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Cordae Tendinae.

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I had an echo done recently. The cardiologist over the phone said there were some minor things but nothing bad and I should not worry at all because my heart was healthy. Then I received a letter in the mail describing some of the findings in more detail and now I'm concerned. The letter says "Echo-Doppler only revealed minimal mitral incompetence (ruptured chordae and minimal pericardial effusion, left atrial size normal). Holter monitoring was unremarkable". Fore the record, I have PSVT. I don't have a murmur and the doctor said my heart sounded fine over the phone. I already knew I had slight pericardial effusion (has been stable for 2 years) but the chordae issue I did not know about. I'm 29, F, normal weight.

1. What does this mean? What could cause ruptured chordae? This really surprised me.

2. Is this a cause for concern? I thought mitral incompetence was serious, but the doctor said it was minimal in that letter. Nonetheless, I'm worried. Details would be appreciated.

3. Will it affect me later in life like in pregnancy? I know pregnancy puts pressure on the heart.

4.Does this mean I will have to take antibiotics at the dentist?

5. Does this predispose me for anything else in the future? Meaning, does this increase my risk for more ruptured chordae, heart failure, valve problems, more arrhythmias… anything?

Category: Cardiologist

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Category: Cardiologist
 18 Doctors Online

Hello and thankyou for approaching DoctorSpring.com
I have gone through your case and understand your concern.
1) Cordae tendinae are tendinous cords that connect the papillary muscle of the heart to the tricuspid valve and mitral valve. These cordae tendinae help in the proper functioning of the valves. Many times if there is minor rupture of chordae tendinae the cause of rupture is not known.

2) Mitral Incompetence also known as Mitral Regurgitation is a condition where due to improper closure of the mitral valve, small amount of blood leaks back from the ventricle of the heart into the atria. This could be normal. Normally there is trace amount of mitral incompetence. Your cause could be due to the ruptured cordae.
This is not a concern as of now, but you will require yearly follow up.

3) Since this is minor, it will not affect pregnancy.

4) No, you will not require antibiotic prophylaxis for this condition.

5) For this I will require you to provide additional information on your pericardial effusion. Was the cause of your effusion found out? If so what was the cause? Do you have any reports with you? If so please can you upload them here.

I hope this has helped. Feel free to follow up.
Thankyou



Patient replied :

Hi Dr. Mahajan,

Thanks for your answer. I really appreciate it. The cause of my effusion was never found out. I've had an echo every year for 3 years and it hasn't increased. I've been told in each case that it's so minor you could consider it on the high side of normal. I've just never heard about a chordae rupture, although the cardiologist seems to think it was barely worth mentioning and told me to relax and assume my heart is healthy. I'm going to talk to him in a couple of weeks but…

1. Can a chordae rupture be found on an echo, or is it deduced from the fact that there is minimal mitral incompetence? Is having this common?

2. Could the chordae rupture be related to my SVT in any way? The SVT has caused me great anxiety in my life. I wonder if SVT or anxiety can cause this...

3. Can this chordae rupture predispose me to risks in the future like heart failure, the mitral incompetence increasing, sudden cardiac arrest, Afib… etc.?

Thanks once again!



Hello,

The chordal rupture could be identified by certain echo characteristics. Minimal mitral incompetence is a supportive evidence for this. It is not likely to be related to SVT. This ruptured chordae itself will not predispose you to increased risk for sudden cardiac arrest , Afib , V Tach etc. But in your case followup by Echo is definitely indicated. I would actually recommend yearly followup.

Edit:

Also you could start low dose betablockers like carvedilol or metoprolol to reduce the progression of mitral valve prolapse in consult with your Doctor. The chordae rupture can occur due to trauma to chest infection connective tissue disorders or myxomatous degeneration of the chordae tissue and valve tissue. So discuss with your Doctor whether these causes have been ruled out.

Hope this helps
Thank you


Dr. Vivek Mahajan
Category: Cardiologist
Experience: 
Fellowship: DM, Cardiology, PGIMER, 2013
Residency: MD, Internal Medicine, AIIMS, 2007
Internship: King Edward Memorial (KEM) Hospital, 2003 
Medical School: MBBS, Seth G.S. Medical College, 2002
Dr. Vivek Mahajan and 4 other Medical Specialists are ready to help you

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