Heart valve changes don’t always warrant treatment
DEAR DR. DONOHUE: I had been feeling slightly uncomfortable in my chest, especially in the morning after waking. I had an echocardiogram. The report reads: “a trace of mitral regurgitation; mild tricuspid regurgitation; pulmonic valve thin and pliable with normal motion; insignificant valvular hemodynamics; normal ejection fraction of 60 percent.” Is this something to be concerned about? How are valves related to the heart? My study was “technically difficult.” Why? I am 68 years old. — J.C.
ANSWER: The heart’s four valves keep blood moving from one heart chamber to the next. The heart has four chambers: two upper chambers (the atria) and two lower chambers (the ventricles). Without valves, blood would back up from one heart chamber to the next as it courses through the heart and out into the body.
A “trace of mitral regurgitation” and “mild tricuspid regurgitation” are of no concern. At age 68, neither is likely to get any worse. Both represent a tiny leak of the valves, too tiny to merit any worry. “Insignificant valvular hemodynamics” means the leak is so small that it’s hardly worth mentioning.
Your heart function gets an A. The ejection fraction of 60 percent is normal. It’s the amount of blood the heart pumps with each beat. Yours is a fabulous number.
“Technically difficult” pertains to the trouble the technician had in taking the echocardiogram pictures. Perhaps you have large breasts or a large chest. The comment has nothing to do with your health.
You couldn’t ask for a better report.
The booklet on valvular heart disease explains the working of the heart valves and how heart-valve defects are discovered and treated. Readers can obtain a copy by writing: Dr. Donohue — No. 105, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.
DEAR DR. DONOHUE: I take Zetia every day, and I have read and heard that it is not good. A friend told me her doctor indicated it could cause cancer. Other drugs I have taken in the past have created problems for me. I would appreciate your writing about this. — V.B.
ANSWER: Zetia (generic name ezetimibe) lowers cholesterol by blocking its absorption from the digestive tract. This is a mode of action different from other cholesterol-lowering drugs Ezetimibe is combined with simvastatin (Zocor), which is a statin drug, the class of drugs that lower cholesterol by interfering with the liver’s production of it. The combination drug is called Vytorin.
The tempest over ezetimibe arose with the combination drug Vytorin. A study measured the efficacy of Vytorin compared with the cholesterol-lowering efficacy of its two components taken separately. The combination did effect greater cholesterol-lowering. However, as part of the study, a measurement of plaque in the carotid artery, before and after taking the drug, was made. Plaque is the buildup of cholesterol and fat on the artery wall. The carotid artery is the artery that supplies the brain with blood. Plaque buildup didn’t regress with the combination drug. In fact, it might have slightly increased. That threw some doubt on the effectiveness of the combination drug. This study was not performed with Zetia, your drug. An early study suggested an increased cancer risk among Zetia users. Subsequent studies did not support that finding. If Zetia is working for you and since other cholesterol-lowering drugs caused you problems, you can safely take this medicine.
DEAR DR. DONOHUE: This is about the seventh time I have written to you. Often I see questions in your column that could be answered by advising the person to check the book “Eat Right for Your Blood Type.” I know a person bothered by hives who went on this diet and had no more outbreaks. If people ate the right foods, they wouldn’t need so much medicine. — M.S.
ANSWER: I am aware of that book, and I greatly admire your perseverance. I am sorry to have edited your letter. My only reason for not giving you space previously is my lack of faith in the premise of the book.
Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com.

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