Asymptomatic vs. Symptomatic

[SatoriFound]

I am trying to figure out if I am symptomatic. Constant fatigure finally led me to the doctor 19 months ago. I thought it was low testosterone because I am getting older. I will be turning 51 in September. I started going to the gym more, thinking I would gain energy, but I was still tired. I don't think I have any real shortness of breathe. The big thing was during the power outage when my body got overheated I had some heart palpitations and I felt pressure in my chest, which I read tonight is the same symptom as chest pain, most of the charts just list it as pain and I never have chest pain. I have no swelling, or anything like that. I guess I am just still unsure if the fatigue is actually because of my heart. I hate the wait between doctor's appointments and am just wondering whether I would be considered symptomatic or asymptomatic.

One article I read seemed to be saying the symptoms were things related to left ventricular funtion, like ejection fraction. My report states asymmetric septal hypertrophy, but normal left ventricular wall motion and LV systolic function. Does septal hypertrophy mean LV hypertrophy? It is under the heading of LV.

I have never had an exercise stress test, although as I am reading it seems that this is a necessary test to check for actual symptoms? Wednesday I have my CT. Maybe that will give me more answers. Hopefully my vacation right after that will let me forget this for awhile.

 

[dick0236]

Getting it checked out is the smartest thing you can do now. If the CT checks out you are free to go. If the CT identifies an issue you can deal with it in a "thought thru" way. This Forum will be a good place for help if there is an issue. Good luck!

 

[SatoriFound]

Getting it checked out is the smartest thing you can do now. If the CT checks out you are free to go. If the CT identifies an issue you can deal with it in a "thought thru" way. This Forum will be a good place for help if there is an issue. Good luck!

There is definitely an issue. LOL The echo showed severe aortic stenosis. And it progressed quite a bit in 18 months, more than what I read as the norm, so it appears to be progressing quickly.

 

[dick0236]

I apologize if you think I was making "light" of your situation. It appears you have had tests that indicate "severe aortic stenosis". That was my diagnosis as well and it is serious......but it is also "fixable"......with little effect on your life and lifestyle. You are fortunate to have resources like this Forum to help you thru this process. We all know how you feel because we have all been there.

 

[SatoriFound]

I apologize if you think I was making "light" of your situation. It appears you have had tests that indicate "severe aortic stenosis". That was my diagnosis as well and it is serious......but it is also "fixable"......with little effect on your life and lifestyle. You are fortunate to have resources like this Forum to help you thru this process. We all know how you feel because we have all been there.

I didn't think you were making light. I just thought you didn't see my previous posts and didn't realize I had actually been through some testing.

 

[dornole]

I'm having a stress echo in August to get some info on this point.

 

[Chuck C]

The echo showed severe aortic stenosis.

You have severe stenosis. What you describe, fatigue and chest pressure are symptoms associated with aortic stenosis. Palpitations are often a symptom as well. In another thread you also shared that you sometimes get dizzy. This is another symptom of severe aortic stenosis and should not be ignored. I hope that in your consults you are sharing all of the information about these symptoms with your cardiologist, especially the dizzy spells.

Is it possible that these symptoms are from something else? Yes, but it's unlikely. It may be impossible to know for sure whether the symptoms are from your severe stenosis or something else. Given that you have severe stenosis, I would err on the side of assuming that they are caused by your stenosis unless proven otherwise.

Also, your echo indicated that your heart has already started to enlarge with thickening of your LV walls to compensate. "My LV wall measurements went from Septum of 1.1 cm and Posterior of 1.1 cm to Septum of 1.8 cm and Posterior of 1.3 cm. " With your heart already compesating this much, I think it adds significantly to the argument that your symptoms are stenosis related.

I would not delay surgery. Don't get me wrong, I am not telling you to rush to the ER, but I would get it scheduled within a few weeks. You will obviously seek the guidance of your doctor, but keep in mind that there are cardiologists out there who don't refer their patients to surgery until they can barely walk across the room. You don't want to be that guy. If your cardiologist does not take your symptoms seriously and refer you for a surgical consult, I would seek a second opinion. It is a good idea to seek a second opinion anyway

The good news is that there is a highly successful surgery which will take care of your valve disease and give you a normal life and a normal lifespan, as long as you don't delay too long. The thickened LV walls are not a good thing, but they generally reverse after surgery, as long as things don't progress too far.

Best of luck and keep us posted following your CT scan.

 

[carolinemc]

There is definitely an issue. LOL The echo showed severe aortic stenosis. And it progressed quite a bit in 18 months, more than what I read as the norm, so it appears to be progressing quickly.

Nothing to be laughing about in the progression into severe aortic stenosis. This is serious and not to be taken lightly, for OPS is coming soon.

 

[carolinemc]

I had that before OPS to replace the aortic valve. It was scary to hear the murmur get so loud in the echo. But felt better after surgery.

 

[JoeWanderer]

There is definitely an issue. LOL The echo showed severe aortic stenosis. And it progressed quite a bit in 18 months, more than what I read as the norm, so it appears to be progressing quickly.

The message from Chuck is right on the spot, but I'd like to add something that I've heard the last time I've done a treadmill stress test (the "fancy" one with a mask, which also happens to be a PITA but that's other story). The doctor who's applied the test mentioned that regurgitation responds better to exercise than stenosis, which makes total sense when you think about it - it's much harder (if even possible) to the heart to compensate for a blockage than for regurgitation.

As such, I'd strongly advise against strenous exercise in your condition, at least until you get a better assessment of your situation. It does seem you'll have to go through surgery soon. I'm on the same boat (sorta), and being on this forum has been so helpful to deal and get used to the idea. Hope everything turns out fine!

 

[SatoriFound]

You have severe stenosis. What you describe, fatigue and chest pressure are symptoms associated with aortic stenosis. Palpitations are often a symptom as well. In another thread you also shared that you sometimes get dizzy. This is another symptom of severe aortic stenosis and should not be ignored. I hope that in your consults you are sharing all of the information about these symptoms with your cardiologist, especially the dizzy spells.

Is it possible that these symptoms are from something else? Yes, but it's unlikely. It may be impossible to know for sure whether the symptoms are from your severe stenosis or something else. Given that you have severe stenosis, I would err on the side of assuming that they are caused by your stenosis unless proven otherwise.

Also, your echo indicated that your heart has already started to enlarge with thickening of your LV walls to compensate. "My LV wall measurements went from Septum of 1.1 cm and Posterior of 1.1 cm to Septum of 1.8 cm and Posterior of 1.3 cm. " With your heart already compesating this much, I think it adds significantly to the argument that your symptoms are stenosis related.

I would not delay surgery. Don't get me wrong, I am not telling you to rush to the ER, but I would get it scheduled within a few weeks. You will obviously seek the guidance of your doctor, but keep in mind that there are cardiologists out there who don't refer their patients to surgery until they can barely walk across the room. You don't want to be that guy. If your cardiologist does not take your symptoms seriously and refer you for a surgical consult, I would seek a second opinion. It is a good idea to seek a second opinion anyway

The good news is that there is a highly successful surgery which will take care of your valve disease and give you a normal life and a normal lifespan, as long as you don't delay too long. The thickened LV walls are not a good thing, but they generally reverse after surgery, as long as things don't progress too far.

Best of luck and keep us posted following your CT scan.

The reason I question the dizzy spells is that it is always when going from laying down to sitting up, but yes, I am very communicative with my doctor about it.

As far as scheduling soon, the problem is my doctor is slow walking everything. It took almost two weeks for his office to call me and tell me he was referring me for CT. The CT is tomorrow. After that we go out of town for a week for vacation. We have a yearly lakehouse vacation we do with family, so it will be relaxing. After the CT results come in I am planning on switching my care to the DeBakey Heart Center at Houston Methodist. They have a very good reputation and I am not happy with communication from my current doctors.

 

[SatoriFound]

The message from Chuck is right on the spot, but I'd like to add something that I've heard the last time I've done a treadmill stress test (the "fancy" one with a mask, which also happens to be a PITA but that's other story). The doctor who's applied the test mentioned that regurgitation responds better to exercise than stenosis, which makes total sense when you think about it - it's much harder (if even possible) to the heart to compensate for a blockage than for regurgitation.

As such, I'd strongly advise against strenous exercise in your condition, at least until you get a better assessment of your situation. It does seem you'll have to go through surgery soon. I'm on the same boat (sorta), and being on this forum has been so helpful to deal and get used to the idea. Hope everything turns out fine!

When I go to the gym I keep my heart rate under 130. Should I aim for lower? Also from what I'm reading I don't understand why the doctor hasn't had me do a stress test. They seem important to check for symptoms. I do get back flow through one of my valves, which was the change to my murmur the doctor initially heard and was concerned with. I have Pectus Excavatum, sunken chest, and have had the murmur all my life. My heart is slightly dispaced in my chest cavity due to my chest pushing it down and over. I had surgery for it when I was 7, it was horrible, and it didn't last. They don't do the surgery that young anymore unless it is so severe it is truly impacting heart function. It is just yet another worry, that the internal scarring from it might make heart surgery harder. Hopefully not. It seems to be a different placement of cut, all the way across my body, just under my pectus. The surgery for this was a lot more brutal back then than it is now. They cut a lot of parts and pieces from what I have been able to glean from searching online. Also the metal bar they put in back then would also cause additional internal scarring.... It's difficult because I don't have the records, and am not certain of the exact procedure used. I assume it would have been the Ravitch, before it was modified, which sounds horrific when I read what they do for it. Anyway, hopefully the CT will give some answers to some of my questions since my doctor didn't think he needed to discuss my echo results with me.

 

[JoeWanderer]

Also from what I'm reading I don't understand why the doctor hasn't had me do a stress test. They seem important to check for symptoms.

I don't understand either! By the way, one of the major reasons to perform a stress test is exactly to find out the ideal heart rate for exercise - and this is true even for "normal" people. 130 for cardio activities should be ok for "normal" people (it's actually on the low side depending on your age), but I have no idea if it's adequate for someone with stenosis. Maybe you should get a second opinion with other doctor?

 

[SatoriFound]

I don't understand either! By the way, one of the major reasons to perform a stress test is exactly to find out the ideal heart rate for exercise - and this is true even for "normal" people. 130 for cardio activities should be ok for "normal" people (it's actually on the low side depending on your age), but I have no idea if it's adequate for someone with stenosis. Maybe you should get a second opinion with other doctor?

Exactly. I'm going to transfer all my care to the heart clinic at Houston Memorial. They have top marks.

 

[d333gs]

I had that before OPS to replace the aortic valve. It was scary to hear the murmur get so loud in the echo. But felt better after surgery.

Hi Caroline , What is OPS?

 

[rich01]

It's best not to wait, even if asymptomatic. Your fatigue may or may not be resolved by replacing the valve. Lots of tings can cause fatigue.

 

[SatoriFound]

It's best not to wait, even if asymptomatic. Your fatigue may or may not be resolved by replacing the valve. Lots of tings can cause fatigue.

I still think it is partially my testosterone levels. They aren't low according to the doctor, but when I look at them they are way on the low end of normal and have gone down a lot in just one year. Now with the new thing for me to research from my CT (subsegmental atelectasis in the dependent lower lobes) I wonder if that could cause fatigue too.

 

[carolinemc]

Hi Caroline , What is OPS?

I meant OHS=open heart surgery. My mistake. Oops.

 

[tom in MO]

I still think it is partially my testosterone levels. They aren't low according to the doctor, but when I look at them they are way on the low end of normal and have gone down a lot in just one year. Now with the new thing for me to research from my CT (subsegmental atelectasis in the dependent lower lobes) I wonder if that could cause fatigue too.

You are 51; it's "normal" at that age for your testosterone levels to drop. Plus testosterone levels change during the day, they are usually higher in the morning than at night. Despite the "men's health" marketing for testosterone, which has turned it into a drug of abuse, the chemical will not keep you young. The simple reason is often correct, which is your fatigue is due to your cardiac problems.

 

[SatoriFound]

You are 51; it's "normal" at that age for your testosterone levels to drop. Plus testosterone levels change during the day, they are usually higher in the morning than at night. Despite the "men's health" marketing for testosterone, which has turned it into a drug of abuse, the chemical will not keep you young. The simple reason is often correct, which is your fatigue is due to your cardiac problems.

My tests were in the morning... LOL Yeah, I know the simplest answer is usually the correct one.