Mechanical Valve noise - do you hear it from inside or outside?

[LeakyUK]

Is the sound of a mechanical valve something you hear from 'outside' like a ticking clock, or something you feel from inside, like a pulse. I cannot sleep if there is the slightest sound & have used earplugs every night for many years - so would earplugs
work to mask the sound?

At 57 my preference would be mechanical (2 family members have had warfarin without problems) but the sound could be a decider - I would not expect to be able to choose
a valve manufacturer.

 

[neil]

hi leaky cant help you there, but am sure others will be along soon........

 

[Cooker]

I have never heard my valve tick ... I do feel it sometimes when I lay down but very seldom and it became a non issue shortly after surgery.

 

[RunMartin]

I do not hear my valve very often. It was more obvious in the first few weeks after surgery when the heart what remodeling. It seems to fade into the background.

 

[normofthenorth]

Some people report that others hear their mech valve, so that's obviously through the air. I'm sure there's some bone-conduction hearing going on, too. The experience seems to be quite different among individuals, and not easily predicted from body size and shape and such.

I've posted a few notes with links to the study on the one mech valve that seems to be quieter than the rest -- maybe ats or atf, it's made by a company that's been merged with Medtronics. Google and the search engine here should both "know". That valve gets good reviews in other categories, too, and their own website shows the results of studies "proving" that it's even less thrombogenic (clot forming), and at lower ACT levels, than the On-X, which in turn claims to be unusually non-thrombogenic at low ACT levels.

At least in countries and systems where a patient can choose a heart surgeon, there's usually an opportunity to choose a valve manufacturer. In general, each surgeon and hospital has a short list of valve models that they use, and are comfortable with, but those vary from one surgeon/hospital to another. NHS may be different, but even NHS may respond to some effort.

 

[Superman]

I've gone with St. Jude both times (1990 and 2009). My first one was much quieter than my new one. Not sure if it's the valve or the graft. I'm almost wondering if the dacron graft of my ascending aorta does less to muffle the noise than my real aorta did. My wife wants to invent a special muffler shirt.

It's always on. I hear it even now sitting in at my desk at work. I'm fortunate in that noises don't really bother me all that much, but if you are convinced you can't sleep with the noise - you might want to go bio. Many mechanical valves advertize quiet operation, but I don't think there are any guarantees. Even if there were - seems like an awful big hassle to make a return or exchange.

 

[mecretired]

I also have a St Jude valve plus the Dacron graft. I had never considered that the graft might made a difference--but that makes sense. I hear the "ticking" any time it's quiet. It seems that the sound, for me, is more internal--meaning that when I wear earplugs, the sound is more pronounced. At night, I use "white noise"--cd's of ocean waves, etc. At present, I have an air filter that I run all night. This gives me the "white noise" effect as well as filtering the air. When normal activity is going on, I don't notice the ticking. Even when I notice it, it doesn't really bother me. Have you thought of asking your doctor for something to relax you/help you sleep until you get more used to the sound?

 

[Lynlw]

Is the sound of a mechanical valve something you hear from 'outside' like a ticking clock, or something you feel from inside, like a pulse. I cannot sleep if there is the slightest sound & have used earplugs every night for many years - so would earplugs
work to mask the sound?

At 57 my preference would be mechanical (2 family members have had warfarin without problems) but the sound could be a decider - I would not expect to be able to choose
a valve manufacturer.

I don't havea mechancial (or any) valve, but I believe it is a little of both, inside and out. One of our friends has one that if you are near him you can hear it, it sounds like a loud watch so it is definetly an outside noise (for some people at least) but I think if you have one it is also an inside noise like a pulse

 

[hook]

I hear mine on the inside and out. It does become a non issue after a while. I like being able to hear my heart rate.

 

[scott.eitman]

Is the sound of a mechanical valve something you hear from 'outside' like a ticking clock, or something you feel from inside, like a pulse. I cannot sleep if there is the slightest sound & have used earplugs every night for many years - so would earplugs
work to mask the sound?

At 57 my preference would be mechanical (2 family members have had warfarin without problems) but the sound could be a decider - I would not expect to be able to choose
a valve manufacturer.

There are many times when I do not hear it or feel it. However, there are many times where I feel it, but do not hear it. There are also times when I hear it, but do not feel it. There are times when I hear it through what I perceive to be my chest. There are times when I hear it up the back of my neck.

I can lay on my back to take a nap, but at night I usually need to sleep on my stomach due to both noise and feeling it. Luckily, I am usually pretty exhausted by bedtime and it does not keep me from sleeping.

My children hear it from 20 feet away and even in noisy situations.

Would I choose a bio over this? There are days I would say yes, but those are low days when I am down on myself for not being at 100% yet. In the long run, the On-x valve is the right choice for me.

My recommendation is to put your ear on the chest of someone with a mechanical valve.

Scott

 

[ALCapshaw2]

As has been said by previous posters, hearing a mechanical valve is Highly dependent on the individual, and does not necessarily correlate with body size.

SOME Tissue Valve Recipients have also reported hearing / feeling their heartbeat after surgery.
This is not an uncommon response for patients who had Aortic Stenosis where the heart had become conditioned to pumping (Hard) against a seriously narrowed valve. It can take several Months for the heart to 'recondition' to pumping against a larger opening, assuming that the Heart Muscle damage has not reached the Irreversible Stage (i.e. having Surgery Sooner is Better when it comes to preventing / reversing muscle damage).

'AL Capshaw'

 

[Jeff Edmonton]

When you can hear it, that is a good thing.... I know it will drive me crazy too as I hate clicking clocks. But for some reason my father Willed me my Grand fathers Big Oak Grand-Fathers clock and I know I will learn to love both.
My understanding is that once the tissue arould the new valve and the heart has healed and adjusted to the new flow and pressure changes the sound will decrease.
Most important of all, you must pick a female surgeon because they have small fingers and can sew better.

 

[hook]

If this guy can take it, we all can.

 

[drivetopless]

I'm almost 6 weeks post op. I hear it internally in my right ear (travels up the jugular, I guess) if I tilt my head just right.

In smallish room with good acoustics (bathroom, closet) it can be heard externally.

Sometimes I don't hear it/notice it at all.

I had aortic stenosis, so once the heart adjusts to the new valve it should quiet down.

I don't mind the noise. It is very much like a watch ticking. It is convenient to be able to hear how my heart is beating (pulse rate, regularity).

It has not kept me from sleeping, though I do hear it more when I lay down. I fall asleep wiht the tv on and I'm fine. If someone was sensitive to noise, it might be tough to get used to.

 

[Luana]

I never had anyone say that they've heard my valve. I rarely hear it myself, mostly the only time I hear it is when I go to bed as I sleep on my side and though I'm aware of it, it's not loud. I have a St. Jude Regent valve.

I don't know if ear plugs would solve the problem of hearing it or make it worse. My old valve, the one I was born with, was a whole lot noisier than what I have now.

 

[LeakyUK]

When you can hear it, that is a good thing.... I know it will drive me crazy too as I hate clicking clocks. But for some reason my father Willed me my Grand fathers Big Oak Grand-Fathers clock and I know I will learn to love both.
My understanding is that once the tissue arould the new valve and the heart has healed and adjusted to the new flow and pressure changes the sound will decrease.
Most important of all, you must pick a female surgeon because they have small fingers and can sew better.

Thanks everyone for your helpful advice - no chance of a female surgeon though, there are 6 surgeons at James Cook, Middlesbrough and their surgeries and results are published on an NHS website, they all look to be very experienced with similar results. My Cath is 3 weeks today, then it I will find out exactly what needs to be done (Aortic valve, moderate anuerism (4.2 cm from echo - to be confirmed from CT scan) and possible CABG depending on Cath). I will see what my Cardio recommends first.

 

[pem]

I came across this, which suggests that there is no significant difference among mechanical valves in terms of clicking loudness:

Journal of Heart Valve Disease. 14(1)(pp 89-95), 2005
Psychoacoustic quantification of mechanical heart valve noise.
Nielsen T., Nielsen T.V., Johansen P., Hasenkam J.M., Nygaard H.

closing sounds are annoying for some patients and their partners by causing sleeping disorders or social
embarrassment. Various methods for measuring the sounds have been developed both in vitro and in vivo using
calculation of A-weighted sound pressure level or loudness according to ISO 532 B. The study aim was to evaluate
the relevance of different psychoacoustic parameters in the evaluation of closing sounds. Methods: Closing sounds
were recorded from patients with ATS valves (n = 13), On-X valves (n = 18) and St. Jude Medical heart valve
prostheses (n = 16). The sounds were recorded 5 cm above the chest of patients in a supine position, in a sound insulated
chamber. The mean peak values of loudness and sharpness were calculated and used to determine the
psychoacoustic annoyance using a modification of the Widmann formula. This was verified by a listening test for
ranking closing sounds of different level and sharpness by annoyance. Results: There was no statistically significant
independence between loudness difference or psychoacoustic annoyance difference and agreement among the
test persons. For the valves, loudness ranged from 0.07 to 2.57 sone, and the psychoacoustic annoyance from 0.1
to 5.4. Conclusion: The results of this study showed that both sharpness and loudness have a significant influence
on annoyance from closing sounds from mechanical heart valves, and indicated that the substantial variation in the
parameters may be due to individual patient physiology.

Institution: (Nielsen, Nielsen, Johansen, Hasenkam, Nygaard) Department of Cardiothoracic and Vascular Surgery,
Institute of Experimental Clinical Research, Aarhus University Hospital, Denmark. (Nielsen, Nielsen, Nygaard)
Engineering College of Aarhus, Denmark. (Nygaard) Department of Cardiothoracic and Vascular Surgery, Research
Unit, Skejby Sygehus, Brendstrupgaardsvej, 8200 Aarhus N, Denmark.

 

[pem]

I also came across this, which suggests that the clicking is 2 to 3 times louder for the person with the valve than someone nearby (due to sound transmission through bones):

A new method for quantitative evaluation of perceived sounds from mechanical heart valve prostheses.
Johansen P. Riis C. Hasenkam JM. Paulsen PK. Nygaard H.
Closing clicks from mechanical heart valve prostheses are transmitted to the patient's inner ear mainly in two different
ways: as acoustically transmitted sound waves, and as vibrations transmitted through bones and vessels. The
purpose of this study was to develop a method for quantifying what patients perceive as sound from their mechanical
heart valve prostheses via these two routes. In this study, 34 patients with implanted mechanical bileaflet aortic and
mitral valves (St Jude Medical and On-X) were included. Measurements were performed in a specially designed
sound insulated chamber equipped with microphones, accelerometers, preamplifiers and a loudspeaker. The closing
sounds measured with an accelerometer on the patient's chest were delayed 400 ms, amplified and played back
to the patient through the loudspeaker. The patient adjusted the feedback sound to the same level as the 'realtime'
clicks he or she perceived directly from his or her valve. In this way the feedback sound energy includes both
the air- and the bone-transmitted energies. Sound pressure levels (SPLs) were quantified both in dB(A) and in the
loudness unit sone according to ISO 532B (the Zwicker method). The mean air-transmitted SPL measured close to
the patient's ear was 23 +/- 4 dB(A). The mean air- and bone-transmitted sounds and vibrations were perceived by
the patients as an SPL of 34 +/- 5 dB(A). There was no statistically significant difference in the perceived sound from
the two investigated bileaflet valves, and no difference between aortic and mitral valves. The study showed that the
presented feedback method is capable of quantifying the perceived sounds and vibrations from mechanical heart
valves, if the patient's hearing is not too impaired. Patients with implanted mechanical heart valve prostheses seem
to perceive the sound from their valve two to three times higher than nearby persons, because of the additional
bone-transmitted vibrations.
MEDLINEAuthors Full Name: Johansen, P. Riis, C. Hasenkam, J M. Paulsen, P K. Nygaard, H.
Institution: Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Skejby Sygehus,
Denmark.

 

[LeakyUK]

I think I will have the surgery, see a) How the valve sounds and b) what recovery is like and THEN make a choice!!!

 

[yotphix]

I heard my valve both inside and outside for the first 6 months or so. I used earplugs to sleep for that time and I could still hear it through my body. Since then, the sound has completely disappeared and for the last year or so (I'm about 19 months post-op) I've only rarely heard it at all. In fact, I've tried to let others listen to it recently and they have had a hard time even with an ear to my chest.
For the last week though, I've been sleeping in a nearly silent room in a very well insulated house in rural Transylvania and it has been as loud as a clock to me here. It is entirely external and my wife can hear it from across the room! I haven't been wearing earplugs as I have really grown to like the sound. I find it kind of reassuring actually.
I don't know whether that will help you or confuse you more but I wish you all the best in making your decision. I'm very happy with my ticker.

Paul