CLINIC: Is My Fatigue Definitely Heart-Related?

Wed, 22 Aug. 2012 - 8:16 p.m. MT
Credit: ARA Staff - American Running Association

QUESTION:
I take a beta blocker to control my blood pressure, and have been for the past 20 years. I am in my late 70s and run marathons without any health problems. I typically finish strong on my 10- to 15-mile long runs. I log about 35 miles a week, and crosstrain on a bike. About six months ago I began feeling tired and winded more easily while running. After an echocardiogram, I was diagnosed with leaky heart valves. My physician has advised me not to run more than three miles at a time. I am currently training for several upcoming competitive events. I don’t want to place my health in jeopardy, but surely there must be a way to continue to train at a higher level than my physician has prescribed. What can I do? 
 
Jan Cordova
Kent, MO
 
ANSWER:
Without knowing more details about your medical history, I can only make general comments I hope will be useful. The symptoms you describe—earlier fatigue and increased shortness of breath—are nonspecific; there are a number of entities that can account for these symptoms. 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 you only have mild to moderate regurgitation of the aortic and/or mitral valve, you should be able to continue participating in competitive events, assuming your symptoms do not otherwise limit you. However, if you have moderate to severe regurgitation, you 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.
 
Todd Miller, MD
Rochester, MN

(RUNNING & FITNEWS®May / June 2010 • Volume 28, Number 3)

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