During a routine exam in December (at age 58-1/2), I was diagnosed with mitral regurgitation by a young GP. I've been a vegetarian for 35 years and I'm a runner. In December I was running 10k at least 4 times a week in about 45 to 48 minutes, and doing plenty of working out (chin up bar, pushups, yoga and Pilates on the Pilates Reformer in my exercise room). I've pretty much always had arrhythmia, but I never thought much about it until that day.
He sent me to get an ecocardiogram (transthoracic) and I scheduled an appointment with one of the clinic's cardiologists. The eco showed moderate mitral regurgitation, with left ventrical dimension in the normal range. The cardiologist said "If you don't have any shortness of breath, then go home and enjoy your life and forget about it."
I went home and got on the Internet and started downloading medical reports -- most notably "Mitral valve surgery: wait and see vs. early operation" by de Bonis and Bolling (European Heart Journal (2013) 34, 13-19) and "Association Between Early Surgical Intervention vs. Watchful Waiting and Outcomes for Mitral Regurgitation Due to Flail Mitral Valve Leaflets" by Suri et al, published in the Journal of the American Medical Ass'n. After the latter study was published in August 2013, the Mayo Clinic eliminated watchful waiting as a strategy for a wide swath of patients. I also downloaded the 2006 American Heart Ass's Practice Guidelines for the Management of Patients with Valvular Heart Disease.
The first thing that I realized after doing my reading was that the cardiologist who said not to worry was an idiot. He based that on my stress test and blood work, but MR can be assymptomatic but still severe. My next realization is that I had no baseline comparison. My last ecocardiogram was in 2009 and there was no sign of mitral valve prolapse or regurgitation. So was my condition relatively stable or getting worse quickly?
I looked on the Internet for a cardiologist with a published CV and other information -- something very difficult to find in Brasil, it seems. I found Dr. Wanewan Andrade a surgeon who first brought minimally invasive surgery to Salvador (just a few years ago in fact), and figured he would be good to talk to even though he was 'out of network.' I had to wait until January 9th to get an appointment due to the intervening holidays.
Dr. Wanewman (in Brasil, we use the doctor's title and then the doctor's first name) explained MR to me, with diagrams that he drew with his Mont Blanc pen, showing the leaflets, chordae, etc. and said that the transthoracic ecocardiogram didn't really provide enough information about the precise condition. We talked about early surgery but clearly with only moderate regurgitation, it wasn't time.
But I went home and thought about it and a couple of weeks went by. I called Dr. Wanewman again. The part about not having a baseline was bothering me. He agreed that it would be a good idea to get a transesophageal ecocardiogram. I might not get an idea about the rate at which the condition was worsening, but at least we would have a firm anatomical picture.
On January 31st, I had the "eco trans," as they call it. I did it at a hospital that was out of network (but one where Dr. Wanewman operates), since I didn't like the looks of the in-network hospital. (It looked like something out of another century - and not even the 20th century.)
The cardiologist who was to administer the "eco trans," as they call it, looked at my ecocardiogram from December and asked me why I was doing transesophageal ecocardiogram. I told him that we had no baseline or I want to know what the problem is in as much detail as possible. He shrugged, but before he had the anaesthesiologist give me propofol, he did a transthoracic ecocardiogram just to take a look. "Oh," he said. "Your condition has worsened." He showed me how the chordae on the central leaflet had come loose and was moving with a whip-like action with every heartbeat. Then I was given propofol and the eco trans was performed.
Or so I'm told. Next thing I knew, I was being woken up. Before going home about 15 minutes later, the cardiologist said, "don't do any more running." The day before I had run 10k in 45 minutes and felt terrific. Now I didn't feel so good, but it was because I knew surgery was on the horizon. It was a no brainer: once they tell you not to engage in a certain level of exercise, what would I be waiting for? A step closer to death?