Long winded introduction

[Guest]

Before I begin let me say that I am having the same problems others here are having, i.e. I can't post after logging in and can't reply to any post. So if you have a specific reply/advice, etc. my login ID is kentuckyed. Maybe that will help you get in touch with me.

Male, 64 year old in Louisville, KY.
Career engineer laid off in 2010 during the economic downturn.
Have had a heart murmur originally diagnosed in 2003 with echo indicating "mild hypertrophy left side".
Since I would be loosing health insurance with lay-off, Dr. recommended an echo.
Echo results in 2010 showed moderate aortic stenosis.
Never followed up with any Dr. since I had bigger problems to solve; job, insurance, etc.

Presently employed full time by Lowe's and have health insurance again.
Lowe's needed "backup drivers" which involved signing some paperwork, not actually driving, so I was "volunteered".
That required a DOT physical, which required my 2010 echo results.
Moderate aortic stenosis fails a DOT physical so I was advised to see my cardiologist.
I'm asymptomatic so I have no cardiologist and didn't see anyone.
Finally got around to a second echo as required for this yrs. DOT paperwork and now I have severe aortic stenosis.

Waiting for a referral to a cardiologist to discuss the next step.
Google-ing everything I can to learn as much as possible including all of the acronyms.

I remain asymptomatic except for possibly tiring more easily than when I was 40 (who doesn't).
Work on my feet all day long, moving boxes, climbing ladders, etc. with no real problems.

So there you have it.
Totally unprepared for what likely lays ahead of me.
Possibly if not laid off and/or volunteered to be a backup driver I would not even know what I know now.
Strange way that things work sometimes.

 

[Paleowoman]

Hi kentuckyed - hope you'll be able to read this. Did they tell you why you have severe stenosis ? IThis can be due to bicuspid aortic valve which you're born with, or some damage to the valve from infection, or calcification due to age. The echo should have showed that. But regardless, when you see the cardiologist he/she will doubtless tell you and tell you the next step. Severe stenosis usually means that soon you would have to have valve replacement surgery. Not everyone is symptomatic when they need surgery - I wasn't. Surgery is done before damage to the rest of the heart happens, i.e. enlargment of the heart as it tries to compensate for the increased workload to force blood through the stneosed valve. Hope you get your refferal soon.

 

[dick0236]

Hi kentuckyed. I can't help about the posting problem.....this forum has had a lot of "growing pains" since it was redesigned several months ago. You will find a LOT of good, useful info here and most typical, and non-typical concerns have been addressed.

BTW, I also live in Louisville KY.........and had OHS a long time ago. If you like, send me a PM(private message), if you can, and I may be able to give you some local info.

PS: You can answer a post by going to the bottom of the page under the "camera" and just type in your response and then hit "Post Reply" at the bottom right.

 

[cldlhd]

It is strange how things work out. I didn't get a physical for over 10 yrs, stupid I know, because I was young and healthy and , obviously, invincible. We changed our health insurance at work which now required a pcp and a physicsl. I decided to get a stress test at that time even though my ekg was normal and that's when they found my BAV and my ascending aneurysm. I don't have stenosis but I do have a cdl but that just gets renewed without a physical.
I would imagine severe stenosis means the valve will need to be replaced .

 

[pellicle]

Dick

PS: You can answer a post by going to the bottom of the page under the "camera" and just type in your response and then hit "Post Reply" at the bottom right.

what camera?

 

[dick0236]

Dick
what camera?

At the bottom left, above the block where I am typing this, is an illustration of a "camera" along with an illustration of something that looks like a "paperclip" ???

 

[pellicle]

At the bottom left, above the block where I am typing this, is an illustration of a "camera" along with an illustration of something that looks like a "paperclip" ???

curiously I never get that ... I wonder if its because I don't have a webcam attached?

 

[Lisa2]

deleting this duplicated text...it is below

 

[Lisa2]

duplicate posting

 

[Lisa2]

That's what I was talking about earlier....I used to have the camera when I was a premium level user. I only have the paper clip and smiley buttons. No more camera

 

[dick0236]

curiously I never get that ... I wonder if its because I don't have a webcam attached?

Pellicle, that can't be it........I don't have a webcam either. Maybe it's what Lisa2 says. I think I am a premium level user since I pay dues of $25 bi-annually to the forum(Hank). A few years ago the website notified the forum users that some features would be available to dues paying members only. Since I am not very computer literate there are very few features, other than starting threads, answering posts and receiving/answering a few PMs,that I use.

 

[pellicle]

Firstly kentuckyed sorry to hijack this thread ...

Dick

Pellicle, that can't be it........... that some features would be available to dues paying members only.

that's probably it ... man its been dreadful ever since that "update" (is it) a year ago...

PS: in Australia a colloquial name for ones anus is "date" ... Australians often disparage by saying "stick that up your date" ... so naturally I view with suspicions any "up-dates"

 

[Paleowoman]

I'm not a premium level user and I haven't got a camera icon but I have been able to post photos. You get round this by using a program such as dropbox for your photo, then type

That works for me…try it.

Just to prove it….

Continuing the Aussie date theme, here's a photo of a pillcam I sawllowed once to take photos of my insides:

it took a photo every few seconds on it's journey through from mouth to 'date' tramsmitting them to a contrapution I wore on my waist. I couldn't bear to let something like that be flushed away in the loo so I 'went' in a bucket, retrieved it, washed it and have kept it as a souvenir ! It's highly sophisticated technology with cameras and lights in a thng the size of a large vitamin capsule, most impressive.

 

[pellicle]

but I have been able to post photos. You get round this by using a program such as dropbox for your photo, then type

That works for me…try it.

Indeed, but this is linking, (not that I give a hoot as that's what I normally do) not uploading.

Personally I reckon uploads of images is just a waste of server space

Continuing the Aussie date theme, here's a photo of a pillcam I sawllowed once to take photos of my insides:

it took a photo every few seconds on it's journey through from mouth to 'date' tramsmitting them to a contrapution.

You clearly do have the latest update there

 

[kentuckyed]

Just to update everyone. I received an email today indicating that my account has been activated. So I can now post and reply.
Thanks to the web master or whoever helped.

 

[kentuckyed]

I know you're not doctors and am not asking for a medical opinion, but if everything worked below my recent echo should appear below. I'm very new at this and am pouring over the internet trying to learn as much as I can. If anyone has anything to offer after looking at the echo, I'm all ears. Still haven't talked to a cardiologist, but am hoping I can put this off for maybe 12 months.

TRANSTHORACIC ECHO 2D MMODE SPECTRAL COLOR, COMPLETE - Details

< >Comments from the Doctor's Office

• Severe aortic stenosis is noted. There is also mild dilatation of the aorta likely due to the stenosis.
  Highly recommend seeing cardiology. Will place referral.
  Narrative
  CARDIOLOGY REPORT
  
  FACILITY: NORTON CARDIOVASCULAR DIAGNOSTIC CENTER - SPRING
  ROOM NUMBER:
  PATIENT NAME/DOB: kentuckyed, , 10/06/1950
  
  
  EXAMINATION(S): ECHO DOPPLER 2D MMODE SPECT COLOR COMPLETE
  Site Loc: Ht / Wt: 183(cm)/93(kg)
  Pt. Loc: BSA: 2.15
  Study Date: 02/24/2015 Pt. Type:
  
  
  
  Physicians:
  Reading xxxx MD
  Referring xxxx
  Technician xxxxxx
  
  Chambers 2D/MM
  Value Units (Range)
  RVIDd (AP) 2.16 cm (0.8 - 2.6)
  IVSd 1.67 cm (0.3 - 1.1)
  LVIDd 4.03 cm (3.8 - 5.7)
  LVIDs 2.72 cm (2.2 - 4)
  LVPWd 1.53 cm (0.7 - 1.1)
  LVFS 33 % (20 - 80)
  Ao Root Diam 4.2 cm (1 - 3.4)
  LA Diam 3.5 cm (1.5 - 4)
  LA Ao Ratio 0.83 ratio
  LA Vol bp (MOD) Inde 37.7 ml/m2
  RA ESV A4C Index 20.9 ml/m2
  LVs Vol 27.5 ml
  LV EF (MOD) 58 %
  EF 4 Ch (MOD) 58 %
  
  Valves
  Value Units (Range)
  AV Pk Vel 3.932 m/sec (1 - 1.7)
  AV Pk Grad 62 mmHg (Less Than 36)
  
  AV Mn Grad 43 mmHg
  AV VTI 104 cm
  LVOT Diam 2.1 cm
  LVOT Pk Grad 2.5 mmHg
  LVOT Mn Grad 2 mmHg
  LVOT VTI 25.1 cm
  AVA (VTI) 0.84 cm2
  MV Pk Grad 2 mmHg
  MV Stroke Vol 59 ml
  E Vel 0.76 m/sec
  A Vel 0.706 m/sec
  E/A 1.08 ratio (1.1 - 1.5)
  Sep E to E Prime rat 9.1 ratio
  Lat E to E Prime rat 10.3 ratio
  
  Valves
  Value Units (Range)
  RAP 5 mmHg
  RVSP 30 mmHg
  
  
  
  FINDINGS:
  
  Technical Comments:
  The study quality is good.
  
  Left Ventricle:
  The left ventricular chamber size is normal. Moderate concentric left
  ventricular hypertrophy is observed. Global left ventricular wall motion
  and contractility are within normal limits. There is normal left
  ventricular systolic function. The estimated ejection fraction is
  55-60%. Borderline criteria for diastolic dysfunction.
  
  Left Atrium:
  The left atrium is mildly enlarged.
  
  Right Ventricle:
  The right ventricular cavity size is normal. The right ventricular
  global systolic function is normal.
  
  Right Atrium:
  The right atrial cavity size is normal.
  
  Aortic Valve:
  The aortic valve is trileaflet. Moderate aortic leaflet calcification is
  visualized. Systolic excursion of the aortic valve cusps is reduced.
  There is no evidence of aortic regurgitation. There is severe aortic
  stenosis. The mean gradient of the aortic valve is 43 mmHg. The peak
  instantaneous gradient of the aortic valve is 62 mmHg. The aortic valve
  area, by VTI's, is calculated at 0.84 cm2.
  
  Mitral Valve:
  The mitral valve leaflets appear normal. There is a trace of mitral
  regurgitation. There is no evidence of mitral stenosis.
  
  Tricuspid Valve:
  The tricuspid valve leaflets are normal. There is a trace tricuspid
  regurgitation. The right ventricular systolic pressure is estimated to
  be 30-35 mmHg. No pulmonary hypertension is noted.
  
  Pulmonic Valve:
  The pulmonic valve is not well visualized.
  
  Pericardium:
  There is no pericardial effusion.
  
  Aorta:
  There is mild dilatation of the ascending aorta. (The ascending aorta
  measures 4.2 centimeters. )
  Impression
  Conclusions:
  The study quality is good.
  Moderate concentric left ventricular hypertrophy is observed.
  There is normal left ventricular systolic function.
  The estimated ejection fraction is 55-60%.
  There is severe aortic stenosis.
  The mean gradient of the aortic valve is 43 mmHg.
  The peak instantaneous gradient of the aortic valve is 62 mmHg.
  The aortic valve area, by VTI's, is calculated at 0.84 cm2.
  There is a trace of mitral regurgitation.
  The right ventricular systolic pressure is estimated to be 30-35 mmHg.
  There is mild dilatation of the ascending aorta.The ascending aorta
  measures 4.2 centimeters.
  
  <Electronically signed by xxxxx MD>
  02/27/2015 1522
  Component Results
  There is no component information for this result.
  General Information
  Collected:
  02/27/2015 3:22 PM
  Resulted:
  02/27/2015 3:22 PM
  Ordered By:
  xxxxxxxx
  Result Status:
  Final result

 

[pellicle]

Hi

.... I'm very new at this and am pouring over the internet trying to learn as much as I can. If anyone has anything to offer after looking at the echo, I'm all ears.

my view goes like this. dig up the absolute BARE BONES basics of the heart, know what a ventricle is and how it works basically as a pump. Understand the basics like where it comes in and what those bit of anatomy are called. You know that a pump should not leak back and should not have too much restriction to flow. The rest is jargon.

THEN apply logic and reasoning to what you get in discussion with your cardiologist. Ask them to simplify their descriptions and draw diagrams on paper. So that way YOU have a good chance of understanding it.

If you run at this trying to learn all the medical stuff you will certainly never succeed in any short term and you run the risk of being a personification of "a little knowledge is a dangerous thing".

Measurements is VERY specific and there are WAY too many variables to consider even becoming a poor understudy. Its not like working out any other consumer item you ever saw and is hundreds of times more complex than working out which is the best (insert consumer item) to buy.

Fundamentally you are now part of a team, so in any team each plays their part. I'd say discuss things with the cardiologist and then bring that here in simple terms and pass that around to see what people think.

To be honest that's as much as you really can do (well unless you have a degree in physiology you've kept under your hat).

Right now what I see is you've headed for a meltdown of figures and facts which are difficult to understand and really won't help you.

I know that the above may seem the opposite of what I tend to do here to some, but I know where my limits are and try to extend them slowly. I did a degree in Biochem some years ago and so pathology and pharmacology are areas which I don't mind digging in ... but when it comes to understanding and interpreting Ultrasounds and Angiograms I back way off to the basics and ask for simplifications.

 

[Paleowoman]

You need to see that cardiologist - chase up your appointment. You don't have bicuspid aortic valve, yours is the regular trileaflet kind but it is severely stenosed, hence the abnormal pressure gradients (mean pressure gradient of 43 mm/Hg, peak gradient 62 mm/Hg) and low valve area size (0.82 cm2).

 

[kentuckyed]

Update. Thank you pellicle and Paleogirl for the good advise above. I did see my cardiologist and he convinced me that thinking of waiting was nonsense. His root cause for concern is the much increased wall thickness of my heart muscle, indicating it's adaptation to having to work into too much back-pressure. Very simplistic analysis that bypasses a lot of numbers and just comes down to good common sense.

Yesterday I had my catheterization which seems to be normal procedure here prior to heart valve replacement (in order to check arteries for possible blockage, need for stents or bypass, etc.). Interesting procedure and was glad that I was able to see the screens as the probe was moved around. Result is that I have no blockage in the arteries and won't need anything other than the aortic valve. Also was told that the cardiologist could not get the catheter through the aortic valve to measure on both sides. He tried many times but apparently the valve wasn't opening enough for him to get through.

April 6th. I have my first meeting with the surgeon to discuss the operation. Will probably have the valve replacement mid to late April depending on his schedule.

Still debating which valve to go with (I'm 64 years old). Leaning toward mechanical but don't like the Coumadin aspect. Don't know of any quantitative difference between porcine or bovine valves, but much prefer the non-Coumadin result. In any event I won't loose any sleep over it and will wait to discuss with the surgeon. Will post again when my surgery and valve choice is set.

And once again thanks for the advise.

 

[MrsBray]

I'm a CDL driver, and my murmur was found through my DOT physical as well. I had BAV, and now have an On-X mechanical valve and am an anti-coagulants. my lifestyle has not changed at all because of "blood thinners." My lifestyle has changed because of surgery - I'm not sleepy and out of breath all the time, so I have energy to participate in this magical thing called life. My AVA (aortic valve area) was .79 at surgery time. I did NOT enjoy watching the monitors during my heart cath!