HEART KNOCKING?

[thehoffr]

I still remember the first thing I noticed upon waking up from the AVR surgery 7 1/2 years ago was a throbbing sensation (not pain) of my heartbeat from the back of my head where it rested on the pillow down to my shoulders. Mine was a tissue valve so I was surprised to feel every heartbeat that way. It was so noticeable that I could easily count the beats. That sensation disappeared over the course of the first year post surgery, but I believe it had to do with the fact that even a tissue valve has a different architecture from the natural valve. Hoffr, I hope your issue eases over time as mine did, although your description of the symptoms sounds like it is more noticeable than mine ever was.

My shower is a stand up with the plastic floor and today after the water was off standing in it I could hear my heart beat sounds transferring through my feet against the plastic floor echoing in the shower like a small drum in the shower. I think I will try to record it next time..

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[thehoffr]

thehoffr-
I have same treatment as you, knocking as you indicate can be rather bothersome. I find fan required for sleep, and lying on right side gives less 'bang' compared to on back or left side. I've been playing percussion for a little more than year and a half (drums with a little symbol mixed in). Previously had Ross procedure 20+ years ago, without any percussion set. Went on a factory tour last week, with ear plugs and ear muffs - ugh..

I had 90+ bpm in recovery - until taking Metropolol, which i continue taking. Started out with Tartrate, which was something of a roller coaster (down to ~ 35 bpm <hibernating?>), now taking Succinate which only drops me to 50 bpm.

Before surgery I was always 68 to 72 resting and was a road cyclist. Now in the 90's am afraid to cycle the way I used to never having an issue before, but guess we don't always feel the poor valve, I had great endurance though.

I don't think I'd want to be below 60, but maybe so.. these valves only have so many beats in them right? I have a tissue valve and a dacron ascending aorta.

 

[pellicle]

I truly appreciate everyone's contribution and please keep them coming I'm sure this is not as uncommon as it's made out to be and there is a common cause.

I don't think there are many members here who say their mechanical valve is silent (although there are some), without us standing together and comparing sounds (and having a 3rd person too) it would be hard by description for us to know if yours was louder than mine.

I recall being in a room with a friend and him saying after a while "ahh, that's you, I thought it was a car stereo outside" ... because in some rooms the bass reenforcement is sufficient to make it sound deeper (like when I sit on the dunny in some bathrooms).
However others (like my doctor) have said that it sounds like a single cylinder diesel engine. (so there's that)

At the end of the day I believe its also a perception management thing because if you want to you can get used to it ... conversely if you pointedly hate it and focus on it it won't ever be something you'll get used to.

I would say that after 2 years I became sufficiently used to it that I hardly made any considerations of it. (although I had some distractions amid that time)

Humans are quite adaptable and for me in my situation I'm comfortable to adapt to this because the likelihood of a good surgical outcome on a 4th surgery (meaning one where I'm not a cripple) is very low. Thus I'm happier to be active, healthy and clicking than waiting for the certainty of my next requsite surgical intervention (had I chosen a tissue valve).

As to common cause:

1. mechanical valve
2. exacerbated by the aortic graft
3. exacerbated by scar tissue (which is different to but related to adhesion)

I had some ass doctor tell me I couldn't scuba anymore because I would be sure to have thoraccic adhesions ... my surgeon on my last surgery reported when I asked that he found none.

so sometimes doctors don't know these things. I'd be guided by your cardiologists interpretation of the scans (and btw did you have the gore-tex?)

 

[pellicle]

...I don't think I'd want to be below 60, but maybe so.. these valves only have so many beats in them right? I have a tissue valve and a dacron ascending aorta.

so wait ... you have a tissue valve?
and "so many beats in them" is a difficult proposition, as the duration before Structural Valve Degradation (SVD) is dependnt on a number of factors (age being the most significant, the younger at implant the shorter the duration usually)

 

[thehoffr]

so wait ... you have a tissue valve?
and "so many beats in them" is a difficult proposition, as the duration before Structural Valve Degradation (SVD) is dependnt on a number of factors (age being the most significant, the younger at implant the shorter the duration usually)

..
Just learning about the structural valve degradation acronym has taught me a lot tonight. I would like to have a sense for how long this valve will last, unless that's discouraged on some unspoken hex violation . I don't know how you guys are surviving these multiple chest surgeries. I almost died during the 1st one and I have spotty memory from being on the heart machine too long. I will have to see and visit the discussion blog on that one to get prepared.

 

[pellicle]

..
Just learning about the structural valve degradation acronym has taught me a lot tonight.

ok ... well if I'm not presuming to teach you how to suck eggs, here's a good introduction
https://www.sciencedirect.com/science/article/pii/S0735109717387740

I had wrongly assumed you had a mechanical valve, which in general do not suffer from SVD

I would like to have a sense for how long this valve will last, unless that's discouraged on some unspoken hex violation .

certainly not by me, as I advocate strongly for knowledge ... speaking of which, how old are you again please?

I don't know how you guys are surviving these multiple chest surgeries. I almost died during the 1st one and I have spotty memory from being on the heart machine too long. I will have to see and visit the discussion blog on that one to get prepared.

LOL ... its not that bad, although I guess it must be a shock for the first time (and it depends on your age as well as other factors). Give it time and you'll move past the haze ... even knowing what to expect it was a few months of crap after my last one (although one could argue it was not until 1.5 years after my last OHS that I returned to any sort of physical normality ... but I was luckier than some to get an infection ;-)

 

[Agian]

Hoff the thud is real. What I meant by 'perception' is what is made of it, not that it is in one's head.

 

[scott.eitman]

I do not feel every heartbeat, but i feel enough of them. It is really bad at the night for some reason. I can take a nap and it doesn't bother me, but at night...wow! I tell people it is as if someone is pulling on your earlobe with every beat. Meaning it gets annoying. However, it is better than imagining a third OHS.

 

[bobr33543]

We have to remember that all surgeries carry risks of unwanted side effects, and open heart surgery is pretty serious no matter what the surgeon says. And this type of surgery has added years to our lives and we should remember to be grateful for that. Your symptoms sound markedly more severe than all others posting here, and only you can decide if you will be able to tolerate the annoyance for possibly the rest of your life or if another surgery is worth the additional risk.

 

[pellicle]

...Your symptoms sound markedly more severe than all others posting here

and given it seems he has a tissue prosthetic I'm more concerned about the descriptions

 

[thehoffr]

We have to remember that all surgeries carry risks of unwanted side effects, and open heart surgery is pretty serious no matter what the surgeon says. And this type of surgery has added years to our lives and we should remember to be grateful for that. Your symptoms sound markedly more severe than all others posting here, and only you can decide if you will be able to tolerate the annoyance for possibly the rest of your life or if another surgery is worth the additional risk.

Just having your perspectives and knowing other people have this problem too and have learned to live with it helps me live with the issue also, so thank you all for the feedback.

Still strange there is not a clear cut explanation of the cause, like diminished pericardium, or angle of heart beating is different..anything. At least an echo that can color highlight impacts if nothing else than for research to do better future OHS. I made friends with a guy in the hospital who had the exact operation as I did and he has no sensation at all so why one will suffer and the other not should have some level of explanation in medical science at least, but as mentioned doctors seem to avoid even researching it. Only we and our voices asking question can influence that.
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[Classtime Sailer]

Successful OHS are determined by other metrics. The vibration dampening effects of an unmolested pericardium are not measured before hand and the diminished dampening of the altered pericardium is insignificant. Docs should let us know before hand though. I have a porcine valve but if a future exam were to reveal a mechanical valve, I would not be surprised as that would finally explain the noise

 

[thehoffr]

Successful OHS are determined by other metrics. The vibration dampening effects of an unmolested pericardium are not measured before hand and the diminished dampening of the altered pericardium is insignificant. Docs should let us know before hand though. I have a porcine valve but if a future exam were to reveal a mechanical valve, I would not be surprised as that would finally explain the noise

Still feel this topic is very important to discuss especially if you're the one suffering from knocking sensation.

Sailer, where do you get your information from that the pericardium cannot be diminished much or it's insignificant?

The way to deal with understanding our issues is we have to "rule out" what cannot be the cause and I was hoping to do that in this topic with the help of others. Especially since doctors do not seem to care.

 

[Paul1972]

Still feel this topic is very important to discuss especially if you're the one suffering from knocking sensation.

Sailer, where do you get your information from that the pericardium cannot be diminished much or it's insignificant?

The way to deal with understanding our issues is we have to "rule out" what cannot be the cause and I was hoping to do that in this topic with the help of others. Especially since doctors do not seem to care.

In my eyes it must be from the mechanical valve for some of us. My first surgery which was the David’s procedure with graft (No noise or thudding whatsoever) to my second surgery which was only 10 months later , which was onx valve with graft and I’ve been thudding ever since

 

[AZ Don]

In my eyes it must be from the mechanical valve for some of us. My first surgery which was the David’s procedure with graft (No noise or thudding whatsoever) to my second surgery which was only 10 months later , which was onx valve with graft and I’ve been thudding ever since

I had a well functioning BAV so I had a valve sparing procedure to replace my Ascending & Aortic root with a graft. So I've always assumed it was the graft. Wonder if there is anyone here experiencing this without an aortic graft?

Also, as I recall when I first discussed this with the Dr's, it was suggested that it may go away after 6-12 months as my pericardium closed over with scar tissue. There was never any change, it has been thumping since I woke up from surgery over 6 years ago now.

 

[Gustav]

Hi

Hi, my first surgery I had a valve repair and aortic graft and I didn’t have any thudding or knocking . A year later I had to have a mechanical valve again with aortic graft and from day one I have had a thudding/knocking which gets harder the more I breathe in.In my eyes it’s definitely got to be the mechanical valve as I didn’t have it after my repair with a graft. They say it’s from the lungs expanding and the chest cavity getting smaller making it more noticeable but the mechanical valve must amplify it. At night if I sleep on my right it’s loads more noticeable than sleeping on my left . I also had a superior vena cava graft which might make it vibrate more. My surgeons say it’s all normal so that’s good enough for me I’ve learnt to adjust to it . Best wishes

Exactly same symptoms whilst sleeping and only get the knocking with deep breaths, cardiologist told me its normal and honestly don't often realise its happening and just adjust to my situation.

 

[Classtime Sailer]

Sailer, where do you get your information from that the pericardium cannot be diminished much or it's insignificant?

A little googling informs me that some surgeons leave it open, some close it, and some close it part way. No matter what, the paricardium, which surrounds the heart with vibration dampening membrane and fluids is in every case altered. As I type this, my iPad jiggles a bit with each heart beat. I think about it less and less after 7 years. If it was significant with regards to surgery outcomes, it would be discussed prior to surgery. If they knew how sensitive some of us were, they might take better care of our paricardium, but I suspect the apprentice surgeons close them after the expert finishes the significant work on the heart. You should see the nice scar on a lady who had the same surgery as me done by the same surgeon! You can barely see hers while mine looks like a kindergarten bean bag project. This lady seriously discussed the scar outcome prior to surgery and the results are noticeable. For my third surgery, I seriously discussed having the breathing tube removed before I woke up instead of making me wait "forever" again -- I made it a significant issue and the hospital took care of it. Next time, I'll ask them to do their best with regards to my head shaking with each heart beat--

 

[thehoffr]

I had a well functioning BAV so I had a valve sparing procedure to replace my Ascending & Aortic root with a graft. So I've always assumed it was the graft. Wonder if there is anyone here experiencing this without an aortic graft?

Also, as I recall when I first discussed this with the Dr's, it was suggested that it may go away after 6-12 months as my pericardium closed over with scar tissue. There was never any change, it has been thumping since I woke up from surgery over 6 years ago now.

There you go.. reinforcing my point we need explanations, and is there not some type of scan that color highlights impact? Seems an obvious simple way to view the source of the knocking.. unless we don't want to know.

DOES ANYONE KNOW ABOUT THIS TYPE SCAN? Can an echo highlight knocking impacts?

Plus, here's and excellent presentation on heart sounds.. so one approach is to determine..

Q: IS THE KNOCK AN S1 OR S2 KNOCK? If the knock is during S1, and valve replaced was an S2 valve, then we can "rule out" it being the new valve knocking. RIGHT?

So timing is everything, and just like an auto mechanic uses an oscilloscope what does a cardiologist use? And those loud peaks should be readily apparent if a valve knocking..

If our "intention here is collaboration" to self empower and diagnose as a team rather than be in servitude to scant explanations from doctors and others that don't care, then these videos below will help in our understanding.





Here's a very good entertaining presentation of how to listen to the heart, where to place the stethoscope.. APTM



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