Monday, March 30, 2009

Good Cardio Report

My cardio called today to tell me that the stress test was negative, good news. My symptoms are probably related to the AV stenosos. Finally, it's not time for surgery. So I will see him again in October and we'll take it from there. Incidentally, in the literature there are references to people with BAV to the effect that usually they do not get CAD. Works for me!

Sunday, March 29, 2009

Walks By The Graff Memorial

The recently restored Frederick Graff memorial at the Fairmount Water Works here in Philadelphia. This is placed next to the trail where I do my afternoon walks every day.

Saturday, March 28, 2009

NST Final

I completed the test yesterday and I think I did pretty well.. I did get that dull pressure in my throat and center chest that I have noticed for the past four years. Even hours after the test I could still feel it a little. I do feel encouraged to say the least that I can still do something like this at age 60 with a stenotic BAV and a dilated aorta. It pays to try to stay in condition. And as has been said many times, the body compensates for the AV disease.

Friday, March 27, 2009


I finished the treadmill part of the test a few minutes ago. I think I did pretty well. I reached my target heart rate of 136. There didn't seem to be any irregularities in the ECG, and it looked like a had a good blood pressure response to exercise. I did get that dull pressure in my throat and center chest that I have noticed for the past four years. Even now, about 45 minutes after I got off the torture machine, I can still feel it a little. So we'll see what the cardio says after he looks at the report. In a few minutes I go in for the last scans then I can go home.

Nuclear Stress Test Part II

I just finished the first series of scans with the fancy "camera" they use to scan the heart after the radioactive isotope has been absorbed. The next step is the dreaded treadmill test. We'll see how it goes!

Live Blogging The Nuclear Stress Test

The new Perarman Center here at the University Of Pennsylvania hospital is really nice. The whole complex has wireless for patients and guests...which make me happy since I have a computer attached permanently to me. So I got my first injection of isotope and I'm waiting to start glowing before they start taking images. The IV line is a little uncomfortable when typing but not too bad. They do the resting part first, then later on comes the treadmill part. (UGH!)

Monday, March 23, 2009

Stress Test "Positive?"

For patients with AS, a stress test can be "positive." Here's what that means:

A Positive exercise test indicates symptoms, abnormal ST-segment response, or abnormal blood pressure response (less than 20-mm Hg increase) with exercise.

In one series,117 patients manifesting symptoms, abnormal blood pressure (less than 20-mm Hg increase), or ST-segment abnormalities with exercise had a symptom-free survival at 2 years of only 19 compared with 85% symptom-free survival in those with none of these findings with exercise. Four patients died during the course of this study (1.2% annual mortality rate); all had an aortic valve area less than 0.7 cm2 and an abnormal exercise test. In another series,118 exercise testing brought out symptoms in 29% of patients who were considered asymptomatic before testing; in these patients, spontaneous symptoms developed in 51% over the next year compared with only 11% of patients who had no symptoms on exercise testing. An abnormal hemodynamic response (e.g., hypotension or failure to increase blood pressure with exercise) in a patient with severe AS is considered a poor prognostic finding.117,125 Finally, in selected patients, the observations made during exercise may provide a basis for advice about physical activity. Exercise testing in asymptomatic patients should be performed only under the supervision of an experienced physician with close monitoring of blood pressure and the ECG.

Getting "Nuked" On Friday

I have a nuclear stress test this Friday. My new cardiologist wantrs to check that there is good blood supply to all areas of the heart. The ACC/AHA guidelines recognize the value of exercise testing for people with valve disease:

2.1.6. Exercise Testing

Exercise testing can provide valuable information in patients with valvular heart disease, especially in those whose symptoms are difficult to assess. It can be combined with echocardiography, radionuclide angiography, and cardiac catheterization. It has a proven track record of safety, even among asymptomatic patients with severe AS. Exercise testing has generally been underutilized in this patient population and should constitute an important component of the evaluation process.

Friday, March 20, 2009

Hooray! Someone I Can Talk With

I had my appointment this morning with Dr. Martin Keane at the Hospital of the University of Pennsylvania. Finally I found someone who I am comfortable with, who listens as well as speaks, with an easygoing and reassuring manner, yet who is frank about the situation. He suggested that I get a nuclear stress test so I signed up for that next Friday. It will be interesting to see how I manage during the stress part now that my aortic valve is moderately stenotic. This test is supposed to show the condition of the coronary arteries, I believe. According to the literature, people with BAV disease are usually not prone to developing CAD. I don't think I have coronary artery blockages. When I get my usual tightness it's in my throat area. Other people with valve disease have reported this tightness or pressure in the throat area. Well, we'll see if there is any more information after the test next Friday. I hope I don't keel over during the test!
In any event, I feel a lot better now after having seen Dr. Keane.

New Cardiologist

I'm meeting my possible new cardiologist this morning. I say "possible" because we'll have to see how it goes. More later.

Wednesday, March 18, 2009

Endocarditis! Scary Stuff.

I've been reading a few posts on written by people who have had endocarditis as a result of valve disease. It really is scary because according to one report the overall mortality rate is 20 percent. I used to take preventative antibiotics before dental appointments because that was recommended. However, the guidelines were recently changed and I no longer need to take them. Still, it's a scary prospect when you read how sick some people become by, in some cases, merely brushing their teeth!

Tuesday, March 17, 2009

Blood Pressure Wars

Read the instructions. That's always good advice. I read the instructions that came with my Omron blood pressure monitor on how to take your blood pressure properly. Sit, relax, make sure your back is supported, arms at the level of your heart, take three measurements a minute apart and average them. If you do it this way you may find that your readings are generally lower. I did.

Friday, March 13, 2009

Road Trip

It's been quiet on the medical front here lately. I did get a clean bill of health from my dermatologist yesterday which made me happy considering how much time I spend in the sun. On Wednesday Dan and I made a day trip by train to Washington, DC. We had fun and saw several major attractions while we were there. Next Friday I have an appointment with a new cardiologist. So, we'll see how that goes. I daydream often about the heart valve problem trying to figure out how much time I have left before it finally goes. One year? Two? More? Who knows?

Wednesday, March 4, 2009

Winter Walks

It's been tough lately to get my daily walks in with all the snow and wind and cold. But I get to see beautiful sights like these sculptures in Fairmount Park. So, there are incentives to get out there and walkl. I have cleats that I wear over my sohes so that I don't fall on the ice.