Brief Answer:
I would explain as follows:

Detailed Answer:

Hello!

Thank you for your question on HCM!

I reviewed carefully your past medical history and echo reports, and would like to explain as follows:

The main clue of all your clinical scenario seems to be your mitral valve prolapse and regurgitation. They may raise complains such as palpitations, breathlessness, tiredness and exhaustion, dizziness, dry cough, and other more specific heart failure signs like fake weight gain, body and limbs swelling, which are in fact an expression of excessive and abnormal fluid retention.

Other symptoms and signs may be derived by mitral valve prolapse, such as increased anxiety with underlying angry and weird feelings, chocking, burping, etc (which get better when laying down).

The most serious issue in your cardiac ultrasound picture is your mitral valve regurgitation,. from your 2014 echo report is was shown that it is a mild to moderate mitral regurgitation. This may have some consequences leading to left heart chamber dilation (remodeling) with time, pulmonary congestion with underlying dyspnea, increased systemic venous pressure with underlying clinical edema.
Seems that the reason of your heart valve dysfunction is a myxomatous degeneration, expressed with redundant valvular tissue.

Returning to your questions, I would say:

(1) This is a progressive process and needs to be closely monitored by periodic cardiac ultrasound to quantify aggravation of mitral regurgitation, as well as the above mentioned consequences.

(2) Repairing process is determined by clinical and especially cardiac echo findings. When cut off values are reached (level of regurgitation, chamber dilation, increased pulmonary pressure, etc intervention may be indicated.

(3) I think that you need actually a medical therapy optimization to relieve your complains, and after that a meticulous clinical and echo follow up.

(4) Medical therapy is the best option, facing your actual clinical conditions. It will help to stabilize your symptomatology.

(5) Valve tissue degeneration is a genetically determined process, it has nothing to do with your diet.

I would like to assure you that your health cardiac issue is totally curable, and you don;t have to be panic. just follow your doctor's advices!

Hope to have been helpful! Greetings! Dr. Iliri

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Brief Answer:
You are welcome!

Detailed Answer:


Hi again!

A beta-blocker is OK, but you need to be careful even for your limbs swelling.

Probably a try of diuretics would be necessary, but it remains on your doctor's discretion to make the decision.

Just keep being in close contact with your attending cardiologist.

If you have any further uncertainties, don't hesitate to ask me!

Best wishes! Dr. Iliri

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Brief Answer:
Most important issue in your case is a careful medical follow up program.

Detailed Answer:

Hello!

Chest discomfort (tightness, pin pricking, palpitations etc), are associated symptoms of mitral valve prolapse. So don't worry!

Wish you a good health! Dr. Iliri

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Brief Answer:
A careful check of risks/benefits balance is necessary during follow up.

Detailed Answer:

Hello!

Regarding cardiac valve surgery, I would explain that deciding for intervention would be based on a careful investigation of a delicate balance between short and long term clinical outcomes from one side, and the risk level for potential periprocedural complications from the other.

As a general rule, when dealing with the possibility of a valve repair, the actual tendency is to intervene earlier and prevent irreversible chamber remodeling and myocardial insufficiency.

The opposite is true for surgical valve replacement with prosthesis. Native valve preservation is first attempted (to avoid complications related to valve prosthesis), and when (a) the clinical conditions as well as (b) cardiac tests criteria of severe valvular and myocardial implications are met, comes the decision for surgical intervention.

Returning to your concrete question, what would be my personal decision in that case??

I think that the actual clinical conditions has not reached the borderline for taking surgery into consideration.

There is further need for a careful follow up, by (a) clinical and (b) cardiac ultrasound evaluation.

If (a) mitral regurgitation severity during follow up is more than moderate, and echo parameters of cardiac structure and performance show important deterioration, justifying (b) all clinical symptoms and signs, then I would care to engage a well experienced cardiac surgeon to promptly consider a surgical option.

An exception form these universal principles, would be the availability of a highly experienced and very well trained top surgeon (who could change the balance between surgical risks and clinical outcomes). If mitral regurgitation would reach (a)more than moderate severity (by echo) , in the absence of (b) clinical important implications, I would break the rule and anticipate the guidelines criteria. I would dare to undergo cardiac surgery.

That is my XXXXXXX opinion.

Hope to have been clear and helpful for you!

My best wishes! Dr. Iliri

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Brief Answer:
You are wellcome!

Detailed Answer:
I wish you too a nice weekend!

Best regards! Dr. Iliri

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