about cardiac refraction rate?

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Cardiologist, Interventional
Practicing since : 1996
Answered : 192 Questions
My 67yr husband was recently dx with mod to severe mv regurgitation-no cardiac enlargement yet. He was not aware of symptoms other than some increased fatigue which he attributed to his age until he had a bout with afib. That converted on its own in 2 days with dilitiazem and he is not on meds now-just has available prn. He has always been a very hard worker in construction. He takes no medications. His normal resting heart rate is 42-52, with his heart rate becoming more often 40-45. Is hr becoming slower a sign of worsening mvp/regurg? He will have more tests in a couple of weeks. What should we know about cardiac refraction rate? What determines when a mitral valve is repaired or replaced?
Posted Thu, 19 Apr 2012 in Heart Rate and Rhythm Disorders
Answered by Dr. Raja Sekhar Varma 20 hours later
Thank you for your query.

As regards the heart rate, 60 - 100 beats per minute is considered normal. However, lower heart rates in awake individuals are commonly seen in athletes and other individuals who do a lot of physical work and are fit physically.

What is also important is the rhythm - is it a sinus rhythm or is it a non-sinus rhythm. If it is non-sinus rhythm, it warrants treatment, possibly a pacemaker. If it is sinus rhythm, a simple exercise test will tell us if the heart rate is increasing normally with the exercise (chronotropic competence).

If the heart rate does increase with exercise and there are no exercise-related blocks, there is no need to be alarmed about this heart rate.

If you can upload an ECG of the patient on this website, I can analyze the rhythm and give you specific recommendations.

As regards the mitral valve regurgitation, the cause for the leak is also important. If it is due to ischemia, correction of ischemia will reduce the leak.

There are two types of surgery for mitral regurgitation - MV repair and MV replacement. Whenever it is possible to repair the mitral valve, that is always the best option. The results of MV repair are dependent to a large degree on the skills of the surgical team and invariably, patients who get operated in high volume, experienced centres who regularly perform MV repair do well.

Mitral valve replacement with a prosthetic valve is done whenever repair is not possible, or when there are greater chances of recurrence of the leak, or if there is no expertise available to do repair.

Those with severe MR and symptoms due to MR, or asymptomatic patients with any degree of LV dysfunction (LV ejection fraction < 60%) or chamber enlargement (LV end-systolic diameter > 40 mm) are candidates for surgery. MV repair is sometimes done even in asymptomatic patients with severe MR, normal LV function and no/minimal chamber enlargement when there is a very high chance of a successful repair at a low risk. MV repair/replacement is also done in patients with severe MR who develop persistent atrial fibrillation or pulmonary artery hypertension (estimated pressure more than 50 mmHg).

Mitral valve replacement is usually not done if there is very severe LV dysfunction and EF is less than 30%. In such cases, mitral valve annuloplasty can sometimes be done with an undersized ring in an attempt to reduce the severity of the leak.

Before a decision is taken on surgery, the patient will need a coronary angiogram to ensure that there are no significant blockages of the coronary arteries.

I hope this clarifies your query. Feel free to ask me for any further details that you may need.

Please accept my answer in case you do not have follow up queries.

With regards,
Dr RS Varma

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