Problems with aortic valve replacement ?

[Paleowoman]

Within the past two weeks I have had three episodes of partial loss of vision in my right eye which lasted 1 minute each time. On advice of GP I went to the local hospital eye unit day before yesterday - had lots of tests and a doctor at the end who surprised me by saying he thought I had TIA (ministroke). He arranged some blood tests: CRP, ESR and full blood count, and prescribed baby aspirin, and made urgent referral to the TIA clinic which I went to yesterday (all very efficient of the NHS). Had brain MRI, ultrasound of carotid arteries and an ECG and saw TIA doctor. The brain MRI was fine and shows no damage, and the carotid arteries are fine, no blockages, the blood tests are all normal, but my ECG is abnormal, especially in that there is right atrial enlargement - on last year’s echo the right atrial was of normal size.

The TIA doctor said she thinks I had blood clots in the right eye and that I should bring forward my scheduled appointment with cardiologist for echocardiogram. I'm to see the eye doctor on Monday again and I’ve an appointment now fixed with cardiologist for next Wednesday. I wonder if this means the valve which had its eleventh birthday last January is having problems ?

 

[tommyboy14]

Hi Paleowoman,

I dont think it necessarily means that. I had a tissue valve and had two neurological events. One around the three year mark and then one a year ahead of second surgery. The first one was more scary because it was like bells palsy, but brain all fine.

I suspect that tissue valves are more stroke prone than our native valves, but less than mechanical valves. This is why it is good to stay one some sort of anticoagulant, like baby aspirin, but this didnt prevent me from having the Bells palsy type episode. So I will keep my fingers crossed that your valve is still good, but they can throw small clots sometimes (even tissue ones) based on my own experience.

Good luck with the Echo

Tommyboy

 

[Paleowoman]

Hi Tommyboy,

The migraine auras I’ve been getting since valve replacement are neurological, and the double vision I get. Initially I thought the partial loss of vision in my right eye, about half the sight in that eye, was also a type of migraine aura but since it’s in one eye only that apparently means it isn’t, as the migraine aura and double vision are in both eyes, hence I suppose the the eye clinic doctor thinking it’s a TIA especially since it's totally new and only lasting a minute….oh and my blood pressure was high, but that’s probably due to the situation.

I’m concerned the right atrial enlargement in my heart must mean my heart is having to work harder because of the valve….though I’ve had no symptoms of that. The echo will doubtless show what’s going on.

Anne

 

[dornole]

I had a near complete loss of vision in my right eye that lasted about 2 minutes last summer during the countdown to mitral valve replacement of my rheumatic native valve, and they did a similar work up scanning brain and carotid arteries. No sign of recent stroke or blockage of carotid but they still said it was a TIA. It was disturbing because I was already on Eliquis due to afib (which increases strike risk). Neurologist said definitely follow up with cardiology.

You said your ECG was abnormal - how? Did they say afib, another rhythm problem?

I would follow up with cardiology for sure.

My left atrium was severely enlarged prior to MVR. For what it’s worth. They told me this enlargement can cause afib.

 

[Paleowoman]

Hi Dornole, that's interesting you had a similar work up, must be standard after this type of thing.

The ECG says "right atrial enlargement" - my echo last year said "right atrial normal size" so there has been a change there. The ECG also says "non specific ST and T wave abnormality" and Prolonged QT" - my heart rhythm is normal though, there's no afib.

I'm seeing my cardiologist next Wednesday and he'll do an echo then.

 

[pellicle]

wonder if this means the valve which had its eleventh birthday last January is having problems ?

I think it does, but there is the afib possibility. Are you on warfarin?

I hope no permanent damage has occurred

 

[pellicle]

I suspect that tissue valves are more stroke prone than our native valves, but less than mechanical valves.

agreed, especially as they age (and perhaps calcification on the leaflets provides opportunities for a different type of thrombosis (growth then break off VS pressure related triggerings)

I would recommend having a listen to this (you too @Paleowoman )

https://www.medscape.com/viewarticle/838221

the embedded MP3 may not work (but of course you can read the transcript) on some desktop browsers (mobile seems fine) but that is available here:
https://bi.medscape.com/pi/editorial/studio/audio/2015/core/838221.mp3

short answer seems to be that yes bio (as I have reported for over a decade now) eventually requires warfarin in a significant portion of cases and adds in the view that bioprosthesis benefits from warfarin from the get go to increase its durability. I would posit however that INR may not be needed to be as high (perhaps INR ~ 1.5) and that may not require as much management.

HTH

 

[Paleowoman]

I think it does, but there is the afib possibility. Are you on warfarin?

I hope no permanent damage has occurred

Hi Pellicle - the ECG shows sinus tachycardia at 103 bpm (normally my heart rate is in the 70s and 80s) no afib. I should find out more next week.

 

[pellicle]

Hi Pellicle - the ECG shows sinus tachycardia at 103 bpm (normally my heart rate is in the 70s and 80s) no afib. I should find out more next week.

tachycardia is also common (I'm on metoprolol for that) and may also lead to thrombosis (but I was already on warfarin before I had tachycardia).

I hope you get some answers and resolution. If it turns out that you get prescribed warfarin (as did @Seaton ) then its not hard to manage. People here can help.

Best Wishes

 

[dornole]

“non specific ST and T wave abnormality" and Prolonged QT" is not afib but it ain’t normal rhythm either

I’d expect them to refer you to an electrophysiologist to look into it more, esp since your HR has gone up so much. Are you on any medication to reduce the rate?

In my case everybody got together at a valve conference to make a care plan - valve cardiology and electrophysiology cardiology. Hopefully your valve is ok but with those changes you gotta wonder.

By the way I also had more migraine type auras in the run up to surgery but the TIA was distinctly different. I have a few threads on here about it.

 

[Paleowoman]

Hi Dornole - my HR was only high because of the situation being in hospital and the stress of all this sudden, possible, TIA over me. I’d gone to the eye clinic expecting to find there was an issue with my eye, not anything cardiac related at all ! My HR is normally in the 70s and 80s. I can imagine that if a person's HR is over 100 a lot of the time it can’t feel good at all.

I shall make a point of asking my cardiologist about the “non specific ST and T wave abnormality" and Prolonged QT” !