My second cardio visit since my AVR

[d333gs]

Valve is perfect but my heart seems thick: She said it could be from lots of things but thinks it is my weight lifting.
I lift weights about 3 times a week but moderately . On the other hand I push very hard on my bike = strenuous exercise.
I bike or hard walk between an 1.5 hours and two hours a day. I have no symptoms of MYOCARDITIS.
https://myocarditisuk.com/myocarditis-symptoms-and-causes/#symptoms

Athletes heart could be a possibility
https://my.clevelandclinic.org/health/diseases/23920-athletes-heart
I will get a stress test Dec 23.

I will keep you updated

 

[tjay]

Valve is perfect but my heart seems thick: She said it could be from lots of things but thinks it is my weight lifting.
I lift weights about 3 times a week but moderately . On the other hand I push very hard on my bike = strenuous exercise.
I bike or hard walk between an 1.5 hours and two hours a day. I have no symptoms of MYOCARDITIS.
https://myocarditisuk.com/myocarditis-symptoms-and-causes/#symptoms

Athletes heart could be a possibility
https://my.clevelandclinic.org/health/diseases/23920-athletes-heart
I will get a stress test Dec 23.

I will keep you updated

You mean you've LV "concentric" hypertrophy, or thickening of the heart wall? Did you have it prior to the surgery too, and how long it's been since surgery?
Heart takes time to remodel after surgery, so it may be just that?

I'm glad you're following up on that, and otherwise you seem to be doing great and in a good shape working out both aerobically and anaerobically.
Keep us posted.

 

[d333gs]

You mean you've LV "concentric" hypertrophy, or thickening of the heart wall? Did you have it prior to the surgery too, and how long it's been since surgery?
Heart takes time to remodel after surgery, so it may be just that?

I'm glad you're following up on that, and otherwise you seem to be doing great and in a good shape working out both aerobically and anaerobically.
Keep us posted.

Thanks for the reply tjay!
Before surgery,I asked the senior cardiologist at the hospital if the left ventricle had thickened and he said no. My first post-op visit to my local cardiologist said everything was in working order. This time she said it had thickened and that she thought it was weight lifting. She told me to stop and give it a year. But ,in the mean time she set up a stress test. I know where I am doing excessive force,and it is on my bike.I don't ride like a tourist. There is a lot of standing up on the bike to pump up hills, which is hard. My blood pressure can get up in the mid140s if I check it directly after typical daily life running around activity.What it gets up to when biking ,I don't know but I bet it is high. On the other hand, when I sit down and relax for a couple of minutes it will be between 128/ 68 and 118/68 and less.

 

[d333gs]

In regards to the findings of my cardio , I had my stress test yesterday and got my results.
I have a copy , in French, which I have been doing my best to translate.

In fact it was a stress test and imaging test. I was injected with a liquid , then scanned with some kind of imaging machine , then put on a bike for ten minutes, and then scanned again.
I put out 180 WATTs. BUT my Ejection Fraction is inversed to what it should be: 62% under effort and greater than 65% at rest.

My translation of the results below:
Normal fixation of the tracer with effort and at rest
ejection fraction estimated at 62% during exercise and greater than 65% at rest
no global or segmental kinetic disorder
Ejection Fraction preserved without notable deterioration with exercise.

No sign of scintigraphic argument but perhaps ischemic events.

Which I think can be described as a shortage of blood and oxygen while exercising due to
plugged arteries?

Before my heart surgery, they did find two arteries with 30% blockage and said they would put in stents if they got worse and I got symptoms.

Of course, all this is my speculation and I will get the real story when I see my cardio in the new year

​

 

[d333gs]

OK , This sounds like my test:

Nuclear stress test​

This advanced heart stress test uses safe levels of a radioactive substance and a cardiac imaging scan to assess heart function. A healthcare provider takes pictures of your heart before (at rest) and after you exercise. A cardiologist compares the amount of blood flow to the muscle of your heart at rest and after stress. A decrease in blood flow signal usually indicates a blockage in one or multiple arteries in your heart.

Nuclear cardiac stress tests can:

• Determine the severity of blockage of coronary artery disease.
• Assess whether previous treatments, such as stents or bypass surgery are working as they should.
• Help you avoid more invasive heart tests, such as cardiac catheterization.
• Show whether your heart is healthy enough for non-cardiac surgery or exercise.

Cardiac rehabilitation stress test​

 

[d333gs]

Well............ In regards to my ejection fraction of +65% at rest and 62% stress/on the bike....
I dropped the stress test results off to my cardiologist and she said it is all good , don't worry, see you next year.

From what I have read, a drop in EF during stress is an indication of coronary artery disease:
https://pmc.ncbi.nlm.nih.gov/articles/PMC1396567/
"The ejection fraction rose in Group I (healthy) from 66 to 80% during exercise, while in Group II it fell from 69 to 67%, and in Group III from 60 to 46%. These findings indicate that patients with ischemic myocardial disease respond to the stress of exercise by cardiac dilatation to maintain of increase stroke volume at increased heart rates. Moreover, the magnitude of this response appears to be greatest in patients with left main coronary artery stenosis. This approach for evaluating myocardial function during exercise provides useful data of importance in selecting medical versus surgical management of patients with ischemic coronary artery disease."


Any comments out there?

 

[tom in MO]

Did she allow you to resume lifting weights? If so I’d go on with life. If not, you may want to ask more questions about the issue or get a second opinion.

 

[tjay]

Well............ In regards to my ejection fraction of +65% at rest and 62% stress/on the bike....
I dropped the stress test results off to my cardiologist and she said it is all good , don't worry, see you next year.

From what I have read, a drop in EF during stress is an indication of coronary artery disease:
https://pmc.ncbi.nlm.nih.gov/articles/PMC1396567/
"The ejection fraction rose in Group I (healthy) from 66 to 80% during exercise, while in Group II it fell from 69 to 67%, and in Group III from 60 to 46%. These findings indicate that patients with ischemic myocardial disease respond to the stress of exercise by cardiac dilatation to maintain of increase stroke volume at increased heart rates. Moreover, the magnitude of this response appears to be greatest in patients with left main coronary artery stenosis. This approach for evaluating myocardial function during exercise provides useful data of importance in selecting medical versus surgical management of patients with ischemic coronary artery disease."


Any comments out there?

65% and 62% in echo is the same. It's not a drop. Perhaps your cardiologist told you that.
Echo results could be +/- 5%, depending on who does it, who reads it, etc etc.
Looks like your Ejection Fraction is great, both at rest and at stress. Congratulations.

 

[d333gs]

Thanks for responding TJAY. What is your assessment of the article I posted?

 

[d333gs]

Did she allow you to resume lifting weights? If so I’d go on with life. If not, you may want to ask more questions about the issue or get a second opinion.

Hi Tom.
She thought I may have scarring on the left ventricular wall that was causing the thickening. But that was not the case. But the stress test DR did note in his conclusion the lower EF under stress. She has not given me a clear answer . She just says "everything is good , see you next year". I think my age of 70 is probably a consideration in her response.

I hope to get clearer answers!

 

[tjay]

Thanks for responding TJAY. What is your assessment of the article I posted?

Well, I think you're fine especially if your cardiologist told you so.

As far this paper you referenced:
- looks like you would fall in Group II which is much-much-much better than Group III.
- then this 2% difference in EF may be within the margin of error of this technique (radionuclide angiocardiography). Not sure, read the full-text of this paper and in its overall context.
- note that this paper is from a scientific study, and they probably had better trained personnel taking readings and controlled way to ensure numbers are what they mean. You probably went to a regular lab, a different lab, where they may not have that level of controls.
- Group 1 is "normal" people. Note that while we're technically normal now (hopefully ) after the AVR, we aren't perfectly normal especially within months (or couple of years) after the AVR. The heart may still be remodeling and continue to get better. The minor EF drop, if at all, may be coming from that surgery (valve, LV, electrical, etc), rather than coronary arterial issues.
- Then you mentioned you've mild narrowing (30%?) of some coronaries. Well who doesn't . That's quite normal at a certain age. "Normal" people may also have that. You can find tons of papers on how common that is.
- There are so many other attributes too, not just EF. Like cardiac output. Perhaps everything (else) looks good, when you take a look at the overall picture, and not go into micro/local-analysis (which often means nothing by itself).
- If you're looking at your arterial health, CT angiogram (or invasive angiogram) would be a better test. Looks like you already had it done, and no one was concerned. Just because they did an extra test doesn't mean you get worried. Looks like you are very active. Did you have angina etc that they did this stress test? And this test results are good anyway.

I wonder what the full-text of this paper says. Once you read thru it in its entirety, your concerns may just be noise.

I just checked my stress test report a couple of years before the surgery. It was treadmill test (stress "echo"), not this radioactive-bike test. It's simply noted that my EF at stress and rest are "normal". So numbers given (perhaps not important).

I say you are just getting little worried for no reasons ... All of us do that, so very understandable. Especially if your cardiologist isn't concerned. I would rather look at her assessment (copying from your post), which looks great:

Normal fixation of the tracer with effort and at rest; ejection fraction estimated at 62% during exercise and greater than 65% at rest; no global or segmental kinetic disorder; Ejection Fraction preserved without notable deterioration with exercise.

Keep up your workouts if your cardiologist is ok with it. All the best to you.