A year out... now a question?

[AllForDad]

I'm posting for my dad. His surgery was a year ago Jan. 31st... crazy how fast the time goes. He was 48 at the time, aortic valve replaced, and ascending aortic arch replaced. Congenitally bicuspid valve and aneurysm formation. Before surgery he worked out everyday and was in very good shape, very asymptomatic, but tests showed he needed surgery done ASAP.

In his year out he's had a couple bumps... in the weeks after surgery had a pleural effusion drained (they collapsed the lung to do the surgery so this was not something extremely surprising). He would randomly get night sweats since surgery, then around Christmas (11 months out) he was getting them more frequently with fevers around 102. He is a very anti-doc sort of person (like many young men are unfortunately). He likes to see if it will just go away or he can work it out of him. During workouts he would get a slight pain behind his sternum when his HR got to around 120. He finally went to his cardiologist (whom I myself do not like as he has been wrong on numerous occasions). The Echo showed a moderate pericarditis and he was sent home with ibuprofen. This wasn't doing anything so he went to his family practitioner who gave him an antibiotic and the sweats went away and the pericarditis slowly corrected itself.

The question I and he have... has anyone else experienced this slight pain in the chest when working out this far out of surgery? He feels fine all day, but when working out (running/elipticals) he gets the pain still around heart rate 120... now sometimes even lower ~100. One may think it's a blockage in a coronary artery, but his coronaries were shown to be crystal clear (usually not the case in someone almost 50). Anyone else experience this and figure out why??????

Thanks!

 

[tprice54]

Pain

Pain

I did have some pain, but not that far out, when running. Perhaps his pericarditis has an effect. Also, if he is still taking meds(I saw metropopol on your profile), they are like a governor for your heart...it will not go too fast (120-130 max). If he is working so hard and trying to get this HR up, maybe that is a problem.

Hope this clears up for him. Tell him at 12months, it was like a switch turning on-my running improved almost overnight!

 

[MikeHeim]

I'll assume that if he is/was getting frequent high fevers that he was checked for endocarditis when he went in. Night sweats can be another symptom. I occasionally get chest pain when I am working out, but usually it is sharp twinges and can occur anywhere on my chest or stomach area. They do not happen with any regularity or and do not seem to happen at a particular HR (in fact, I often get the same twinges at rest). I personally assume that they are related to my sternum, incision, or something else they messed with while they were in there.

I don't have any idea how long it takes for an artery to become blocked, but perhaps someone will come along that does. I agree that it would seem unlikely that if they were clear through the first 50 years of his life, that they would suddenly block up in period of 12 months. You are doing the right thing by pushing him to get it checked out, and I am sorry I can't be of more help.

 

[MrP]

AllForDad,
Like your father, I also experienced night sweats after surgery. Night sweats were significant during the first several weeks and gradually stopped altogether over the course of months. This symptom is also an indicator of endocarditis, as Mike points out, and requires attention. With respect to chest pain during exercise, my experience has been very much like Mike describes. Your father's coronary arteries may remain clear even if he has high cholesterol. Studies by Elefteriades and others at Yale show that those diagnosed with bicuspid aortic valve with aneurysm have a protection mechanism against systemic atherosclerosis.
All My Best,
MrP

 

[Magic8Ball]

I sometimes get pain when active, throwing ball etc...just assumed that it was muscle pain from chest.

Get teh odd heart twinge also but not tied to exercise.

Regards.

 

[Ross]

First off, anytime he has a fever of 100, he needs to contact his Doc. Playing with possible infections could lead him back to surgery for another valve. What your describing is classic Pericarditis. Get him to lax up and not push to pain point. ?Did the anti inflamatories seem to help at all?

I'm thinking he's still got some residual from the infection and is not fully healed from that round.

 

[Curtsmum]

Sorry yor dad is having problems so far out after surgery, hope all goes well.

 

[cirrider]

Along with what everyone else has said, his symptoms are very similar to mine when I had endocarditis. Best way to check that is with a blood culture, which I hope his dr already had done. If not, probably worth asking about. Hope things improve

 

[tcopel]

Just random thoughts...in some cases the coronary arteries are reimplanted into the dacron graft. I wonder if it is possible that one of the arteries may have been partiallly blocked, not by atherosclerosis but by the reimplanted portion of the artery. I cannot even say if that is possible but it has crossed my mind as a potential problem,

The fact that he has night sweats and fever responding to antibiotics suggest a potential source of infection. Pericarditis is an inflammation of the pericardial sac around the heart which responds to inflammatories, not to antibiotics. Given that he improved with the implemention of antibiotics makes me suspicious of infectious sources such as endocarditis and I would have strongly requested blood cultures. Generally, these are drawn two samples at a time, on three successive occassions.

Pleural effusions can also get infected to form abscesses but it sounds as if that problem was addressed shortly after his surgery. Has he had a chest Xray recently as a precaution.

Stay after him. Us guys need someone like to push us along and get treatment. I dont know why we're like that but he is fortunate to have someone like you.

 

[AllForDad]

Thank you to everyone responding.... Much of my own thoughts you all have also.

When he had the pericarditis/fevers blood cultures were drawn and they all came back negative. The night sweats haven't returned since that bought with the flu during the christmas season.

The thought of the coronaries being reimplanted was also something I'd been wondering about, however, Dr. Coselli didn't detach the coronaries because that area of tissue looked good and he believe reimplantation can cause further complication. Instead, he removed the bad tissue and sort of worked around the coronaries, though I still wonder if something could've gone awry there.

I have been bugging him to get a new cardio, my mom as well... hopefully it happens soon. Other than the pain upon working out things look great, it's just hard to watch one set back after another in someone so young!!