Am I putting too much thought into this "murmur" or should I be cautious?

[Roxx]

Last echo/followup in December of 2011 was the first time in my life anyone (doctor, nurse, cardio, etc) had ever said they detected a "murmur."

Upon this finding.....an immediate echo was performed on the spot with the cardiologist sitting in watching the screen.

His finding both in person during the echo and on the sheet in front of me were:

Aortic root 3.7
Once suspected bicuspid valve appears to have 3 trileaflets and is in fact tricuspid with 1 smaller leaflet
Aortic Valve are is in the 2.3 to 2.5 area
Trace aortic regurgatation and stenosis detected, insignificant at this time.
Ef% 55-60%
Conclusion: periodic follow up to watch aortic valve and root size.

So my mind cant help but question what might be the cause of this murmur that his wonderful ears can hear?

Could a congenital irregular shaped aortic valve create the murmur?
Is trace stenosis or regurge creating this sound?
Could i have been doing something strange with my breathing or what not? As he is the only ever to mention it.

 

[normofthenorth]

My first-ever-detected heart murmur led to the discovery of much worse numbers than that, Roxx, and I didn't do anything cautious, except have a bunch of follow-up echos over the years, until the numbers (and two bouts of minor symptoms) suggested it was time to replace my valve. With your situation, that may never happen.

There have been several recent studies and essays -- the recent US recommendation against PSA screening leaps to mind -- pointing out the downsides of excessive medical scanning. I've read (and readily believe from my own experience) that people who get MRIs of the spine routinely are subjected to worry and follow-up tests or worse, to solve problems that are either non-existent or unimportant. Only hindsight is really 20:20, but I'm guessing that you've just joined the swelling ranks of "the worried well"!

 

[Bill B]

"Once suspected bicuspid valve" - when did this happen and what caused a doctor to suggest you had a bicuspid valve?

Your echo findings are largely normal, but the deformed valve could be causing the murmur. Your doctor should clarify this for you on your next visit.

 

[epstns]

Roxx,
As Bill B said, your measurements don't raise warning flags to most of us. The trace stenosis and regurgitation are common, too. My guess is that they will want to just wait and watch your echo measurements for a number of years.

Mine was a somewhat similar situation. When I was in my early-mid-50's a doctor asked me "How long have you had this murmur?" That was the first time I knew I had a murmur. We watched it for over 9 years before it progressed to the point where I chose to have the valve replaced. Some people never need surgery. Others do. All you can do is get used to the fact that you will need to watch this, but don't obsess or worry about it. There is nothing you can do but watch. You may be fine forever, or you may need surgery some time in the future.

Just remember. . . you are in charge of your life. The valve is not. Live a normal life (unless a trusted doc says otherwise) and just keep track of the valve and heart statistics. The docs will tell you if anything needs to be addressed.

 

[Roxx]

"Once suspected bicuspid valve" - when did this happen and what caused a doctor to suggest you had a bicuspid valve?

Your echo findings are largely normal, but the deformed valve could be causing the murmur. Your doctor should clarify this for you on your next visit.

Bill.... in 2009 I had a panic attack (always suffered with anxiety since childhood) so I landed myself in the local E.R. actually 3 years ago today. So at my follow up doctors appointment I volunteered for a Holter monitor (against docs orders.....lots of anxiety people are heart obsessed).......so anyway..... I wore a 24 hr Holter and I had a few PVCs and one run of NSVT which really didnt alarm either cardio I was seeing as I had just started Zoloft a few days before (one thought new meds could be cause of pvcs) and the other cardio wasnt concerned about the pvcs or run of nsvt regardless if the zoloft caused it or not..... he said "many people in the general population and especially those with anxiety suffer various degrees of pvcs"........ so I wore a 2nd Holter..... it came out fine, I think I had less than 50 PVCS in 24 hours..... so they said thats nothing. just to be thorough, they had me wear a 3rd Holter for 24 hours.... it had less than 100 pvcs in 24 hours, they told me thats fine. So to further be on the safe side, the one cardio asked me if I wanted to do a Echo. I said yes. Echo in 2009 had good numbers throughout, and neither cardio said anything about it. A nurse from the 2 cardios office called and said "everything looks good." About a month later, I had a follow up appointment at my general practitioner, and it was he who pulled up the echo results on his laptop and said "oh, it says here that your aortic valve is either bicuspid or a irregular shaped tricuspid."So the long version answer is: Had I turned down these test I volunteered for.....I wouldnt have a clue about any of this.

 

[Mentu]

In 2001, I had to change doctors. Almost the first question my new doctor asked was "Has anyone said you have a heart murmur?" It was news to me. As a result of that first examination, she sent me to meet the fellow who has become my cardiologist. He confirmed that stenosis was causing the annomally and recommended annual followup. At that first meeting with him, my numbers were very much like your's and remained so for almost 10 years. In 2008, my numbers began to change and by the time of surgery in 2009 my aortic valve diameter was something like 0.7. Some people have valves that change so slowly it is never a problem. For others, the valve degrades and must be replaced. Either way, you have the best tool with which to start and that is knowing there could be a problem and that it needs to be watched.

No one knows what causes stenosis but it can have a genetic component and appear in several generations as in my family. Infection can also damage the heart and lead to the same place. We really like to have answers to the Why? and Why Me? but for most of us there is no simple answer. What you can do something about is keeping your cardio vascular system as healthy as possible. In the event surgery becomes necessary, you will then be in the best position to experience a smooth recovery. Focus on what you can do something about; speculation is pretty fruitless.

Larry

 

[Roxx]

Larry, you are right no doubt.
I have been seen by 3 total cardios since 2009, 1 predicted this will never be a problem, 1 said I probably have 30 years before this is a issue. The other said it will probably be about 20 years before intervention is needed. I wish this was a "genie" I could bottle back up. Some days are pretty normal, some days it consumes most thoughts.

 

[Bill B]

OK, so you have a valve that appears to be a bit deformed and an aortic root that is probably in the upper end of the normal range. Please try to go about your life and enjoy it without worrying about this. Regular annual physicals and "periodic" (maybe every 2-3 years unless something changes) echos will keep tabs on this. I'm not even sure I'd waste that much medical resources on this if the next echo or two are the same. There's a very good chance this is a stable variant.

 

[Roxx]

Bill you are probably right. I was doing really well for about 18 months, then at my last visit in December this murmur thing was mentioned for the first time, then I noticed that my AVA number was 2.3cm so I found new things to "obsess" about. As wonderful as many folks are on the various medical websites I frequent, perhaps I should take a break from looking up web info and all that. It really doesnt seem to do my mental health any favors.

 

[Bill B]

You mention a history of anxiety and it seems that worrying about health issues goes hand-in-hand with that and creates an endless loop. If you look hard enough you can find all kinds of scary things. Rather than thinking you can understand this better than your doctors if you just keep poking around the Web, I would simply continue to pose your concerns to your doctors. If they are at all good at what they do, they will put it into proper perspective. You are focusing on the assumption that the murmur is new and significant. Neither may be true.

I was born with BAV but had no idea it was there until it was diagnosed at age 60. Various doctors had listened to my heart and a very few commented about a murmur but made nothing of it until that one doctor said I needed an echo. I had lead a perfectly healthy life up to that point, including running track and even marathons, very quickly I would add. But at 60 it appears the valve had deteriorated enough that the murmur was judged by that doctor to be "significant", requiring an echo. Unlike your essentially normal echo, mine came back with an AVA of 1.1 with a lot of related, clearly abnormal findings. It progressed from there until the valve area reached 0.7 and surgery was deemed necessary. It could have been stable for many years, never requiring surgery, or progress rapidly, as it did. It's not predictable, and like most things in life, you have to just see how things work out. In your case, you are essentially normal at this point. After the original echo, those doctors decided whatever little anomaly was present on your valve was not significant and they didn't bring it up. Nothing wrong with that. Your GP seems a little more aggressive, and he re-raised the issue. So, you got another round of tests and various cardiologists' opinions, most of which seem to indicate there is nothing significantly wrong and probably won't be for a long, long time if ever. I would put this on the back burner and see how the future unfolds. Note that there is nothing you can do to change the course of valve and/or aorta disease, if that is even what you have. It will be whatever it will be. Worrying certainly does nothing useful.

 

[Roxx]

Terrific advise Bill..... this is why I love this forum, it is full of supportive and people with so much knowledge as many here have "been there" ai appreciate all your comments.

 

[chrisc]

Roxx,

Chiming in as I understand the anxiety component as a sufferer myself. Statistically speaking, from your numbers (and stated by others here), you are in the ‘normal’ range and as others stated I don’t think it is even fair to classify you with aortic or valve disease at this point. As you have seen from my previous posts, my aortic root has been 4.2 since 2004 (maybe longer as I have never had any imaging prior). It was just never described to me as such until 2012. My root may stay under 4.5-5cm for life or it may swell in 10 years and require removal, but only time will tell. Since I am a suffer of self induced anxiety myself, I don’t feel so bad saying it. I think the root and valve issues we have are of little to no consequence compared to our obsession we have over these (and if you are like me) other health issues. Being honest (because my anxiety over this is likely worse than yours), my family, g/f and close friends have all told me I obsess a bit too much over this. It is fixable (if ever needed) and the last thing I should be doing is wasting time obsessing over it. Our time here on the planet is short and we need to enjoy it. So in short, yeah you are likely obsessing over it too much (I know I am).

We (you and I) know about the valve and root issues and will subscribe to monitoring. We know it has been proven that these issues can be addressed if/when the time comes. As I enjoy lifting weights I have always been a fan of Arnold whom we all know had a BAV and I understand an enlarged aortic root (I wish I knew if Arnold truly had an aortic root dilation). I my opinion, Arnold is still one of the (if not the greatest) body builder of all time; BAV and all… So I have now tailored my workouts to what the cardiologist recommended and try to keep my mind clear of it (as much a challenge it is for me though it is getting MUCH better).

For me, despite the 4.2 root being present since 2004, It was never described to me as such until 2012 as stated (which in a way worked to my benefit as I happily did what I wanted). If you ever want to chat PM me, I spoke with some other folks and at least for me, there is a huge calming effect knowing I (we) are in good company with those around us. We are not going through this alone… Since I think you and I have similar though processes, let us shelf this valve/aorta stuff and concentrate on beating the anxiety component.

On a side note, do you do resistance training or are you P90X only? For me I am trying make this transition from high weight/low rep to what is recommended. I find it a bit challenging to put on and keep on mass without going HEAVY…

Chris

 

[Roxx]

Roxx,

Chiming in as I understand the anxiety component as a sufferer myself. Statistically speaking, from your numbers (and stated by others here), you are in the ‘normal’ range and as others stated I don’t think it is even fair to classify you with aortic or valve disease at this point. As you have seen from my previous posts, my aortic root has been 4.2 since 2004 (maybe longer as I have never had any imaging prior). It was just never described to me as such until 2012. My root may stay under 4.5-5cm for life or it may swell in 10 years and require removal, but only time will tell. Since I am a suffer of self induced anxiety myself, I don’t feel so bad saying it. I think the root and valve issues we have are of little to no consequence compared to our obsession we have over these (and if you are like me) other health issues. Being honest (because my anxiety over this is likely worse than yours), my family, g/f and close friends have all told me I obsess a bit too much over this. It is fixable (if ever needed) and the last thing I should be doing is wasting time obsessing over it. Our time here on the planet is short and we need to enjoy it. So in short, yeah you are likely obsessing over it too much (I know I am).

We (you and I) know about the valve and root issues and will subscribe to monitoring. We know it has been proven that these issues can be addressed if/when the time comes. As I enjoy lifting weights I have always been a fan of Arnold whom we all know had a BAV and I understand an enlarged aortic root (I wish I knew if Arnold truly had an aortic root dilation). I my opinion, Arnold is still one of the (if not the greatest) body builder of all time; BAV and all… So I have now tailored my workouts to what the cardiologist recommended and try to keep my mind clear of it (as much a challenge it is for me though it is getting MUCH better).

For me, despite the 4.2 root being present since 2004, It was never described to me as such until 2012 as stated (which in a way worked to my benefit as I happily did what I wanted). If you ever want to chat PM me, I spoke with some other folks and at least for me, there is a huge calming effect knowing I (we) are in good company with those around us. We are not going through this alone… Since I think you and I have similar though processes, let us shelf this valve/aorta stuff and concentrate on beating the anxiety component.

On a side note, do you do resistance training or are you P90X only? For me I am trying make this transition from high weight/low rep to what is recommended. I find it a bit challenging to put on and keep on mass without going HEAVY…

Chris

Chris, great post, I will try to answer your questions in the order you have them.

1) Yes, if I wasn't obsessing over "heart issues" it would likely be something else..... which everything else miraculously got healed when I shifted the focus to this heart stuff....what does that tell you?
2) Your anxiety may equal mine, but probably doesn't surpass it. When I first found out about this possible BAV, palpitation stuff... I went into a 60 day tizzy where I met with a psychologist and was diagnosed with Panic, GAD (General Anxiety Disorder), and slight OCD (Obsessive Compulsive Disorder)
3) My wife of 13 years knows nothing about this, nor does my two kids, nor does my father..... my mother only knows a small portion of it, and that's the way its going to stay. I don't want anyone looking any different of me, or thinking any different of me. My wife will be told IF/WHEN there is ever a problem. If there never is, I take all medical stuff to my grave. She is my high school sweetheart, my first and only love, the only woman I have ever been with, as I with her. I will not have her worrying needlessly about something that may never occur..... and I don't feel the least bit guilty about keeping this one little secret.
4) Agree, even a lifespan of 90 years is nothing in reflection of the universe. It's like a fleck of sand on a long beach. We are all terminal, no one gets out alive, so we can choose to live our dreams or live our fears for the short time we are here.
5) Yes, Ahhhhnold, the greatest bodybuilder of all time had a BAV, and I do believe his root replaced, and part of the aorta. What made Arnold so great in his day was his mass on a 6'1.5 height frame..... lots of thick well developed bodybuilders, but so many are 5'6 and under. Arnold stood out like a giant. Note: Robbin Williams is said to have had a BAV with a critical .06cm stenosis at time of surgery.
6) Chris, long before this heart stuff, I have been a health & fitness guy....I have ate healthy my whole life (almost 34 yrs old) and I haven't drank pop since June of 1994 (18 years ago next week) simply because I wanted to.

I have never been a "power lifter" kind of guy. While Arnold in his prime was a sight to behold. It simply takes genetics that 1 in 250,000 have to attain that size (and some vitamin S in Ahhhnold is being honest)..... so I have always went for the lean, muscular look.

P90X is a TON of weight training, and easily has got me in probably the best shape I have ever been in. I have trained with local Division 3 college teams, and various other semi-pro bodybuilders, and no routine has a better affect on me than p90x. It gives me a look that I like where I look normal in clothes, and pretty cut up when the shirt comes off. At 5'11, 183lbs.... I don't desire to lose or gain any weight, rather I try to keep my body fat percentage down as low as possible while still being healthy. I never drink, never smoked...etc.... just trying my best to live as healthy as possible.

I am not ashamed to say that when I had my little panic spell a few years back, I ended up being put on 10mg of Lexapro a day. I know...I know.... its a drug. I don't like taking anything either..... Trust me, I avoid taking a Tylenol for a headache, I prefer to suffer through it.... but Lexapro made the difference in me curling up in a ball and never leaving my house, or finishing my masters degree, holding down a job, enjoying my wife & kids...etc.... my family knows I have anxiety, have since age 7 or 8, probably always will deal with it, and unless needed.... that's all they will ever know.

I would love to chat with you sometime about life, working out, etc.....

Scott

 

[chrisc]

Scott we have some striking similarities..

*if it wasn't one heath issue it was another

*I never drink alcohol anymore (did in college and IF i went out after), but general health is more important for me plus i have NO interest in alcohol

*Never smoke

*Rarely take any drugs (pain killers, etc) i just deal with the pain

*Have been prescribed anxiety medication

I also seem to have a similar thought process to you in regards to lifting and fitness. I used to lift HEAVY for my weight and I did carry some decent mass for my weight. Recently i have been focused more on cardio since there were lifting restrictions due to the aortic root, and it may even be a good thing in a way. Mass is very difficult to sustain as one ages but a lean body is not. I'm currently 5'11" @ 170 ish (skinny from all the running now). Just want to put a slight bit of mass back on but now much.

I also had to slow down my life in general which helped, a lot. Quite possibily the best thing i did. I was living live at 100mph AND obsessing over these heath issues. The stress and anxiety pushed me to mild OCD. I was misplacing my wallet ,forgetting if i put the windows up on the car (actually running out in the middle of the night in the rain to check them). I had a hard time falling asleep at night because my mind raced over health issues or something work/personal related. Slowing down just the slightest bit has helped me tremendously in regards to anxiety, stress and OCD type symptoms...

Not sure how hard you run yourself, but slowing down just a tad may help you also... i certainly see the value in work/life balance now a days. i used to work 50-60 hours a week, every week and ALWAYS lose my PTO. I am actually on PTO this week and getting ready to go for a jog.

Have a good day man...

 

[Roxx]

To further prove how OCD I am, I called my cardiology office today to ask for notes from my visits. I picked them up at lunch. I saw one of the cardiologist there 4 times, then he moved to Columbus, OH to OSU medical center, on all 4 of the office visit notes from my appointments witb him, he says "normal S1 and S2 with no click, rub, or whoosh." This is word for word what it says from a July 2011 office visit.


On December 14th 2011 I had an appointment to see another cardiologist in his office. It was then and there that I was told for the first time I had a murmur. The guy seemed good, but his accent was so thick I couldnt really understand him. So i was really interested in reading the office notes. What they said was:

"The patient is a 33 yr old seen here at his request. He has a 3.7 aortic root. He has a questionable history of bicuspid aortic valve. He is very anxious about that. The nurses said he was pleasant and charming upon conversation, but seemed to be having some panic issues when I spoke to him. His family history includes a father who had a MI at age 58 from untreated high cholesterol and a mother who has had an ablation for afib. He does not know if he he has a thyroid problem and he has occasional PVCS.

His exam showed his BP is 110/70. He was in sinus rhythm. No fever. Respritory rate 16. The patient has a 2/6 diastolic murmur. THERE is no S3. Lungs are crystal clear, obvious non smoker. Abdomen is soft. Good femoral pulsation bilaterally. No lower limb edema.

EKG showed sinus bradycardia which doesnt alarm me given his physical condition/muscular build.

Impression: possible bicuspid valve. Possible ascending aortic root dialation. Will obtain an echo to measure and assess the status of the aortic valve. Will get electrolytes. Will get a thyroid function test. Family history of CAD. Will obtain a lipid and liver profile. Suffers from borderline severe panic attacks, close to having one during our exam.

The patient was reassured. The patient will be seen periodically.

DR. XXXXXXXX

so..... given this..... and the fact that I am only 33. Chances are, I won't make it out of the game without some sort of intervention. The question is when? 5 years? 10? 20? Hard to say.

My biggest obstacle is living one day at a time. I seem to be naturally programmed to put a greater value on the future than the present. This stuff weighing on my mind really messes up my plans when I think "future." Thanks for listening.

 

[chrisc]

Scott, I have had similar anxiety comments on my notes and while I can't recall them word for word, I know I was actually aggravated at what was written. Ignoring the anxiety component, it appears your chances of requiring surgery are lower then your chances of needing it (at this point anyway). If they screened the entire population I am sure the % of people with dilated roots and valve issues would increase dramatically. Many of them walking around with no knowledge of them and passing away of old age completely unrelated to the valve or dilation.

Go do something fun with your family this weekend...

 

[epstns]

Roxx - I'd not hazard a guess, but you may never need surgery at all. A large percentage of the population that has one or another of these conditions never needs surgery. I would just stay on schedule with your check-ups and go live your life. Nothing to worry about now. Don't worry about it until somebody tells you there is something to worry about. There isn't anything you can do about it anyway, other than to keep up the regular check-ups.

Chill, my friend.

 

[Roxx]

Roxx - I'd not hazard a guess, but you may never need surgery at all. A large percentage of the population that has one or another of these conditions never needs surgery. I would just stay on schedule with your check-ups and go live your life. Nothing to worry about now. Don't worry about it until somebody tells you there is something to worry about. There isn't anything you can do about it anyway, other than to keep up the regular check-ups.

Chill, my friend.

Thanks Steve, means a lot coming from you. So glad you are doing so well post surgery. You are a wonderful addition to this already excellent supportive website.