Leaky Valve ???

After an echo I have found out that I have a leaky valve. I asked my doctor if this could be causing the afib. He said no and that the leak was very small and trivial. I bought a stethescope and have been listening to my heart when I am standing or sitting normal beat..... as soon as I lay down the extra beat kicks in.... stand up right back to normal..... any futher help or suggestions would be much appreciated as this is all confusing to me. I am scheduled to see the cardiologist on the 30th of this month.

You may be interested in these CR sessions:

SESSION 25: Mitral Valve Prolapse, Magnesium Deficiency and LAF (February 20 - March 6, 2004) [www.afibbers.org]

SESSION 51: MVP, ANP, P cells, hydration and LAF (May 17, 2006 - June 15, 2006) [www.afibbers.org]

It is far more likely that your a-fib is causing the leaky valve. The valve support structure is embedded in the wall of the atrium. A-fib causes changes in the atrial wall. Support for the mitral valve is thereby affected, resulting in the leakage.

You also have to be suspicious of the medical descriptors used for quantifying the leakage. The terms used suggest the leakage is relatively insignificant, while studies of the consequence of that supposedly insignificant leakage is essentially that your death rate doubles.

While doubling doesn't sound too bad, that is only for the first year. The second year is doubling doubled, or four times higher. And so on.

In my case I was in 24/7 a-fib for about four years, during which time no leakage was observed on echos. However, a small amount of leakage was then seen on a routine echo. The leakage increased exponentially over the next few months as seen on repeated echos. Given that data I changed my decision from tolerating the a-fib to aggressively pursuing an ablation. The successful ablation caused the leakage to regress. Disappearance of valve leakage is commonly observed during the months after a successful ablation.

Not treating the leakage, if it starts increasing, leads to congestive heart failure.

However, beware, because medical types regard the a-fib, the valve leakage, the failure of the valve, the complications of the open heart surgery to replace the valve, the complications resulting from the replacement valve's operation, and the congestive heart failure, as separate unrelated medical problems.

This is a situation where you have to be responsible to monitor the leakage via regular echos. If you see the leakage increasing you need to arrange an immediate ablation with a top EP. If you instead depend on your doc, he/she will likely recommend replacing the defective valve, rather than solving the valve problem by eliminating the a-fib.

Good luck.

Chuck:

Suspect two things with minor leakage from mitral valve prolapse: ...dehydration and magnesium deficiency. With dehydration, the chords operating the valves become stiff and don’t allow the valves to seat properly to allow for complete closure. Often it’s just as simple as hydrating well and often and taking supplemental magnesium. I have quite a few files if you’d to read some of the articles, email me. Otherwise,
here’s a start:

Jackie

Check out Conference Room #25 [www.afibbers.org]

Following are a few clips from my files regarding MVP:

Be sure you read this article by Leo Galland, MD...

Magnesium Deficiency in the Pathogenesis of Mitral Valve Prolapse
Leo D. Galland, Sidney M. Baker, Robert K McLellan
Gesell Institute of Human Development, New Haven, Conn., USA [www.mdheal.org]


Also read that Dr. Galland has discovered many patients with MVP also have Candida overgrowth. Worth checking out.

Mitral Valve Prolapse and Candida
People with the yeast syndrome, fibromyalgia or multiple chemical sensitivity are more likely than others to have a heart condition called mitral valve prolapse. In fact, Leo Galland found that almost half of those being treated for chronic Candida albicans infections also had mitral valve prolapse. Depleted taurine, coenzyme Q10 and low magnesium are associated with both mitral valve prolapse and candida overgrowth. This suggests that yeast may play a major part in the development of this condition. With mitral valve prolapse, the body appears to have a problem with controlling the release of noradrenaline and adrenaline.
[www.healthyawareness.com]

More From Dr. Galland:
Irritable Bowel, Mitral Valve Prolapse, and Associated Conditions
[jama.ama-assn.org]

A couple of clips from a 10-page document file from Han’s online newsletter International Health News Data Base indicating magnesium deficiency is wide spread and found to be a factor in not only heart disease and arrhythmia but disease conditions such as diabetes, asthma, hypertension, chronic fatigue, osteoporosis, mitral valve prolapse, muscle cramps. These are summaries of journaled articles from all over the world:

Magnesium combats mitral valve prolapse syndrome
WARSAW, POLAND. Mitral valve prolapse syndrome (MVP) is a fairly frequent disorder and is particularly prevalent among women of childbearing age. It usually manifests itself through symptoms such as chest pain, palpitations, anxiety, headaches, and a low level of vital energy. It can be clinically confirmed through an echocardiogram. The cause of MVP is not clear and there is no effective conventional treatment. Researchers at the Grochowski Hospital in Warsaw now report that MVP is related to a magnesium deficiency and can be successfully treated with oral administration of magnesium supplements. Their study involved 141 patients (124 women and 17 men aged 16 to 57 years) whose diagnosis of MVP had been confirmed by echocardiography. The researchers measured the serum (blood) level of magnesium in the 141 patients and in 40 matched, healthy controls. They found that 60 per cent of the MVP patients had an abnormally low magnesium level (<0.7 mmol/L) while only five per cent of the controls had a low level. Seventy of the patients (64 women and 6 men) were then randomized to receive either oral magnesium supplementation or a placebo for a five-week period. The magnesium group received 1800 mg/day of magnesium carbonate (510 mg of elementary magnesium) for the first week and than 1200 mg/day of magnesium carbonate (340 mg of elementary magnesium) for the remaining weeks. At the end of the test period all participants were evaluated for MVP symptoms, anxiety level, serum magnesium level, and urine content of adrenaline and noradrenaline. The average number of MVP symptoms in the patients treated with magnesium decreased from 10.4 to 5.6 after treatment. There was no significant change among the patients in the placebo group. The number of patients reporting a high level of anxiety decreased from 32 (54 per cent) to 9 (15 per cent) after supplementation with no change observed in the placebo group. The level of noradrenaline excreted in the urine also declined markedly after magnesium supplementation (from 42 micrograms/gram/24 hours to 26.8 micrograms/gram/24 hours), but increased in the placebo group. The researchers conclude that MVP symptoms are linked to a magnesium deficiency and believe that this deficiency may be caused by an increased release of adrenaline and noradrenaline in MVP patients. They also conclude that magnesium supplementation is effective in combatting MVP symptoms particularly anxiety. They speculate that this beneficial effect could be due to magnesium's ability to inhibit the toxic effects of an excessive release of catecholamines (adrenaline and noradrenaline).
Lichodziejewska, Barbara, et al. Clinical symptoms of mitral valve prolapse are related to hypomagnesemia and attenuated by magnesium supplementation. American Journal of Cardiology, Vol. 79, March 15, 1997, pp. 768-72


Magnesium effective in treatment of osteoporosis
ADELAIDE, AUSTRALIA. Dr. Ivor Dreosti of the Commonwealth Scientific and Industrial Research Organization has just released a major report detailing the current knowledge of the importance of magnesium in human nutrition. Magnesium is involved in the functioning of more than 200 enzymes and is a key player in the body's energy (ATP) cycle. The recommended dietary intake is 300-400 mg/day (in the U.S.A.), an amount which many scientists now feel may be insufficient. It is also clear that many people do not even get the recommended intake and that this can lead to problems with muscle spasms and idiopathic mitral valve prolapse. Dr. Dreosti points out that the body's requirement is increased markedly by both stress and vigorous exercise. Recent tests have also shown that exercise capacity can be significantly increased by the use of magnesium supplements. Many researchers are now also reporting that magnesium deficiency plays a significant role in the development of osteoporosis. Studies have shown that women suffering from osteoporosis tend to have a lower magnesium intake than normal and also have lower levels of magnesium in their bones. It is also clear that recommendations to postmenopausal women to increase calcium intake can lead to an unfavourable Ca:Mg ratio unless the magnesium intake is increased accordingly; the optimum ratio of Ca:Mg is believed to be 2:1. A magnesium deficiency can also affect the production of the biologically active form of vitamin D and thereby further promoting osteoporosis. Some very recent research shows that magnesium supplementation is effective in treating osteoporosis. A trial in Israel showed that postmenopausal women suffering from osteoporosis could stop further bone loss by supplementing with 250-750 mg/day of magnesium for two years. Some (8 per cent) of the treated women even experienced a significant increase in trabecular bone density. Untreated controls lost bone mass at the rate of 1 per cent per year. Another experiment in Czechoslovakia found that 65 per cent of women who supplemented with 1500 to 3000 mg of magnesium lactate daily for two years completely got rid of their pain and stopped further development of deformities of the vertebrae. Other studies have shown that magnesium is helpful in the treatment of cardiac arrhythmias and that an adequate intake may help prevent atherosclerosis.
Dreosti, Ivor E. Magnesium status and health. Nutrition Reviews, Vol. 53, No. 9,


From Magnesium researchers, Drs. Mannsman and Mildred Seelig:

MAGNESIUM RESEARCH LABORATORY
DEPARTMENT OF PEDIATRICS
DIVISION OF ALLERGY AND CLINICAL IMMUNOLOGY
HERBERT C. MANSMANN, Jr., M.D.*
Director
REVISED 12/31/02

1.The following conditions, which are associated with MgD, occur statistically and significantly more frequently in females as compared to males; Alzheimer's disease, Carpel Tunnel Syndrome, competitive swimmers symptoms of MgD, diabetes, heart disease (worse types), migraine, Mitral Valve Prolapse Syndrome, osteoporosis and Status Asthmaticus (life-threatening asthma).


Consequences of Magnesium Deficiency on the Enhancement of Stress Reactions; Preventive and Therapeutic Implications (A Review)
Mildred S. Seelig, MD, MPH, Master ACN

Patients with latent tetany of Mg deficiency, who have psychoneurotic complaints (97,98), may also be especially vulnerable to mitral valve prolapse (97,99,100). [www.barttersite.com]

97. Durlach J: MAGNESIUM IN CLINICAL PRACTICE. (transl by D Wilson), John Libbey & Co, London, UK, 1988.
99. Durlach J, Durlach V: Idiopathic mitral valve prolapse and magnesium. State of the art. Magnesium Bull 8:156-169, 1986.
100. Galland LD, Baker SM, McLellan RK: Magnesium deficiency in the pathogenesis of mitral valve prolapse. 5:165-174, 1986.

From the Intro to Hans paper on Lone Atrial Fibrillation
Atrial fibrillation is the most common cardiac arrhythmia and affects more than 1.5 million Americans. Its primary characteristic is a rapid and irregular heartbeat. The incidence of atrial fibrillation shows a significant increase beyond the age of 50 years and the condition is considerably more common among men than among women. Atrial fibrillation may be chronic or intermittent (paroxysmal) and may be triggered by an underlying heart disease such as mitral valve prolapse or stenosis, coronary artery disease, hypertensive heart disease, a heart attack or an inflammation of the membrane surrounding the heart (pericarditis). Atrial fibrillation is also a common complication of heart surgery(1-3,5-7).

Mitral Valve Prolapse: Can Magnesium Help?
by Melvyn R. Werbach, M.D.
[www.healthwell.com], February 19, 2004

Will:

How often did you get the echo done? How much time do you think you give between exams to see if there has been any change?

In about late 2004 I had been in continuous 24/7 a-fib for about four years. I hadn't had an echo for about a year. I made an appointment with an EP with the intention of reviewing my decision to just live with a-fib long term. He recommended, at a minimum, to get an echo every year to monitor possible heart changes. (though he didn't give me any information about how significant that data might be)

I scheduled an echo and I think it came up with the second of the official levels of mitral valve leakage. (That echo was almost five years ago, so the details are a little hazy now.) I think the lowest level was physiologic and the level of leakage I had I think was called "minor". (The actual details were documented in the messages on this bulletin board back in the late 2004 or early 2005 time frame) The doc who supervised the echo downplayed the importance of such leakage, but mentioned that if it got worse they could replace the valve with a mechanical valve. That got my attention. (Especially after my MD daughter explained to me how problematic open heart surgery to replace a valve was - brain damage, death on the operating table - etc.)

I looked up the published studies on heart leakage and found that leakage, once present, tends to increase relentlessly. This is a much bigger problem for an a-fibber because the leakage, from the ventricle to the atrium, "blows up" the atrium and thereby increases the stress on the atrium, thereby reinforcing the effect of a-fib to cause enlargement the atrium. The atrial enlargement affects the mitral valve support structure causing more leakage. A classic vicious circle doubled (The combined effects on the atrium of a-fib plus the effects on the atrium of mitral valve leakage).

The studies showed that typical leakage was associated with a doubling of death rate (when no a-fib was present). The actual increase of the death rate when a-fib is also present has apparently not been studied.

Another echo a few months later reported further increased leakage.

At about that time I started (when we, as a group, were still very skeptical of ablations) gathering data here, and there were some five or ten a-fibbers who could contribute echo/leakage data. The pattern that appeared supported the idea that the presence of valve leakage, for an a-fibber, was typically followed by an exponential increase of leakage thereafter. Sometimes it was soon thereafter, and in one case it had occurred many years later, but all a-fibbers contributing valve leakage data, experienced a rapid increase of leakage.

There is not enough data available to conclude how often to have echos. In my case it would have had to be every 3 months to catch the beginning of runaway leakage. Runaway leakage inevitably leads to congestive heart failure, or open heart surgery to replace the valve, which usually leads to a different downward spiral.

My personal conclusion, given the small amount of data gathered, and given that the combined effects of a-fib and valve leakage to enlarge the atrium seem highly plausible, is that if an a-fibber shows up with mitral valve leakage, then getting back into nsr becomes a life and death condition.

The messages back in late 2004 and 2005 will explain the above in greater detail.

Wil - I also had mitral valve leakage diagnosed on ultrasound when I first joined the CCF for care . The cardiologist who specialized in rhythm disturbances said it was so insignificant that he wouldn't even say it was notable for the chart.

After ablation, the leakage has resolved and has not progressed as you suggest it will. Good news and one less thing about which to worry!

Jackie

Jackie, you didn't understand the reality I communicated.

You did arrange to get back into nsr, via an ablation. That removed the effect of your a-fib on the support structure of the mitral valve that had caused the leakage, and the leakage thereafter resolved itself.

As I've been trying to reinforce among the a-fibbers here; tolerating a-fib episodes incurs a risk of physical complications, that no amount of nutritional/lifestyle changes can always prevent, so long as the episodes are allowed to continue. Such toleration can be a fatal mistake unless frequent echos monitor the effect of those episodes on the heart.

The medical community is completely oblivious to such consequences, so I contend we are obligated to emphasize them here, even if that suggests fear mongering to many. Leaving the impression that nutritional/lifestyle changes can successfully treat a-fib, without simultaneously warning that that is not always true, is irresponsible, partly because it plays to the natural hope, in new a-fibbers, that a-fib is not a dangerous medical problem. It is!

Wil, do you feel that NSR resulting from ablation is more healthy than NSR resulting from nutritional interventions?
PeggyM

Thanks for all the help Jackie and Wil. I haven't been to the cardiologist yet but my doctor told me it was Afib. However, after everything I have read and some self diagnostics ... lol I am in doubt. Whenever I am vertical normal heart rate and normal blood pressure. The second I go vertical heart rate drops to about 48 and with a stethescope and can hear the 3 rd beat come it. BP drops as well. It doesn't matter what side I am on. As soon as I go vertical back to normal rates and no 3 rd beat. This doesn't take a minute to convert either way, it is instantaneous. My hear never races as all of you describe with afib. Any thoughts?

Posture affecting the heart behavior of a-fibbers is commonplace, and takes many forms.

One simplistic explanation is the physical stress imposed on parts of the heart, and on the associated veins and arteries and on their attach points at the heart, as the body's (heart's) orientation is changed, stimulates the abnormal sensitized heart tissue to send out anomalous electrical signals, which then change the atrial and ventricular electrical wave patterns, thereby causing changes in a-fib/flutter, ectopics, heart rate, blood pressure, etc..

Stated more simply, one way to stimulate abnormal heart behavior is to physically stretch or compress abnormal sensitized heart tissue. One easy way to do this is the change the orientation of the body.

Average heart rate when in a-fib/flutter can vary all the way from tens of beats per minute to hundreds of beats per minute. This is because various kinds of damage to the neural circuits in the heart affect the timing and phasing of heart beats and ectopics.

I don't know of any reason to believe the beneficial effects of being in nsr, achieved by nutritional/lifestyle changes, would produce different beneficial effects than would nsr achieved by ablation.