Chest discomfort laying on back?

[lcwhitney]

Chest Discomfort Is Never A Good Thing

Chest Discomfort Is Never A Good Thing

I have had 2 oOH surgeries and the cworse my aortic and pulmonary regurg got the harder it became to sleep. at all. Before I had my second surg. I spent a lot of nights sitting in a chair. sleeping in any thing that resembled a reclining position was out of the question.
Lettitia

 

[davidwattsjr]

fantastic

fantastic

Fantastic discussions here - that's what I appreciate about valvereplacement.com so much - good healthy respectful sharing of ideas.

Lots of decisions to make. I'll consult with cardiologist and plan to get with a surgeon as well.

My echo-cardiograms apparently show a bicuspid valve.

Anyone hear of a repair on a bicuspid valve?

As far as everyone knows - moderate exercise (pulse rate 130-150 bpm) ok with my level symptoms (moderate-severe Aortic regurgitation/insufficiency)? When exercising - a few times I pushed my self a bit hard - and I could feel a little chest pain. I guess that was a little angina? As soon as I backed off - the pain went away.

Otherwise - 130-150 bpm has seemed ok.

As far as the group knows - this kind of exercise is cool with AR and bicuspid valves. Doc says no stenosis is present.

Thanks again,

David.

 

[atydev]

David

David

This was a common problem for me before I had my surgery 4 weeks ago. Now I have the same pain now but it is due to having my chest cut open....hehehe I never new what it was or why at least not for sure. I always thought it was because I had fluid around my heart. Or I was having some fluid on my lungs. It never really hurt just really uncomfortable. That is why I got in the habit of laying on my right side. Well that was the only way I could get comfortable now......I still have not figured it out yet.....

 

[ALCapshaw2]

Hello again David,

Repairs to the Aortic Valve are rare. Most repairs are to the Mitral Valve. As someone else mentioned, there seem to be only a few really good 'repair specialists' in the country. I've never heard of a repair for bicuspid valves. Sorry.

It sounds like you are moving in the right direction, getting a second opinion from another cardiologist and searching for a surgical consult.

You may want to look over the Valve Selection Forum as well. If you are interested in the Ross Procedure or Homograft valves or even some of the specialized tissue valves, you may have to look for a surgeon who specializes in those valves.

We'll all be interested to hear what your new consults reveal.

Onward and Upward !

'AL'

 

[Gemma]

David,
My boyfriend Jim went to his doctor last January because he was getting chest pains whilst in bed at night. No SOB (maybe further into the year when walking uphill, but otherwise no problems with exercise), or any of the other normal symptoms of regurgitation. Also no knowledge of a heart problem. By March 2003 he'd been diagnosed with a bicuspid aortic valve and told he'd need a replacement within a year. He also had really weird blood pressure - 160/30 the week prior to his surgery Took 2 months to refer him, but that's another story.
Well, he had his AVR in December and his cardio was surprised because that timeframe meant he was on the surgeon's "urgent" list. As the surgeon said - Jim's LV was 7cm, it wasn't going to get any better, and the sooner it was operated on the better as that way any LV damage would be minimised. He predicted that without the AVR, Jim would struggle with 1 flight of stairs within 5 years' time, maybe sooner. In January his LV was 4.3 cm, and hopefully it will have decreased further by his next cardio appointment in November. We went for a 3 hour bike ride at the weekend and I was the one who was tired at the end of it!
Everyone's experiences are different, but it's definitely worth getting the surgeon's perspective - they seem to err in favour of operating before there's any major damage to the heart, rather than waiting until you're on death's door to fix you. Also means you've got a better chance of a good recovery of course.
Good luck!
Gemma.

 

[KimC]

I love this place!

David, my cardio at the CCF said that 1-2% of the population have uni, bi or quadra-cuspid aortic valves and that most don't even know it. He said that uni or bi-cuspid valves tend to detoriate in the fifth decade, and that a quadra-cuspid valve may last into the sixth decade, (that's what I have). Most surgeons who operate on the aortic valve are experts with replacing the bi-cuspid type since it's the most common problem.

AL/Tom: what do I know? (The danger of MB's). A 1% increase in morbidity doesn't sound awful. I'm not afraid of surgery but being newly diagnosed, having had my third child only a year ago, (his b-day is Friday) I've been told that "wait and see" is the best approach. My heart enlarged during pregnancy but has decreased in size since. I have another echo today.

You can bet that if the chest pressure increases, I'll be in Ross' neck of the woods in no time. I hope I'm making the right decision to trust my doctor(s).



Cheers,

 

[Mary]

I love this place!

David, my cardio at the CCF said that 1-2% of the population have uni, bi or quadra-cuspid aortic valves and that most don't even know it. He said that uni or bi-cuspid valves tend to detoriate in the fifth decade, and that a quadra-cuspid valve may last into the sixth decade, (that's what I have).

David, did you tell us what type of aortic valve you have? Surely you don't have a quadra-cuspid valve like Kim's, do you?
Mary

 

[KimC]

Tom = Bob (sorry, was thinking of your user name and the "t" blocked the "b")

 

[KimC]

Tom = Bob (sorry, was thinking of your user name and the "t" blocked the "b")

 

[tobagotwo]

Chamber size changes over time

Chamber size changes over time

I suppose you posted that twice because you didn't think I would get it the first time, Kim...

My cardiologist said very plainly that if I experienced angina, I was to quit what I was doing until it went away. Angina generally means your heart is having trouble coping. It's working too hard, or not getting enough oxygen. With most aortic issues, exercising it further at that point is not helpful, and may be harmful.

That does not mean that you should reside upon your derriere for the duration. Walking on level ground is good: movement is essential to life. Just don't push it when you feel the angina.

James (Shine On Syd) related a salient point when referring to the chamber sizes. The point is change over time. You can likely deduce the rate of change from your consecutive echo reports (your doctor is required to provide your records at your request, although he can charge a moderate copying fee). And don't just go by the "normal" ranges, if they're printed on the report.

For example: "normal" range for Left Ventricle (LV) End Diastolic Diameter is 3.5 cm to 5.7 cm. My oldest echo puts mine at 3.5 cm. The last one before surgery puts it at 5.7 cm. Both readings are within the "normal" range, but the change was not. That is the type of thing you may spot that could easily slide by your cardiologist, who may just see "normal," with a cursory inspection of only your most current echo.

Also, significant regurgitation or stenosis is usually accompanied by a great deal of calcification of the valve. The measurements of valve opening are a computed estimate, and frequently neglect the effects of the mineral deposits.

Even more importantly, these symptoms indicate that the valve itself is no longer flexible, a fundamental requirement for its task. That is usually captured in the mean gradient (force of flow) required to push the blood through the valve during the pump (beat). The peak gradient indicates the fluid pressure the heart has to develop to force the creaky valve open at the beginning of the beat.

Case in point: my surgeon and interventional cardiologist both originally felt my valve was in the grey area for surgery. However, when he got to the valve, the surgeon said he found that two of the leaflets were completely immobilized, and the third barely moved. He does over 1,000 open heart surgeries a year, and he said without blinking that he really didn't know how I was getting blood through it at all. He looked a bit chagrined

The gradients may not show as much information with regurgitation, especially if stenosis is not strong, but that may just mean that the valve is glued open, instead of closed.

Uh-oh. I've gone on long, and risk boring everyone. Ross will be eyeing my disk usage again.

Best wishes,

 

[ALCapshaw2]

The decision-making behind an AVR is extremely complex, and depends on multiple factors which are completely based on the individual. Pathology is not black and white. Seeking multiple opinions can help you make the difficult decision of whether or not to pursue interventions such as medications or surgery.

Hello Kim C,

FWIW, I agree with your statement above.

I like to CHART all my echo parameters and that way I can spot CHANGES that may not catch the eye of a cardiologist who is only looking at my LAST report. It's also a good way to catch an erroneous or questionable reading made by the echo tech.

Sometimes those changes represent the important key that indicates 'it's time' for surgery.

'AL'

 

[davidwattsjr]

my valve

my valve

My valve is a bicuspid.

I appreciated the perspective on the rate of change in the left ventricle end diastolic dimensions...

Mine started at 4.7 cm.
Six months later 5.6 cm.
Six months later 6.1 cm.
My next echo will be August 23.

I suspect - if the rate of change is constant - I'll be close to 6.7 or 6.8.

David.

 

[tobagotwo]

I agree with you Al, Kim stated that extremely well. You are your own best measure.

Unfortunately, the rate of change is usually not constant with these things, David. It tends to accellerate over time. "The worse it gets, the faster it gets worse."

Your chamber size change is starting to sound significant. I would point it out to your cardiologist and at your consultation with a surgeon.

Next step: even if you're not due for surgery just yet, pick the surgeon and facility where you would want to have it done. This is a key element to success, and one of the few ways you can actually shave the odds.

Best wishes,

 

[Susan BAV]

Hi David -

I am posting a response before reading the entire thread so I will probably repeat some comments.

My experience was that I explained my "complaints" to my cardiologist and he told me that it was all "nothing." My echo, which he personally read, showed moderately-severe calcific aortic stenosis. He told my husband and I that I would "possibly never need the valve replaced." I hadn't researched the symptoms of a failing valve at that time and didn't realize that my symptoms were classic for valve failure and I was also having strong angina when I exercised, up both sides of my neck and between my shoulder blades. Once I did some research, my husband and I decided that I needed to consult with a surgeon. Three highly-recommended and well-respected surgeons all recommended surgery. By the time that I had an angiogram, I was rapidly descending and feeling quite unwell. I had my new valve a little over a week later.

I don't know if the cardiologist was a &*%#!!! idiot or what. But I was extremely ill when I saw him and I was dying. Have you read any of the VR.COM stories? When I found this site and read them, it seemed to me that men and women often had different symptoms of valve failure occuring.

Best wishes to you and now I'll read the rest of the thread and probably be embarassed that I didn't read it all first.

 

[Shine_on_Syd]

Well Bob,
Lets hope Ross goes easy on your 'usage'. I really enjoy your informed posts. You're a great contributor here.

 

[jenny]

Diltiaz

Diltiaz

Hi Susan , I agree. I really do think some Cardio Drs. are just idiots..I am looking at afib and perhaps a leaky valve and without even getting into this for it would take like an hour . However my question here is I am taking Diltiaz ER 360 milligrams a day of this heart med. I feel just awful, I was on 240 and that was ok, but they increased it to 360 to slow my heart rate down. Has anyone taken this medication?
In 2 weeks I will be in Boston to see a surgeon about this valve and the Maze treatment. This sounds crazy but I cannot wait for I am feeling so terrible that anything has got to be better than this....This site has helped me so much..........thank you...Jenny

 

[KathyH]

David, if you have a bicuspid aortic valve, you could also have a weakness in your aorta, I suppose that could cause some back pain. I would see a surgeon now no matter what the cardiologist said. My Cardiologist told me it would be a few years before I would need a AVR, when I saw the surgeon he told me I should have it done within 3 months. My stress test showed that I had EKG changes while exercising. Said the coronary arteries were not getting enough oxygen when I exercised and he was afraid I would have a heart attack if I did too much before the valve was fixed. My heart was still normal size and good EF. I didn't think I felt bad before the operation 3 1/2 months ago, but now that I can ride my bike 10miles again, I realize how tired I was. I no longer blame it on turning 50. I feel better than ever! Good Luck
Kathy H