Ask Dr. Roach: Leaky aortic valve cannot improve solely on its own.

DEAR DR. ROACH >> I’ve had a leaky aortic valve for approximately six years. I recently had an echocardiogram using Doppler. The last test I received was three years ago, which came back with a reading of mild-to-moderate aortic regurgitation. It initially started out as mild, then increased to mild-to-moderate in 2019. My test results for 2022 came back as a mild decrease in the severity of aortic insufficiency: The result stated that there was just a “trace” of transvalvular regurgitation. I am 69 and slim. The changes I’ve made over the three-year period include eating more vegetables and fruits, along with fish three times a week. I’ve increased my cardio training to six days a week (one hour daily) and continued weight training three times a week. My question is, can the valve improve on its own without any medication or surgery?

— G.D.

Dear G.D. >> The aortic valve is the structure in between the heart’s left ventricle and the aorta, the largest blood vessel that provides the blood supply to the entire body. If the valve doesn’t open all the way, it’s called aortic stenosis, but if there is leakage backward through the valve, from the aorta back into the left ventricle, it is called aortic regurgitation, or aortic insufficiency. Usually, this is discovered by a physical exam and confirmed by an echocardiogram with Doppler.

Most people with aortic insufficiency have a long period of time (many years) with no symptoms at all, and an echocardiogram every three to five years is reasonable in people with mild aortic insufficiency. A few percentage of people each year will progress to more severe valve leakage. In addition to monitoring the echocardiogram, we look for a development of symptoms, the most important of which are angina (chest pain or discomfort, especially with exercise) and heart failure (shortness of breath, especially with exercise). This also includes symptoms such as being unable to lie down flat, or waking up at night gasping for breath and needing to sit up.

Valves generally do not improve on their own. However, the echocardiogram is not a perfect test, and it’s possible that either the 2019 result may have appeared somewhat worse than it really was, or the 2022 result looked a little better than how your valve really is.

What’s most important is that the valve is not worsening quickly and that you are able to do your exercises without symptoms. Your healthy eating and exercise may not be improving your valve, but it is very healthy for your arteries and other body systems.

DEAR DR. ROACH >> Every four months, my blood test at my doctor’s office has reported a low vitamin D level. However, I have been eating four eggs a week, and eggs are supposed to be a good source of vitamin D. I can’t tolerate the vitamin D supplement. I don’t understand why my vitamin D level isn’t better with the eggs.

— J.R.

Dear J.R. >> The amount of vitamin D in an egg is about 1.1 mcg (44 IU). Since the minimum recommended intake for adults is 600 IU (800 for older adults, and even more in people with low bone mass or osteoporosis), you would need an unhealthy amount of eggs to get all your vitamin D. Most people get vitamin D from sun exposure: Your skin will make plenty of vitamin D with effective sun exposure. People without effective sun exposure will usually need supplementation, since it is very difficult to get adequate vitamin D through diet.

Contact Dr. Roach

Email: ToYourGoodHealth@med.cornell.edu

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