Friday, November 28, 2008

Where I Fit In With The AHA Guidelines

So, my cardio sent me away in August with the advice to come back in a year unless I developed symptoms of severe AS. But when I got copies of the last two echos from 2007 and 2008, and I saw that the rate of progression of the stenosis had jumped way up, I wondered if waiting for a year was a good idea. I began research in earnest and quickly found the AHA Guidelines. So, where do I stand in relation to AHA Guidelines? Here are some key excerpts with my comments:

"In large patients, a valve area of 1.0 cm2 may be severely stenotic,
whereas a valve area of 0.7 cm2 may be adequate for a smaller patient."

Large Patient? That's 6'5" and 226 Lbs. My valve area in August was calculated at 1.1 to 1.4 cm2 and closing fast.

"studies indicate that some patients exhibit a decrease in valve area of 0.1 to 0.3 cm2 per year; the average rate of change is 0.12 cm2 per year."

I lost between .4 and .7 cm2 between 2007 and 2008...I'm on the express track!

"After onset of symptoms, average survival is less than 2 to 3 years"

I have symptoms...angina on exertion, occasional shortness of breath, palpitations all the time...I HAVE symptoms...even my surgeon says so. Evidently the clock is ticking...evidently.

"Sudden death is known to occur in patients with severe AS but has rarely been documented to occur without prior symptoms."

Well, I know about the possibility of sudden death, but my surgeon, Dr. Bavaria reassured me last week that I was not at much risk...yet.

"many physicians perform an annual history and physical examination on patients with mild AS. Those with moderate and severe AS should be examined more frequently."

Yes, that's what I figured when I found out in August that my AS had progressed to moderate. And that's one reason why I decided to seek out the opinion of a surgeon.

"Patients should be advised to promptly report the development of any exertional chest discomfort, dyspnea, lightheadedness, or syncope."

Of course, but you have to be shocked out of denial first and understand exactly what these symptoms are!

"If the clinical and echocardiographic data are typical of severe isolated AS, coronary angiography may be all that is needed"

And that's what Dr. Bavaria ordered for me.


"AVR is indicated in virtually all symptomatic patients with severe AS."

It's showtime!

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