CLINIC: Concerning Heart Valve Leakage, Proper Diagnosis is Key

Mon, 5 Dec. 2011 - 11:18 p.m. MT
Credit: ARA Staff - American Running Association

My 76-year-old mother has been running for 25 years with no problems. She has run several marathons, enjoying national ranking in the top 10 for her age group, and has set several national age records. She routinely completes long runs of 10 to 15 miles, logging approximately 35 miles a week, and crosstrains with bicycling and walking. She has been taking a beta blocker for over 20 years to control blood pressure. About 6 months ago she began feeling tired and winded more easily on her runs. After a series of tests, her physician switched her to a different beta blocker. After an echocardiogram, she was diagnosed with leaky valves. Her physician has advised her not to run more than three miles at a time. She is devastated, as she is a fierce competitor who is in the midst of training for Senior Olympics. She does not want to compromise her health but still wants to compete at the highest level possible. What can she do and where can she turn for advice?
Patricia Neubert
Saxonburg, PA

It’s hard to provide you with specific advice without knowing more details of your mother’s medical history, but I can make some general comments I hope will be useful. Your mother’s symptoms of being more tired and short of breath are nonspecific; there are a number of entities that can account for these symptoms. Leaky heart valves can certainly account for these symptoms, but the first step is to make sure the symptoms are due to the leaky heart valves, and not some other entity. The echocardiogram is extremely sensitive for detecting trivial or mild degrees of leakage that may be of no clinical significance. For instance, approximately 50% of people with otherwise normal hearts and no clinical evidence of valve leakage will have trivial or mild aortic or mitral regurgitation (these are the two valves on the left side of the heart).
It’s important to know which valves have leakage and the degree of leakage. Grading the degree of leakage is a somewhat subjective process. It’s therefore important that the echo tape be reviewed by someone with extensive experience in valvular heart disease. In some people, the severity of the leakage may be more accurately assessed by a transesophageal echocardiogram, which requires passing a probe down the throat. (The more routine procedure is a transthoracic echocardiogram.)
If your mother has mild to moderate regurgitation of the aortic and/or mitral valve, she should be able to continue participating in competitive events if her symptoms do not otherwise limit her. However, if she has moderate to severe regurgitation, she might benefit from additional treatments, one of which could include surgery to replace or repair the leaky valve. I feel that this type of surgery should only be performed in a medical center that has extensive experience with these types of operations.
ACC/AHA General Eligibility Recommendations for Competitive Athletes with Cardiovascular Abnormalities:
ACC/AHA Guidelines for the Management of Patients With Valvular Heart Disease:
Todd Miller, MD
Rochester, MN
Editor’s note: Also see Marathoning with Mitral Valve Prolapse in this issue.
(RUNNING & FITNEWS®  September / October 2007 • Volume 25, Number 5)
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