The Undiagnosed: Palpitations

I can remember being told as a child that I had a heart murmur, but I was assured that it was noting to be concerned about. I've had palpitations, pounding sensations from my heart, for a long time. I can remember actually going to a cardiologist about 20 years ago to simply ask him why I was having these sensations. "Too much caffiene," was one of the possibvle explanations he gave. Again, not to worry, I was told.

It wasn't until 2004 and my first echocardiogram that someone finally told me, oh, by the way, you have a problem with your aortic valve. It took a long time for the alarm to finally go off. I wonder how many other people are out there walking around with heart probelms that they don't know about. No wonder a lot of poeple just keel over and die.

The photo shows one of the the beautifuly reconstructed pathways near the Philadelphia Museum of Art. I walk by this just about every day on my afternoon walk.

Walking For Exercise

Walking continues to be my preferred mode of exercise. Having a great dog who likes walking along with me helps to insure that I get out twice a day at least. I usually walk four miles a day 365 days a year. Only rain, snow, or ice slows us down or stops us. On our morning walk we pass this lovely boat house on the Schuylkill River.

Symptoms

People feel a variety of symptoms of valve disease and aneurysms. My experience is a tightness in my throat on exertion (sometimes into my jaw and face) which has gotten worse over the years. It stopped me from jogging a few years back and now I get it if I climb two flights of stairs or walk up a hill. It'[s a reminder that no matter how well I feel otherwise, I've got this valve/aneurysm problem.

More Doctors Appointments

I made an appointment to see the new cardio in March. I'm trying to convince myself to keep it. Since I've relaxed after the intense month of heart related emotional ups and downs, I just really feel like moving on and enjoying my life for a while. Worst case is I wait for more serious symptoms - then do something. I may just do that for a while. I also made a dermatologist appointment for a check up. I spend a lot of time in the sum out on Fire Island, so I figure it's a good idea to get a look over once in a while (any excuse to take my clothes off! :)

I do read and post regularly on VR.com. I find it interesting to read about the various different kinds of issues we valvers face. And it's an OK place to hang out on line although I don't really have any close friends there.

CT (Cat) Scans vs. Heart Catheterization

I was supposed to have both in December but I ended up only getting the CT Angio due to an office error. I don't really know whether just the CT is sufficient but the surgeon seemed to want it then. I guess it depends on the doctor. However, when I next go back I'm just supposed to get another CT, so that tells me that it's not a bad idea to ask if the more invasive procedure is really necessary.

But, are CT scans dangerous due to radiation exposure?

Here's what the hospital (Penn) says:

This test provides a different and more detailed picture of tissue and bone than is possible with a routine x-ray. The scan itself is painless and very safe. our radiation exposure is slightly more than a routine x-ray.

Pre-Meds For Dental And Other Procedures

The current AHA/ACC guidelines no longer recommend antibiotics prior to dental and other procedures fro people with murmurs and heart valve problems to prevent endocarditis. The one exception is for people with prosthetic heart valves. I recently re-read the revised guidelines. I had a colonoscopy last week...which resulted in a single plolypectomy...and, of course, the new guidelines do not require pre-meds for these sorts of procedures so I have not been doing pre-meds since the guidelines changed.

They make a strong case for the revision. The primary argument is that so few cases of endocarditis are actually prevented by pre meds that the benefit is out weighed by the down side effects, e.g. the development of resistant strains of bacteria, cost, etc. Of course, if you are one of those who gets endo then their arguments don't help much.

Exercise And Aneurysms

The literature on BAV disease seems to indicate that aneurysms can and do occur independently of valve stenosis/regurgitation...e.g., even after AVR. BAV disease is thought to be a connective tissue disease (like Marfans.)

I don't remember reading that more intense forms of exercise have been shown to exacerbate the formation of aneurysms. Recommendations for exercise seem to be based on the individual patient's situation. In my case, I was recently told not to lift more than 1/2 of my lean body weight, and that I can do any exercise that does not make me grunt or cause extreme fatigue. This comes from a top surgeon at a major university heart center (Bavaria/HUP).

Aneurysms develop because of weakened tissue in the walls of vessels due to genetic factors. However, once an aneurysm is present, then certain activities, like competative sports and weight lifting, should be avoided because of the risk of rupture or dissection, while other forms of exercise, like walking, are actually beneficial. Blood pressure control is the therapy for aneurysms.

Still Wanting Answers

Well, I've decompressed some since the surgeon kicked me out of his office a month ago, but I'm still uneasy about my heart valve situation.

The "2008 Focused Update Incorporated Into the ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease" chart on the severity of valve disease in adults is here.

As you can see, a valve area index of < .6 is considered severe. My "numbers" are: valve area 1.3 cm2 (technically "moderate"), but "severe" - when adjusted for my body size - valve area index = .55. Even so, my surgeon put me on hold for surgery for the time being. And I have a dilated aorta (aneurysm) and I'm BAV to boot!

When I met with the surgeon he seemed annoyed that I was taking up his time and indicated that he didn't think my situation was that bad...I forget exactly what he said, something to the effect that my aortic valve is only moderately calcified, if I remember correctly. He's not the kind of doctor that is interested in you understanding what he feels your situation is...not easy to converse with...he came off to me as impatient. My Long Island cardio is like that too.

I guess I'll try to find another cardiologist who has some patience and see if I can get someone to discuss my situation with me.

Aspirin Therapy And Colonoscopy/Polypectomy

Yesterday it was time for my once every five years colonoscopy. Part of the prep instructions was for me to stop taking aspirin a week before the procedure. I had one polyp, which was removed, but now I was told that I cannot resume my aspirin therapy for another week over concern about bleeding.

However, According to the American Institute Of Gastrointestinal Endoscopy guidelines, it was really not necessary for me to stop aspirin therapy:

Aspirin and other NSAIDs in patients undergoing elective endoscopic procedures Aspirin and most NSAIDs inhibit platelet cyclooxygenase resulting in suppression of thromboxane A2-dependent platelet aggregation. Limited published data, however, suggest that aspirin and other NSAIDs in standard doses do not increase the risk of
significant bleeding after EGD with biopsy, colonoscopy with biopsy, polypectomy or biliary sphincterotomy.

So I guess my doctor is just being over cautious. I like him and have a lot of confidence in him. But I'm aware that not all gastroenterologists may be up to speed on these sorts of issues.