mitral valve prolapse

[robint]

I have been having various medical tests done this past year, mostly related to a knee injury... but we have (yesterday) discovered I have a mitral valve prolapse. I have been diving for 14 yrs now, about 500 dives, many in the 100' range with zero problems. BUT my cardiologist has informed me that I should never dive again over 20' depth, if at all. I am probably having the valve repaired in the near future (he says it is a significant prolapse and will need surgery). For now I am starting on an ACE inhibitor to see how I feel, then we will go from there.

so.... my husband is not happy that his dive buddy is now a snorkeler. He thinks I should have the surgery asap, that way I can start diving with him again. True? Or is this a case of wait-and-see like my cardiologist says (might not need the surgery for years). The cardiologist says that there are 2 schools of thought - some say repair it now while I am in good health and heart is good, others say wait until it starts to fail me.
Is open heart surgery going to put me back into diving like my husband wants? Will they let me dive afterwards?

I am leaning towards wanting the surgery now, as I am only 56 and in reasonably good health. It has nothing to do with the diving, though. But if it means next year I might be back diving, well then it might make me want to get the surgery asap.

robin

 

[agilis]

In connection with the surgery, get a second opinion from a top cardiologist connected with a major teaching hospital. Heart surgery is very very serious stuff. A friend of mine, in his late 40s at the time, was in a similar situation, a wait and see or do it now type question. He simply accepted his local cardiologist's opinion and decided to get it over with, as if it were a bad tooth.

The surgery was a successs, but a heart infection developed shortly thereafter. He will have health issues and require blood thinners for the rest of his life. This sort of thing happens more often than many people realize.These are results that don't show up in mortality statistics, but they can change your quality of life. I stongly suggest that you consider very carefully and consult with the best you can find about the surgery, and also consult with a DAN recommended cardiologist about the diving limits and implications. Be very careful.

 

[TSandM]

I'd PM debersole here on SB. I have never heard of mitral prolapse requiring surgery -- mitral REGURG, yes, but not prolapse. Mitral prolapse is generally asymptomatic and I can't imagine why someone would forbid you to dive, if that's all you have.

 

[robint]

I'd PM debersole here on SB. I have never heard of mitral prolapse requiring surgery -- mitral REGURG, yes, but not prolapse. Mitral prolapse is generally asymptomatic and I can't imagine why someone would forbid you to dive, if that's all you have.

It is MAJOR regurgitation, I don't know the volume, but watching the echocardiogram as it was being done, it was obvious that a large volume was being lost back each pump. My cardiologist also said he was shocked at how severe this regurg was. My valve is a complete V shape and flapping (I saw it so I know what he means).

I have been on lisinopril for only 2 days and I already feel 10 years younger. Really scary that I could be feeling this good already since he said the drug would take 2 weeks to take full affect. I am thrilled with that aspect... feeling better, I mean. But he also said that if I am feeling better from this drug, it means that my heart was starting to show the effects from the MVP and sugery would be suggested sooner rather than later.

For those here who don't know my full medical history... 3 years ago this month I was diagnosed with endometrial cancer, had a full hyst, and have been cancer-free since. HOWEVER, every time I sneeze or burp my oncologist and primary care doctor panic and send me for tests. It is so weird that my heart thing has not been discovered after all the tests, CT scans, and bloodwork I have had done over the past 3 years. My biggest focus the past 6 months has been constant knee injuries and swelling (I am an avid mountain hiker). If not for the knee problems sending me to doctor over and over, the heart issue may not have been discovered.

agilis -- I am a military wife/dependent, so I cannot go out and "get" the best cardiologist, I have to use the doctor assigned to me by my insurance. Luckily, the cardiologist is from the local university heart dept. If I do need the surgery, which I am guessing now, I will be assigned to a heart surgeon group covered by the military (I think there are 2 here in town).

 

[DocVikingo]

It is so weird that my heart thing has not been discovered after all the tests, CT scans, and bloodwork I have had done over the past 3 years. My biggest focus the past 6 months has been constant knee injuries and swelling (I am an avid mountain hiker). If not for the knee problems sending me to doctor over and over, the heart issue may not have been discovered.

Hi robint,

The various tests & imaging procedures you would have undergone for endometrial CA & knee injury issues would have been focused elsewhere than the heart, both figuratively & literally. When mitral regurgitation is asymptomatic (e.g., no shortness of breath, fatigue following of increased physical activity, lightheadedness, sensations of a rapid, fluttering heartbeat, etc.), unless a heart murmur during routine physical examination raises suspicion it's unlikely to be diagnosed. For all intents & purposes, the definitive diagnosis requires an echocardiogram and there needs to be a specific indication to perform this technique.

Hope all goes well for you.

Regards,

DocVikingo

This is educational only and does not constitute or imply a doctor-patient relationship. It is not medical advice to you or any other individual, and should not be construed as such.

 

[robint]

DocV - true, but everyone was listening to my heart at every appt, too. Think they would have mentioned it to me? Nope. Only one doctor asked me if I had every been told I had a heart murmur, and that was this past August.
The doctor last month asked me about it, I said I had just been told I had one... he said not only could he hear it, but it was very distinct, and could even see pulsing in my neck (as did the medical student attending with him) that was a symptom of the backwash.

 

[DocVikingo]

DocV - true, but everyone was listening to my heart at every appt, too. Think they would have mentioned it to me? Nope. Only one doctor asked me if I had every been told I had a heart murmur....the doctor last month ...said not only could he hear it, but it was very distinct, and could even see pulsing in my neck (as did the medical student attending with him) that was a symptom of the backwash.

Hey robint,

I can fully appreciate your consternation, but cannot give you a confident answer as to why your murmur and prominent, active pulsing of veins of the neck went uncommented upon until late this summer. Taking a charitable perspective, I'll note that in some cases mitral regurgitation can have a sudden/acute onset, so it is possible that doctors who had previously examined you in fact did not detect a murmur, or pulsing neck veins.

Hope all goes well for you.

Regards,

DocVikingo

This is educational only and does not constitute or imply a doctor-patient relationship. It is not medical advice to you or any other individual, and should not be construed as such.

 

[robint]

DocV - I am not angry, just wonder why they missed it. The cardiologist says I have had this from birth, but it has definitely become worse IMHO this past year. I have always found that I need to "rest" more than most of the hikers in my group, doing altitude gains is a killer for me... and this has been for years and years. In fact, in college even jogging medium distances seemed to be a big issue (though I still did it). So I totally believe I have had this from birth. Now, I do believe that doctors have noticed it before now, but it was minor. This past year I am sure it has gotten worse... so the neck vein pulsing is something that may not have been present. Still, I just find it odd that so many doctors have looked at me this past year for whatever reason, yet didn't mention I had a heart murmur. Just a comment... I would like to have known this years ago.

 

[JTemple]

Hi Robin. Sorry to read this! I think it would be a tough decision if it were me. Closing the PFO was a no-brainer, I wanted to go diving! But it wasn't open heart surgery. Interesting perspective mentioned above, that there could be complications that you might have to endure the rest of your life if you proceed sooner than it is absolutely mandated. Of course that was the risk for the PFO closure, as well. Hmmm.... I don't envy you. Hope you can get all the info you need to make an educated decision you and your family are comfortable with. Good luck! I'll be watching for updates!

 

[cjfox]

Hi Robin,
Just a post to share my similar experience.
I am 56, have had cancer (Hodgkins lymphoma), and also have recently had a coronary bypass (2011). I am back to diving now, (no restrictions) and wouldn't miss it for the world!
I was not given a choice about the surgery, it had to be done, and despite the risks and unpleasant recovery period, I feel better than I have in years. I am back alpine hiking as well as diving.
Life is all about risk vs reward, and living a full life requires some tough decisions sometimes. This forum was a great resource for support and knowledge from the diving/medical community, even though I was not asking specific questions.
On a purely selfish note, I would dearly miss your expertise with underwater video, I also shoot underwater video, and your sage wisdom on the video forum was spot on.