Cardiologist versus Surgeon...........

[Marguerite53]

I would like fresh discussion on ?the dance?. Cardiologist versus Surgeon. Whom to believe? Who to trust? How to get from one to the next. What steps to take? How to maneuver your way through??.

There are many new members here recently. Some discussion has come up within threads which cautions a blind trust of the cardiologist since they ?tend? to want to wait ?too long? before setting up a date with the surgeon. We hear mostly from the patients for whom that wait was damaging. Do we have any idea the caliber of those particular cardiologists whose advice turned out to be bad? Do we ever hear from anyone who was glad that they waited out the cardiologist?s timespan? Do we know either way whether quality of life on either side of the journey was the source of some of the cardiologists plan? Seeing a relatively healthy person jumping into an unknown outcome prematurely might be ill advised. Sure, the surgery is inevitable, but how does a doctor gauge success on both sides? Does the call for waiting out the new technology hold any relevance?

Many many questions from me, here in the waiting room. 2 months from being an empty nester with 3 all going back or on to college. Feels like a good time to push. My numbers are close. Would relish any and all comments.

Thanks! Marguerite

 

[Central Jersey Steve]

Marguerite,

I have "chosen" to wait. Whether this decision is right or wrong is to be seen.

I have aortic & mitral replacement looming, as well as the ascending aortic root dilation (aneurysm).

My cardiologist (affiliated w/NY Columbia Presbyterian) has told me to wait and assured me that my condition is stable and can be managed until he feels I am ready to go.

5 years ago I had surgery scheduled at Columbia and the cardiologist was assigned to me as the post care doc. When I saw him one week before surgery (after having had x-rays, blood, and seen the anesthesia people) I asked him if I needed this surgery. He studied my records, watched my films, and then said no.

This has been the situation for me since then. I see him every 6 months, have echos, mri's, cat scans, etc. We monitor my condition and he says, "nothings changed, all stable" and I go home. This week I had an MRI of the aortic aneurysm and I am seeing him on June 30. This is my pattern.

There are many people on this site who have taken different paths and it all boils down to personal decisions.

 

[geebee]

I think one of the problems in waiting is, "how long is too long?" There are so many stories out there (mine included) where it was thought the mitral (and I assume other valves as well) could be repaired. However, once the surgery is in progress, it is found that the valve was much more damaged than thought and repairing it was impossible. Many stories of valves "falling apart in the surgeon's hands".

Therefore, symptoms and tests are not always indicative of how badly damaged the valve is. I would think some people probably die waiting for things to get bad enough for surgery.

If I were in the waiting room again, I would go by the surgeon's recommendations but that's just me. I personally think my cardio waited too long to refer me the first time.

 

[Famulus]

Do we ever hear from anyone who was glad that they waited out the cardiologist?s timespan? Do we know either way whether quality of life on either side of the journey was the source of some of the cardiologists plan?

Hi all - Just found you and joined today, mostly because I saw this post, and my experience allows me to answer the above question - I waited 27 years (still 'waiting').....I'm certainly not advocating that anyone else necessarily try this, but just offering it as an alternative experience for another perspective on this question.

Brief history...rheumatic fever at 5, heart cath at 27 (in 1977), and MI caused by/during that cath. The diagnosis was aortic stenosis, mitral and tricuspid regurg, 'requiring surgery WITHIN 5 years', and was told that if I became pregnant, I would have to be hospitalized for the entire pregnancy, but was strongly advised not to become pregnant at all, because it would be life-threatening for me. I followed the 2nd part of this advice, but not the first, and instead completely avoided doctors for a very long time (except GYN's)

It's now 27 years later, and I'm having CHF symptoms now (at 54), but I became very pro-active about my health re nutrition, exercise, walked 5 mi/da., did everything that I could do to control my risk factors, and had approx. 25 asymptomatic years with a very good quality of life. I believe I would have had a VERY different quality of life had I followed the advice for multiple valve replacement surgery at that time.

In my experience, a surgeon is almost always going to present you with a surgical solution. It's what they do, after all....

Food for thought, anyway. In retrospect, in light of this question, I believe I took a very large gamble in the direction of quality of life, and it worked out well - for me. (I'm not suggesting or recommending anything to you - just relating personal experience)

well wishes to all,
Oona

 

[inlaguna]

I definitely went about as long as I could go before surgery. I was having symptoms and it appeared the wall of my ventricle was thickening a bit.
I got opinions from two cardiologists and a surgeon. Up to that point I had a very good relationship with my cardio and he seemed fairly pragmatic when discussing options with me over the years leading to surgery.

When it was all said and done I decided it was better to have it done a little too early rather than wait till it was a little too late.


Dan

 

[savysmommy]

For me, the progression from my diagnosis(severe aortic insuffesesny-BAV) to scheduling surgery happened very fast. I found out in March, and since then it has continued to get worse. So, the decision for surgery was both mine and my cardiologist. He suggested I look into hospitals/surgeons, and get an idea of where I would like to go. At the next apt, he said "next Wednesday wouldnt be too soon." Basicly, he said dont wait 3+ months, but do it at a time that is convienent for you.

So, From March - June 28 (surgery day) was very quick.. For me, knowing something like this, then waiting, and waiting would be torture! Just in the last few months I have become addicted to reading everything I can about valve disease and any kind of heart condition out there. I continue to wonder everytime I have a palpatation, if my heart is enlarging, or if that really bad chest pain I had was a disection.. etc, etc. I am sure many of you out there have felt similar at one time or another.

Best wishes,
Shannon

 

[Marguerite53]

Thanks for all the responses thus far

Thanks for all the responses thus far

Thanks to all of you for responding. Mtnbiker, it was actually your introductory thread which prompted me to start this one. I was somewhat taken aback by AlCapshaw's comments when he said "Your valve disease classifications don't sound too bad (moderate) but your symptoms and the fact that you have a bicuspid valve are a concern. Most of us find that SURGEONS have a better feel for WHEN to have surgery. You don't want to wait too long as you can develop IRREVERSIBLE damage to the heart muscle (enlargement). If your chamber sizes show enlargement, it would be best to go ahead and schedule surgery if your surgeon concurs.'AL Capshaw'" I'm not sure that MOST of us have found what he suggests. That is why I am curious to hear of others' opinions and experiences.

In reading through Burair's recent thread on his 6 month checkup, Tobagotwo states, "I'm happy that you have received a good report, Burair. The pulmonary regurgitation may well not affect you for a very long time, and perhaps never. We all live with small compromises." And that's what I'm getting at here. There seem to be problems post op and lifelong compromises for some. What about the results? For those of us who are not in an emergency situation, how do we want to play this? We know it is not optional. We've heard it could very well be worse than was expected, or measured by the countless tests they've performed. ALL this information is wonderfully available here in this forum for us to try to digest.

In my year, here at vr.com, not many have stepped up to defend the cardiologist. I guess that's what I'm hoping to hear more of (as that's what I've currently chosen to do -- go with her line of reasoning).

Newcomers are flushed with emotion and lurking drama. They may not hear what is between the lines and I just wanted to offer some discussion (and for my own peace of mind, too, of course!) about this quandry.

Thanks again, and I hope this continues...

Marguerite

 

[geebee]

I don't think that comments about cardios waiting too long is actually the same as not defending them. It is simply a discussion about whose advice to follow. I have a great cardio now who supported my last OHS when it was, in effect, an "exploratory" OHS. It was difficult for him because he is self-described as practicing "conservative" cardiology. He usually proceeds more by tests than people's complaints. In my case, he found that the tests did not confirm the problems I was having but decided to listen to me anyway. I would be dead today if he had not, so I am grateful for his flexibility in my case.

We would all be in bad shape if it weren't for cardios. I have had some really great ones over the years (and some bad) but I would not want to try and go directly from a GP to a heart surgeon.

That being said, we each have to make our own decisions on whose advice to take. Yes, surgery presents its own risks as does deciding against surgery (whether short-term or long). Most of the comments about choosing surgery earlier rather than later is based on the concept that we are in better shape and will recover faster at 50 than at 65 (or whatever ages you want to compare). In addition, many situations where surgery is not "pushed" by a cardio may be simply because they are not hearing the words from the patient about how badly they feel. We have to be proactive in our health care in order to get the best care. Too many people don't want to be thought of as complainers so they wait and sometimes they wait too long.

Having my first OHS at 27 was not a factor in my needing 2 more. If it were not for my problem of excess scar tissue, my original valve would probably still be fine 25 years later. I bounced back much faster after my first 2 OHS than I did after my last one. I contribute that to age, but that is my opinion and may not be the case with everyone.

Just wanted to clear up a couple of comments.

 

[Phyllis]

It's hard for us to say as once Dick presented with his first possible and only symptom (fainting while playing tennis), the two cardiologists we met with insisted he needed surgery. The first cardiologist's referral was to a surgeon that we didn't like and wasn't up on the latest valves, minimally invasive, etc. Hence we researched and went to Boston, where we met with the head of cardiology. He also agreed that Dick needed immediate surgery and when he asked us who we wanted as a surgeon, we had a ready answer as we had already researched Dr. Cohn. Of course, Dick had already presented with a "symptom". Our feeling is that surgeons always do want to operate. So if you truly trust your cardio and have all the best tests, no symptoms and he or she suggests waiting, we would most likely go with that scenario.

 

[Nancy]

Joe's had three valve surgeries. He's 74 (tomorrow). He had rheumatic fever as a teenager. When he was about 46, his aortic valve started regrugitating severely and was stenotic causing him to faint. He had surgery shortly after that episode, a mechanical Bjork-Shiley. He still has that one.

In 1999, his mitral valve started acting up. His cardiologist tried managing this for a while. Joe got increasingly debillitated. He finally got to the point that he could do nothing but sit on the sofa. His heart rhythms were also abnormal and he was faint. Still, surgery was put on hold. It wasn't until Joe had a very direct conversation with the cardiologist that surgery was finally suggested.

His heart rhythms were still quite disturbed after surgery, afib and also bradycardia, alternating. He started fainting. He fell several times with great concussion not too long after his mitral surgery. I believe one of these falls caused the newly implanted valve to develop a leak, since he fell directly on his chest without being able to break the fall, dislocating his jaw in the process.

So then he began to have mitral valve symptoms all over again. Testing was done, and a leak was present, which wasn't there just after surgery.

Joe inquired about taking care of the valve problem. This time, since it was to be his third time, the cardiologist was extremely reluctant to suggest surgery. Joe was managed medically for two years, and he became once again, extremely debillitated. He couldn't do any walking at all. He finally insisted that something be done. Still there was great reluctance.

There was a consultation with the surgeon and finally after much discussion back and forth and discussion of the risk factors, a third surgery was scheduled.

Joe right now, has a severely leaking tricuspid valve. I do not believe that any of his other valves are involved, but I am not sure. He was recently in the hospital for severe CHF with ascites, and I requested a TEE. They DID do a right and left cath, and there didn't appear to be any other valve abnormalities, but his cardiologist would not do the TEE, saying that there was nothing found to warrant it.

In my discussion with the cardiologist, I asked him point blank that if a TEE were to be done, and valve abnormalities were to be found, would Joe even be operable. He said that there would have to be extremely strong indications to go in a fourth time, and that the risk factors were too great.

So Joe is being managed medically.

Do I feel that the original mitral valve surgery should have been done earlier? Yes, I do. It could have possibly prevented the rhythm disturbances which lead to the need for the second mitral surgery.

Do I feel that cardiologists drag their feet, sometimes. However, there are cases like my husband's which do require very, very sober thinking. And there are some patients which should be managed medically as long as possible.

But great care must be taken if surgery is not done right away, and lots of testing should be done to make sure that irreversible changes are not about to occur.

After the first surgery, there will be increasing risk to benefit ratios which will be applied to your case.

Surgery is recommended according to test results AND your own symptoms.

Everyone needs to go into this kind of surgery with their eyes wide open and armed with as much information as they can possibly absorb. What is determined today, can have many effects down the road.

 

[Debrinha GT]

Very useful discussion!

Very useful discussion!

I suppose this discussion is something like valve choice. It's hard to precise exactly what's the best thing to do, but it's important to explore all the pros and cons before making the final decision. If the cardio or surgeon wants to wait, we might think he's neglecting us, and if he wants the surgery to be sooner, we tend to think he wants to make some money, not easy at all! I'm 40 years old now and have been having mitral valve replacements since I was ten. The first two times I was under-aged so it was my mum who dealt with these things. However, I really do believe I was lucky then or I doubt I'd still be here owing to the seriousness of my case at the time. When the time for my third surgery came, I was thirty, but since I'd had that valve for nearly 16 years already, I didn't question the need for surgery seeing that there was a significant rupture and I also had PH due to that fact. I did choose to go tissue again though(bovine) because I wanted to have a baby, which I did just over a year after the surgery. I do have confidence in my cardio and the surgeon too. Last October I wanted to know a few things that I felt the surgeon would be the best person to answer so, I made an appointment with him without mentioning it to my cardio. He was surprised to see me there, but since he knows what I'm like, he didn't mind me going to see him at all. I told him that I was very happy with my cardio, but wanted to hear a few answers straight from him. He saw my exams and took a look at me too. We discussed valve choice and the best time for surgery. He said that he'll probably only operate on me when the opening to my mitral valve goes under 1,00cm2, or if there's a sudden rupture. I'll be going in to see the cardio again within the next month or so to see how things are progressing. Here I can arrange for the appointment whenever I like as long as it's done within the months he asks me to go, i mean, he doesn't set a date, and if I feel I need to go earlier, there's no problem, all I have to do is phone. My health plan allows you to go to the same professional once a month and if you need to take exams for him to see or something like that, you can go for a return visit. As for going against a doctor, even though I've always liked my former cardio, I did go for a second opinion regarding pregnancy. One thing I think is worth considering too, is the fact that technology can only get better and the longer we wait providing there's no risk involved, the better our chances are of getting a valve to last longer and so on. Just my opinion!
Débora

 

[tobagotwo]

One appropriate answer would be that, except in cases of real emergency, it is always a judgement call. There will always be a professional who says the patient should have gone sooner, and another who says s/he could wait a few more months or years.

I have read numerous different approaches to defining when someone is ready to have valve surgery. As with any cut-and-dried formulations intended to apply to the general run of humanity, they all have shortcomings.

• The existence of patient symptoms, such as angina, shortness of breath, palpitations, sleep apneas and disturbances, and even anxiety. Yes, anxiety can be a symptom of heart disease - in some people, the body apparently senses the problem by lack of oxygenation or similar and sends out panic chemicals. Some people do not have, fail to recognize, or refuse to acknowledge symptoms.

• When the aortic valve's anulus (valve opening) is less than 1 cm², or .8 cm², or .6 cm², depending on the physician and the size and activity level of the patient. What's sauce for the goose isn't necessarily sauce for the gander. Some bike racers have been brought in, symptomless, for emergency surgery at .6 cm² or less, but I was more than ready at .89 cm².

• When the ascending aorta is larger than 4.5 cm, or 4.8 cm, or 5 cm, or (gasp!) even higher, depending on the physician. There are a number of VR members who dissected at smaller sizes, and were extremely fortunate to even live through the experience, often with long-term consequences. I believe they would hold unanimously that waiting six months with a 5.0 cm aorta and risking dissection borders on criminal malpractice.

• When one or more of the atriums or ventricles gets too large, or the heart walls thicken excessively. Unbelievably, this is not monitored based on the patient's original heart size. Because of this, one can, like the Grinch, have his heart "grow three sizes" and still not show up on the chart as having an enlarged heart. Obviously, that is a poor way to tailor information to a particular person. When you get your echoes, save them to be able to compare valuable information like that.

The numbers are important when there are no reported symptoms. The symptoms are important when the numbers don't seem to be enough.

All anaerobic exercises and even many aerobic exercises are not advised for people with moderate to severe aortic stenosis. Walking is one of the exceptions, but not speed-walking, so leave the timer home. Exercise will not keep a valve from calcifying. That has been proven over and over again. Nor is there evidence that diet will prevent it, although proper weight and good nutrition will always help the body in a general sense.

I believe that in Oona's case, the diagnosis was poorly done or badly explained, and would not likely have held up over time regardless, which is one reason you so often hear the refrain for a second opinion on VR. A statement that someone will require valve surgery in five years is simply a guess, as everyone's rate of stenosis is different, and can even stall for periods of time in individuals.

The Big Generalizations: Cardiologists tend to wait, as they see surgery as a big risk jump for their patients, and potentially a reason to blame them for "giving up" on someone, and sending them to scary open-heart surgery when there might have been "something else that could have been tried." Surgeons tend to go earlier, because they have much better and faster post-surgical results in patients whose hearts have not already been permanently damaged. In the worst case, they are also less likely to have a casualty on their table. Cardiologists point out that once you have had the surgery, your heart is changed forever. Surgeons say, "Yes, and it's for the better."

These generalizations hold up pretty well, in my opinion, even though it was my cardiologist who originally told me to go find a surgeon. The average run will fall within the generalizations, though, based on general observation of VR postings. It comes down to a high-stakes game of chicken: how long can you avoid surgery without cusing the the heart to develop permanent damage from the valve disease.

Surgeons' opinions aren't always to go to surgery, as a number of eager Waiting Room posters have found out over time. They are aware of their reputation as scalpel-toting monomaniacs, and are concerned about claims of unnecessary surgery from both inside and outside of the medical profession.

My own gut response is to lean somewhat toward surgery. If there is doubt, why would you risk a permanent infirmity to push back surgery that you will eventually have to have anyway? Is six months' delay worth permanent atrial or ventricular fibrillation, or on-and-off congestive heart failure symptoms for the rest of your life? We do live with small tradeoffs in life. However, it is also undeniably sweet to avoid big compromises.

The point, when you appear to be getting close, of having the opinions of both is that you really can't know your cardiologist's personal philosophy about surgery, or whether he may have been lulled into inaction by the slow path of the disease. The opinions of the second cardiologist and the surgeon are a reality check for both you and your cardiologist. In the end, the patient often makes the decision for him or herself when s/he feels ready (assuming, of course, that there is also at least a surgeon who agrees that it is time), or goes with the opinion of the professional s/he feels most competent.

Best wishes,

 

[BillCobit]

My cardiologist thought I should wait some more, the instruction book ( http://www.acc.org/clinical/guidelines/valvular/ )said it was time to go. I decided I was more interested in pursuing a good recovery vs. delaying surgery to avoid associated risks, so I shopped for my own surgeon and got it done. My thinking was that my surgical risk wouldn't decrease if I waited another year or two, but the probability of reversing heart enlargement might...and if things worked out like I hoped, I'd have a year or two more of my remaining life to enjoy a properly-working pump.

 

[Debrinha GT]

Very detailed!

Very detailed!

Thanks Bill for the address! I've glanced at it and I think it will be very useful to many of us. I don't know how to do that, but why don't you add that to the REFERENCE SORCES forum? I'm sure more people will get to see it in there since it's not everybody who has visited this thread.
Déora

 

[CCRN]

My opinion

My opinion

Thanks Bill for the address! I've glanced at it and I think it will be very useful to many of us. I don't know how to do that, but why don't you add that to the REFERENCE SORCES forum? I'm sure more people will get to see it in there since it's not everybody who has visited this thread.
Déora

As I have stated before in another thread: When it takes a surgeon to repair the problem, you need to at least get a surgical consult. My condition was much worst than expected and only really recognized after opening my chest.
What does it really hurt?

 

[Famulus]

I believe that in Oona's case, the diagnosis was poorly done or badly explained, and would not likely have held up over time regardless, which is one reason you so often hear the refrain for a second opinion on VR. A statement that someone will require valve surgery in five years is simply a guess, as everyone's rate of stenosis is different, and can even stall for periods of time in individuals.

(((I had two opinions))) both were the same. Actually, the 2nd opinion surgeon wanted to do it the following week. But I have to agree that the statement that someone will need valve surgery in X amount of time is unknowable.

BTW, you are not in the minority in your opinion of a 'misdiagnosis'. And of course I realize that a cath in '77 is primitive by today's standards with the advances in technology, but it goes without saying that surgeries were done at that time based on those diagnostics.

The question becomes - is a heart able to rejuvenate or compensate with exercise - like any other muscle? If that is not the case, then what are you saying about stem cell research that suggests that it is possible? What if you could wait long enough for that? Worth a try?

 

[Debrinha GT]

I'm in favour of it!

I'm in favour of it!

I'm not asking if anyone agrees with me here or not, but I AM strongly in favour of the stem cell research in all aspects. If only I could have a permanent valve one day, it would be just wonderful! There are so many people out there hoping for a miracle cure and I really do hope this research gets off the ground full force soon. There might even still be time for us!! It's just my opinion and nothing will ever make me change my mind about it!
Débora

 

[tobagotwo]

Oona, the reason that exercise won't help is that the act of making the heart pump harder, which would make it stronger in normal circumstances, instead causes more damage, due to the difficulty of pumping through the narrowed valve, and the back-leak after it does.

In fact, the heart initially does get stronger trying to handle it. It enlarges, literally because the muscle grows, and your ejection factor increases substantially. But then it loses its efficiency once it reaches a certain size. It just can't feed the body and itself through its blocked, leaky plumbing. The next step is CHF.

That's why I say you were misdiagnosed. 1977! Like the dark ages for heart surgery - and for catheterizations. Replacement valves were ball-and-cage affairs. The St. Judes mechanical valve wasn't even on the market yet. And it appears the person who was doing the cath and caused the MI might as well have been using a wire coat hanger, for all the value he got out of the procedure. I strongly suspect the cath results were faulty (big time), and caused the later opinions to be misled.

You had multiple problems. You had damage from rheumatic fever, and then a heart attack on top of it. You were complex at a time when diagnostic techniques weren't.

Why do I think so? With mild stenosis and only trace or mild regurgitation, exercise is not such a bad thing. Eliminating risk factors, good diet, and keeping fit generally enable the body to deal better with any problem. And it would help you recover from some of the effects of the MI. However, if you had had severe stenosis (operable level by today's standards), exercise would have killed you or brought you to emergency surgery within months, not made you feel better. A fair number of snow-shoveling deaths each year are victims of undiscovered aortic stenosis. It can make the heart stop from arrythmias caused by overwork, rather than in "standard" heart attack fashion.

This isn't directed at you Oona, so please don't think I'm lecturing you. I have to climb onto my soap box occasionally, and this seems like a good time...

Some of the most interesting AVRs are bicycle racers, who are so intensely fit that they are still symptomless at a half-a-centimeter-squared valve opening, and have to be sent for emergency surgery. I point this out so that no one mistakenly believes that there is a holistic or lifestyle treatment for aortic stenosis or regurgitation, and does something irretrievable, like stop going to their physician. There is not a healthier lifestyle that will fix or prevent these valve problems. And it's not for lack of people trying to prove that there is.

Diet, exercise and eliminating risks are good for you, until you reach a certain point, but they will not stop or reverse aortic calcification, and the stenosis and regurgitation it causes. There are no herbs, nutraceuticals, or natural supplements that will halt or reverse it either. None. Nor, as has recently been shown, will Lipitor.

Best wishes,

 

[Michaelena]

I have severe tricuspid regurit, moderate aortic regurit, chronic A-fib, enlarged heart, and a MVR 20 years ago.

My cardiologist of 25 years said that my condition could be managed with medication. What he did not tell me is that I risk irreparable damage to my right atrium and liver cirrhosis. Currently, my liver is engorged from excessive blood, eating is difficult due to the pressure of my liver on my stomach. I have edema, and fatigue. Alarmed because of my symptoms, I went for a second opinion, the cardiologist felt the surgery should be done within a couple of months or sooner. My internist said that he was concerned that my right atrium and liver would be damaged. My internist referred me to another cardiologist and he agreed that I should not wait, surgery was warranted.

I guess I was very confused by my original cardio's opinion after seeing to other cardio's. I thought he was driven by the insurance company rules, (although I always knew he was on the conservative side, which is what I liked about him); until my quality of life was not what it should be as a result of my current heart valve problems.

I interviewed three surgeons, compared experience and approaches to correcting my problem and made a decision. Currently, I am waiting for the date of my surgery. Based on my symptoms, and the opinions of the three other doctors, the surgery would be in my best interest at this time. I am in good health (except for my heart), and if I could wait (doubtful) perhaps that would not be the case. I have a new cardiologist.

 

[Famulus]

In fact, the heart initially does get stronger trying to handle it. It enlarges, literally because the muscle grows, and your ejection factor increases substantially. But then it loses its efficiency once it reaches a certain size. It just can't feed the body and itself through its blocked, leaky plumbing. The next step is CHF.

Some of the most interesting AVRs are bicycle racers, who are so intensely fit that they are still symptomless at a half-a-centimeter-squared valve opening, and have to be sent for emergency surgery.

Diet, exercise and eliminating risks are good for you, until you reach a certain point, but they will not stop or reverse aortic calcification, and the stenosis and regurgitation it causes.,

Thank you - I really appreciate the response. You make some interesting points to consider.

I have selected these 3 paragraphs above which could fit my theory...(I promise, I'm not trying to drive you crazy, lol!)
BTW they were finished with the cath and withdrawing when my MI occurred, so I'm not sure it affected the readings. I would agree, it was probably like a coat hanger compared to now, though. In any case, this caused my total distrust & avoidance of doctors, so it was more by circumstance than planned that I avoided the surgery - and I thank God it happened that way, since we all know where I might be now. (and I have not had another cath, still terrified of that!)

Your first paragraph describes where I am now. Your second paragraph describes where I was for 25 yrs, but I didn't push it to the point of the bicycle riders, so perhaps did not get into trouble for that reason. And I agree with your 3rd paragraph...also where I am now. Maybe delayed is a better word than prevented. Sure delayed things a loooong time, though!

My current state of affairs....I have had recent echo's - 2004 and 2005. EF is 50. Left ventricular hypertrophy - heart size is normal, not enlarged, so there is the compensation. PH = 40mm Hg (caused by AS?) Sclerotic aortic & mitral - mitral & tricuspid are now showing only mild regurg/no veg. right BBB. Silent MI in '03-04 (?) cardiac arrest in '04 - in the ER! (acute anemia) I used to have a very loud murmur which is now almost inaudible. Anyway, now DHF, and arrhythmia - recently very increased. As you can see, I didn't get away with it, but I was completely asymptomatic thru 2001. What terminated my run of good health was 3 years of acute anemia, and I believe that just threw the HF into hyperdrive. (little did I know - I attributed the symptoms to the anemia at the time)

Why am I here? To learn, that's all. Am I considering valve replacement if it comes to that? No. Same as before. Emphatically no, not a choice I would make. In fact, I don't think it would help at this point. I just chimed in because possibly my experience can be of use to some of you who are wondering about waiting. I doubt there are too many 25 year fitness-enhanced waits. lol! But after all, there's no free lunch with heart disease - it seems it's just a matter of when and how it develops.

I wish you all well,
Oona