Cardiac Hemodynamics

[KimC]

Hi,

First, my right leg that had the cath is improving but the calf has several strange bruises, (and I haven't injured it). Anyway, "no DVT" is the main thing.

Second, can anyone help me read a cath report? What are the normal diagnostic values/ranges for aortic pressure, LV pressure and LVEDP?

My EF was low; Dr. Heupler attributed it to aortic insufficiency in his report. At what point does it become a decision-making factor in AVR?

Thanks,

 

[Ross]

Go see echocardiography in the reference forum "Must have Links" for echobyweb

 

[BillCobit]

Kim - download a copy of:

http://www.acc.org/clinical/guidelines/valvular/3205p149.pdf

which includes discussion of hemodynamics and evaluation criteria for surgery.

 

[KimC]

OK, I admit I was being lazy and wanted someone like Ross to tell me the numbers off the top of his big head!

Thanks. BTW, I should say that the "low" EF is only mildly below normal, (if 50 is the cut off).

Off to do my homework ...

Best,

 

[KimC]

Pissed Off

Pissed Off

Alright. I am not happy. In fact, I'm pissed.

According to the cath values, I'm still a borderline candidate for valve replacement given that I'm "low normal," i.e., EF of 49. A year ago, my EF was 55.

According to the guidelines Bob cited, I don't even warrant AVR because the regurg isn't severe. I'm still in the middle, even though my other numbers show definite decline in function/elevation in pressure.

Here's where I get pissed. My GI doc sent a letter to my cardio and primary care doc saying that the results of my GI tests were "surprisingly" normal. No acid reflux or any other disease that could explain recurring chest pain.

Well, I have to say that ironically I felt some retribution for the results, as I've rarely experienced esophageal "pain" and it's completely different than the chest "pressure" I've been experiencing.

What I'm looking for at this point is recognition that my symptoms warrant some "outside the box" consideration. I'm not begging for AVR, but I also want to live to see my grandchildren.

But I know that if I push the issue, I'll get the "you're overreacting," as I did when I complained about the SOB until I pushed for pulmonary function tests and had PROOF.

Perphas further observation won't kill me or cause irreversible damage. I just don't know. Could the new diagnoses of asthma and angina all in one year be a coincidence?

Do I have to have a heart attack to be taken seriously?

I'm sorry, but that's how I feel at the moment. I'll get over it.

 

[Bryan B]

Kim,

I don't suggest going that route...although it WILL get their attention!

It "felt" to me as though noone took my problems that seriously until I contracted endocarditis. That seemed to get their attention . Now that I've had my surgery and "should" be feeling better I'm back to having to "prove" that something isn't right with my sternum.

With moderate regurg and a borderline EF that does put you in the "gray" zone. Did your cath results mention if you left ventricle was normal in size? That seems to be an important indicator in the decision making process. My EF was in the 60's and my regurg was moderate, but my left ventricle was at the upper limits of normal, I had a VSD, and I had just gotten over having endocarditis. I believe those last 3 variables is what landed me in the OR.

Hang in there, I know it's frustrating when a health care provider may dismiss you even though you know your body better than anyone. I'm learning that you have to be persistent if you honestly believe that "something just isn't right" with your body.

 

[Granbonny]

Hi Kim

Hi Kim

Did you leave Hilton Head for another Cardiologist in a larger town? charleston? Do you trust him? There are so many great Cardiologist in the Atlanta area with Emory Hospital..even tho I had mine done at St. Joseph's.. I thought that when your EF goes low..it will never come back up. even with surgery? But, I know little..Bonnie

 

[BillCobit]

getting a doc to listen

getting a doc to listen

Kim -

I had a different problem - I felt fine, but had enlarged heart and low ejection fraction. Only "complaint" was that I couldn't run 5 miles as fast as other people I knew of similar age/weight/exercise habits, and therefore I was considered to be asymptomatic. The guidelines for mitral valve intervention were clear that EF and heart dimensions were the indicators to be considered - NOT the symptoms...but I had to go through a few cardiologists before I found one that really understood how to evaluate a valve problem.

If you're not happy with your cardiologist, try another one. They're not all similarly competent. I suggest finding a cardio group attached to a hospital with a recognised heart program.

Good luck!

 

[Harrybaby666]

Talk About Terror!

Talk About Terror!

Hi Kim C.
Just thought you should know that I am in the same boat as you are at the moment...I had a hard time finding the right doctor, but this new one seems to at least listen and answer any questions that I might have...I would have thought though that as he was seeing me for the first time in June, that he would have wanted a fresh Echocardiogram, but he didn't. He is waiting until November to do another one. I have the same question that you do, do I have to have a major event to have something done? My Ejection Fraction has been at it's lowest 46% and the doc called that on the low side of normal, but my lower ventricals are thickening at the walls..I mean they seem to think that things are not bad right now, BUT TELL THAT TO THE CHEST PAIN, THE EXHAUSTION AND SOB ON EXHERTION...Just wanted to let you know that I share your pain...Harrybaby

 

[Mary]

clarification

clarification

Kim,
Would you clarify which doctor you're referring to with your most recent heart situation? I assumed that when you asked about the cath values in this thread that you were questioning what the Doctor at Cleveland Clinic told you after your procedure there.

Did the Cleveland Clinic cardiologist give you a second opinion? Is your concern today a result of your reviewing the criteria for valve replacement that Bill posted?

If you aren't confident about his recommendation, is there another avenue to pursue? Could you go back to the pulmonologist for the chest pressure?

Your problems with asthma could cause the sensation of pressure you describe. My son has had severe asthma all his life, and now at the age of 21, he anticipates an episode by the tightness and pressure he feels in his upper chest.

 

[KimC]

Hi,

Thanks. I requested the records from my cath at the Cleveland Clinic which I received and read yesterday.

I'm not questioning the cardiologist. He recommended an echo as a follow-up to the cath. According to his notes, his hypothesis is that valvular heart disease is causing elevated pressure on my left ventricle, as well as the decline in my ejection fraction which came as no surprise to me. I was diagnosed with AI last year.

What came as a surprise is that he never mentioned to me that my EF was low-normal, or that he saw evidence of aortic valve disease. In fact, when my husband pressed him in the hall for more info, the cardio said that he couldn't explain my symptoms, and when I pressed him on this, he said that multiple things could cause what I'm experiencing, but that taking a calcium channel blocker and nitrates would be beneficial.

I think he was being cautious and conservative which to some degree I appreciate. In earnest, he has no evidence to support my symptoms: I'm borderline.

My local primary care doc was more forthright, (he can afford to be in the back seat) and said that the CCF cardio recommended the meds to treat vasospasms related to the declining aortic valve.

My frustration is that I didn't know until today that my EF was lower in comparison to six months ago.

Anyway, I should be getting the results of my most recent echo tomorrow. Hopefully, I'll calm down a bit. But given that the nurse left a message in my voicemail saying that she needs to speak to me about my echo, I doubt it. (I think nurses should hang up if no one answers -- leaving that kind of message only creates anxiety).

Bye,

 

[Arlyss]

Congential Aortic Valve Disease

Congential Aortic Valve Disease

Dear Kim,
I noticed that you have a congenital malformation of your aortic valve -- four leaflets instead of three. I would be concerned about the aorta itself when there is any congenital abnormality of the aortic valve. The medical literature speaks about bicuspid (two leaflets) and unicuspid congenital abnormalities -- I have not specifically searched for four leaflets.
However, what is emerging about bicuspid valves points to an abnormality of the tissue of the aorta as well. It would be well worth investigating that in your situation. Focusing on the valve alone is not wise. It is important to know if the aorta is dilated or aneurysmal. I noticed that you mention a feeling of pressure in your chest. The aorta can be symptomatic if it is dilated. Sadly, I know of too many women who have been told it was anxiety, when they had a symptomatic aorta. I also know of some who were treated for asthma, when it was an aortic aneurysm causing the symptoms.
You might check the reports of the tests you have had to see if they mention the size of the aorta. You are welcome to email me if you would like further information. The program at this link may also be helpful to you
http://www.cedars-sinai.edu/aorta

Best Wishes,
Arlyss

 

[KimC]

Thanks, Arlyss. I've thought about that as a possibility and will bring it up w/ my doc. I THINK they checked for it.

 

[medtronic of borg]

Dr's

Dr's

I have been as high as 45 and low as 18 . All I know is at 18 I was definately not doing well and Dr's were contemplating transplant.
Med