Knocking sensation on sternum

[Seastreet]

Good Morning,
Some 12 days post op, I developed a knocking sensation in my chest in tandem with my heart beat. It intensifies every time I take deep breaths. It’s not painful but uncomfortable. Doctor says it goes away with time but could not explain the source/cause of it. Has anyone experienced this before? Is it normal?

 

[John K]

I have noted the same after my surgery, when I asked my surgeon about it I was told it was my heart beating. It has deminished with time, I am just over 4 months post surgery.

I found when laying on my right side it was apparent and when laying on my left side less apparent. If I am up moving around it disappears however if I am standing still it comes back.

John K

 

[Bryan B]

The heart is enclosed in the pericardium (also known as the pericardial sac). one of its purposes is to limit the motion of the heart. When open heart valve surgery is performed the surgeon opens the pericardium to gain access to the heart. Some surgeons may stitch the pericardium back closed, but my understanding is that most do not. The reason for not closing it is to prevent complications after surgery in which blood or fluid may build up inside the pericardium causing pericardial effusion. One of the side effects of not closing the pericardium back up is a loud, pounding (or in your case "knocking") heart.

I experienced it after both of my surgeries and still experience to a lesser degree 9 years after my last surgery. I've gotten used to it to the point that I don't even notice it unless I focus on it. But it's still "loud" enough that if I have a watch with a second hand I can give you a pretty accurate heart rate just by counting the beats I feel in my chest. I just wanted to let you know it's normal and should become less noticeable over time.

 

[Seastreet]

Can’t help thinking that the heart is knocking onto something and that internal scarring may form over time. Also, deep breaths intensifying the knocks give me the impression that the discomfort could gradually progress into pain if left unchecked. But thanks for your your assurance, could not find any literature on this.

 

[Brokenhip]

Seastreet,
I would say my experience is pretty much identical to John K & Bryan B as above, with no change over 2.5 years.

 

[Seastreet]

Stran

 

[almost_hectic]

Yeah, what Bryan described is right on. My pericardium was removed was my understanding. It will get better, but it will take time, maybe months. I hate to say it because its not easy, but try to get used to it.

 

[user 17402]

Seastreet,

I have been reading up on this forum and debating about making an account until I saw your post. I am twenty years old and just had an AVR with a mechanical valve. I am two weeks post operation today and for the last week or so have had experiences identical with yours. When I take a deep breath I have a very noticeable thumping in conjunction with my heart beat. I am not too concerned about it, considering the trauma the heart and sternum have undergone. It sounds like Brian knows a little more about the science of it and it all makes perfect sense. Everyone I have talked to says it should reside back to normal or very close to it while you recover. It just takes time. I also have a large lump and pain in my clavicles when I take a deep breath. It is not comfortable by any means, but considering what I went through two weeks ago I guess I'm doing alright. I hope this gives you a little comfort to know you are not the only one who is experiencing these symptoms and I hope you have a speedy recovery!

 

[almost_hectic]

You guys thump, do you click too?

 

[Seastreet]

Thanks Tanman! Strangely enough, I can’t hear my st Jude valve for the life of me. By clicking, are you alluding to an unstable sternum almost hectic?

 

[user 17402]

Seastreet,

I think almost_hectic is referring to the “clicking” sound as the valve itself not the sternum. I could not hear my valve for the first week post op. Now, I hear it in certain positions.

 

[AZ Don]

Did you have an aneurysm repair or a valve job? I had an aneurysm repair and have something similar. Dr's either had no idea what it was or said that it had to do with the pericardium and would go away in less than a year - mine did not. This has been discussed several times before and my impression is that most people who had the thumping past the first year post-op, had an aneurysm repair. The best explanation that I was given was that the surgery would have caused slight alterations to my anatomy and as a result the heartbeat could be transmitted differently than before.

 

[Savymom]

Jumping in to say my heart thumps, knocks and clicks! Mostly knocking- sounds like somebody is ‘knocking on the door’ only the door is the inside of my sternum. I hear, but mostly FEEL it. I found it very annoying for about 6 months- now it’s just mildly annoying. I’m almost 2 years post op.
I sometimes click as well, but even when I hear the click I still experience the thud/knock.

For reference, I have the On-X Aortic Valve and a Dacron graft.

 

[Bryan B]

Good point AZ Don. My first surgery was just the valve replacement and my second surgery was valve replacement plus aneurysm repair. My heart is definitely "louder" after the 2nd surgery than it was after the first and has persisted. After the first surgery it seemed to be more of a temporary thing. But like I said in my first post I've grown accustomed to it and rarely notice it unless I focus on it.

 

[Seastreet]

Mine was a valve replacement. Surgeon went in meaning to fix my ascending aorta as well but after inspection, he made the call that it was unnecessary to repair the aneurysm just yet. Also, surgeon says I can no longer run as hard as I used to. ( 10km daily) I was quite affected!

 

[almost_hectic]

Yeah, by clicking I meant valve click. I also had aneurysm removed with aortic graft. I’m told since then that that space or cavity of sorts where the aneurysm used to be has grown over with tissue and filled with fluid, as seen on a scan. Surgeon said it looks nice and tidy. Maybe that cavity has an acoustic element to it? 90% of the time I don’t hear or notice and click/thump, The 10% of the time I am aware of it, I keep getting more and more used to. Even 5 years out now.

 

[charlottekaye]

Yeah, what Bryan described is right on. My pericardium was removed was my understanding. It will get better, but it will take time, maybe months. I hate to say it because its not easy, but try to get used to it.

Wow - I didn't know the pericardium could be removed.

 

[bizinsider]

Hi Seastreet. I'm a little over 4 months out after bioprosthetic (bovine - Edwards Perimount 2700) aortic valve/root (Bentall procedure), ascending aorta plus – as a bonus – CABGx1. I noticed the thumping immediately in the ICU. They said it was common. To eliminate it, especially when lying down, I noticed that breathing through my diaphragm (stomach) did the trick. Now, 4 months out, it is markedly reduced but still here. I've actually come to enjoy it.

I was surprised to see your comment on your surgeon telling you to cut back on running. I'm 68, and was given no restrictions. I haven't run in years, but I do walk quickly for exercise. I followed the post-surgery walking protocol from the Cleveland Clinic, where my surgery was done. Within 4 week post surgery I my exercise capacity was noticeably improved. I listened to my body and when walking up small hills within those 4 weeks slowed if I felt my heart straining. Day by day things improved - and then rapidly improved. I'm now back to my old pace and then some.

At 3 months, once it reopened, I stared cardiac rehab but quit after 5 sessions b/c at that point I was well beyond where they had me. If you have access to cardiac rehab starting at 4 weeks I would definitely try it, especially given your surgeon's advice – and then take it from there. I would also rely on your cardiologist for the running advice.

Best of luck with your continued recovery. Since you were likely in good physical shape, you will probably be startled on how quickly you improve.

Herb

 

[almost_hectic]

Wow - I didn't know the pericardium could be removed.

I guess it doesn't have to be, and when left can grow back or heal itself in a sense, but that if it does not, scar tissue can create potential complications, in which case require additional surgery to correct. As I understand, it is solely based on the surgeons preference whether to leave it or remove it.

 

[Seastreet]

It has now been 6 weeks since my valve replacement op. Just wanted to update on the knocking sternum issue. Brought it up with my cardiologist. She said I was the first patient to report such an occurrence. She says it’s most likely an acoustic effect from the mechanical valve. Taking deep breaths also moves the heart and could make the sensation more pronounced. Younger patients (I’m 35) are also more sensitive to changes. Slowly beginning to get used to it!