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What should be done for mild leakage of the mitral valve?

Q: My recent echocardiogram shows minor valve leakage. The doctor says that on a scale from 1 to 10, I am at about 2. My heart walls are alright. I have no stress or fatigue. My blood pressure jumps from 120/80 to 140s in minutes. I am 57 years old, female, 5ft, 133 lbs. I have high cholesterol (244) and hypothyroidism. Are there any prescription drugs to halt valve disease? When is repair or replacement valve surgery indicated? Do I need anti-hypertensive drugs? Can I weight train and do light jogging?

A:Mild leakage of mitral valve is tolerated very well. The underlying cause also has to be evaluated. Echocardiography is a very good method of finding that. Common causes are rheumatic disease, mitral valve prolapse or secondary to enlargement of left heart (as a part of heart failure). Although you have not supplied the echo details it looks like that it is probably because of mitral valve prolapse and the left ventricular function apparently is normal. Since there are no symptoms like shortness of breath and it is 2/6 grade it does not need any specific medication. Patients with rheumatic MR are recommended to take 3 weekly penicillin injections to prevent recurrence of rheumatic fever. Indications of surgical intervention in mitral regurgitation are left ventricular enlargement with diminishing efficiency of the heart. This is easily ascertained by echocardiography. These features are invariably associated with shortness of breath on effort and fatigue on effort. It is recommended that echocardiography should be repeated in all patients with mild MR periodically ( may be yearly) to look for any progression. In mild asymptomatic mitral leak no restriction of activities is required. However maintaining a proper weight and keeping BP as close to 120/80 as possible is desirable. To achieve this you need medical supervision. You should continue cholesterol lowering drugs and thyroid replacement therapy.

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