Question for Dr Fett

[Theresa Brotherton]

Dr Fett

I had my second trimester echo today. I am at 20 weeks My EF is holding steady at 55-60%. However, I am having moderate to severe regurgitation on my mitral valve. I started out with minimal mitral regurgitation.

I went into CHF 6 days after my last child was born. Initially they said it was from having moderate to severe mitral regurgitation. It wasn't until a few months after I delivered that my heart started to enlarge and my EF started dropping that I was diagnosed with PPCM.

Currently the only symptoms I am having is occasional SOB when chasing my toddler and the feeling that my heart is beating harder when I lay on my back and my left side.

My cardiologist wants to repeat echo in 8 Weeks or sooner if I have orthopnea, edema, etc...... She said that she hopes that my heart doesn't get "tired" again. But as it is now all we can do is take a wait and see approach. Does this sound reasonable?????
__________________
TBRO

[JAMESFETT]

I am assuming that your diagnosis of PPCM was correct, and that the mitral regurgitation was secondary to that and that your mitral valve is anatomically normal. I will say that it is encouraging that your LVEF is maintaining between 55 - 60 %. Increased mitral valve regurgitation may also be seen during normal pregnancy, so that in and of itself is not alarming. With MR, I like to know the size of the LV (EDD or LViDd) and height and non-pregnant weight of the individual--can you tell me those? Here's what you can discuss with your cardiologist:

--careful monitoring of echocardiograhic LVEF as you are planning to do according to time and symptoms
--monitor blood BNP, since an elevation from stress on the LV often comes before clinical symptoms of heart failure. Doing the baseline level and then once every 2 weeks to 1 month is not too frequent. You will see if there is any trend.
--If the LVEF starts to drop or the blood BNP rises above the "cut-off" that is the time to consider early treatment, which is very effective, and consists in use of some combination of diuretics, beta-blocker, hydralazine/nitrates if and as indicated.
--of course careful monitoring of pulse, B.P., physical signs of congestion, edema, as your cardiologist is doing
--although it hasn't caught on yet, I like to monitor the blood high sensitivity C-Reactive Protein, which goes up a little during normal pregnancy, but what I am looking for is the level >10 mg/L as an indicator of potential inflammatory process in the heart muscle, which can often precede heart failure symptoms. I would accept the combination of elevated blood BNP over cut-off and elevated hsCRP over 10 mg/L as indicator of pending relapse and begin small dosages of appropriate treatment at that time.

Glad you are doing well, and best wishes.

JD

[georgie]

Any members in Sydney out there ??

[JAMESFETT]

There are survivors from Australia on the boards. You might try your question on the "General Support" forum.

JD